Mood intervention shows promise in treating IBD

Mood intervention shows promise in treating IBD

In a recently published study electronic biomedicineResearchers conducted a meta-analysis to explore the effects of mood interventions on inflammatory activity in inflammatory bowel disease (IBD).

Mood intervention shows promise in treating IBD
Study: Can mood intervention improve inflammatory biomarkers in inflammatory bowel disease? : Systematic review and meta-analysis. Image source: oneinchpunch/


The activity and progression of IBD, a chronic autoimmune inflammatory disease, are associated with psychological, neurological, and immune mechanisms that regulate the gut-brain connection. Depression and anxiety can worsen IBD prognosis. Psychosocial interventions may reduce proinflammatory cytokines, potentially enhancing immune function and reducing inflammation. However, a recent meta-analysis found no improvement in disease activity and smaller effects on anxiety, depression, and stress, suggesting that interventions with limited impact on mood may not improve IBD outcomes.

About the study

In this meta-analysis, researchers investigated whether mood-related interventions could improve inflammatory biomarker levels in patients with IBD. They also evaluated the potential moderating effects of intervention size, outcome, type, and disease subtype on inflammatory markers.

The team searched MEDLINE, EMBASE, PsycINFO, Global Health and Web of Science databases for relevant studies published between 1947 and October 2023. These include randomized controlled trials (RCTs) in adults with IBD, focusing on mood and inflammatory outcomes before and after intervention. Trial interventions include exercise, psychotherapy, antidepressants and psychotherapy, with mood measured as a primary or secondary outcome in patients with depression, anxiety, stress, distress or poor emotional health.

Comparators included control groups (standby control, standard care, placebo control, and active control), and outcomes included inflammation-related biomarkers (eg, C-reactive protein (CRP), fecal calprotectin, and inflammatory cytokines). The team excluded studies without an IBD diagnosis, animal studies, pharmacological interventions, measures of mood not serving as primary or secondary outcomes, studies without comparators, self-reported clinical measures, non-inflammatory biomarkers and non-randomized studies.

Two reviewers independently performed data screening, extraction, quality assessment, and data merging to estimate standardized mean differences (SMD), with disagreements resolved by consensus. Researchers investigated type of intervention, mood as an outcome, effects on mood-related outcomes, and IBD subtypes as effect moderators. They performed random effects modeling for analysis and estimated statistical heterogeneity using the I2 statistic.

Researchers used guidance from the Cochrane Handbook to assess risk of bias, including randomization procedures, intervention bias, missing data, outcome measures, and selection of reported outcomes. They used Egger’s test and exact effects test to assess publication bias. Sensitivity analyzes excluded impact sites and outcomes of psychotropic medications or antidepressant interventions. The researchers conducted separate meta-analyses of biomarkers from more than 10 studies, including a leave-one-out meta-analysis.


The data search yielded 21,101 records and 15,631 references, of which 15,489 records were ineligible. After title abstract screening, 142 records were screened for full text, and only 36 met the eligibility criteria. Nine RCTs reported complete data, 27 study authors were contacted due to missing data and 5 did not respond. As a result, the team analyzed 28 randomized controlled trials including 1,789 participants. Four studies had a low risk of bias and 18 RCTs had a high risk of bias, six of which had some concerns.

Biomarkers related to inflammation in the included studies ranged from 1 to 21, providing 116 effect estimates. The interventions showed a small but significant effect on inflammatory biomarkers (-0.4) and a moderate effect on mood-related outcomes (-0.5), without considerable between-study heterogeneity and publication bias. Separate meta-analyses showed smaller effects on fecal calprotectin (-0.2) and CRP (-0.3). The researchers observed larger effect sizes for psychological intervention and emotional impact (SMD ≥0.20).

Pooled analysis showed that mood-related interventions significantly reduced inflammatory biomarker levels (SMD, -0.4), indicating an 18% reduction in inflammatory markers. Psychotherapy showed a significant small to medium effect on inflammatory biomarkers (SMD, -0.5), whereas other interventions were not significant. Studies with mood measures as primary and secondary outcomes showed medium (SMD, -0.6) and small (SMD, -0.3) effect sizes, respectively.

CRP was evaluated in 16 study groups and showed a small significant effect (SMD, -0.3). There was significant heterogeneity (I2, 36%) and publication type bias (Egger test value = -0.9). Among the 17 intervention groups investigating fecal calprotectin, the mood intervention significantly reduced levels of the biomarker, by 91 micrograms per gram, compared with the control group. The studies had low heterogeneity (I2 of 11%) and no publication type bias. However, there is potential bias from the small sample effect. Sensitivity analysis showed similar results.

in conclusion

Study results suggest that treatments targeting mood outcomes can reduce inflammation in adults with IBD. Psychological intervention had a greater effect on inflammatory biomarkers than antidepressants and exercise, with small-to-medium effect sizes, confirming previous meta-analysis results. Mechanisms by which psychosocial treatments exert biological effects on inflammatory biomarkers in IBD patients involve mood enhancement, direct effects on the immune system, or indirect promotion of self-management techniques.

Journal reference:

  • Natasha Seaton et al., Do mood interventions improve inflammatory biomarkers in inflammatory bowel disease? : Systematic review and meta-analysis, electronic biomedicine 2023;104910. Publish online, Doi: 104910

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