Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease?: a systematic review and meta-analysis

Natasha Seaton; Joanna Hudson; Sophie Harding; Sam Norton; Valeria Mondelli; Annie S.K. Jones; Rona Moss-Morris

doi:10.1016/j.ebiom.2023.104910

Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease? a systematic review and meta-analysis

Natasha Seaton^*, Joanna Hudson, Sophie Harding, Sam Norton, Valeria Mondelli, Annie S.K. Jones, Rona Moss-Morris

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

6 Citations (Scopus)

Abstract

Background: Psychoneuroimmunological mechanisms and the gut-brain axis appear relevant to disease activity and progression in Inflammatory Bowel Disease (IBD). A recent review showed no effect of psychological therapies on self-reported disease activity in IBD. This meta-analysis aims to establish whether interventions targeting mood outcomes (e.g., depression, anxiety and stress) impact inflammation levels in IBD and possible moderators of these effects. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched five electronic databases and included randomised controlled trials where interventions targeted mood and assessed inflammatory outcomes pre- and post-intervention in adults with IBD. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMDs) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401). Findings: 28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (−0.35, 95% CI: −0.48, −0.22, p < 0.001) and medium effects on mood outcomes (−0.50, 95% CI: −0.73, −0.27, p < 0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (−0.19, 95% CI: −0.34, −0.03, p = 0.018) and C-Reactive Protein (−0.29, 95% CI: −0.47, −0.10, p = 0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD ≥0.2) on mood. Interpretation: Treatments which address mood outcomes have beneficial effects on generic inflammation as well as disease-specific biomarkers (faecal calprotectin and C-Reactive Protein). Psychological interventions and interventions with larger treatment effects on mood accentuated the effect on biomarkers. More research is required to understand the biological or behavioural mechanisms underlying this effect. Funding: The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.

Original language	English
Article number	104910
Journal	EBioMedicine
Volume	100
Early online date	24 Jan 2024
DOIs	https://doi.org/10.1016/j.ebiom.2023.104910
Publication status	Published - Feb 2024

Keywords

Inflammatory Bowel Disease
Depression
Anxiety
Psychological intervention
Meta-analyses
Psychoneuroimmunology

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10.1016/j.ebiom.2023.104910Licence: CC BY

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@article{2bd56c621fb947c184950e2345f1d1af,

title = "Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease?: a systematic review and meta-analysis",

abstract = "Background: Psychoneuroimmunological mechanisms and the gut-brain axis appear relevant to disease activity and progression in Inflammatory Bowel Disease (IBD). A recent review showed no effect of psychological therapies on self-reported disease activity in IBD. This meta-analysis aims to establish whether interventions targeting mood outcomes (e.g., depression, anxiety and stress) impact inflammation levels in IBD and possible moderators of these effects. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched five electronic databases and included randomised controlled trials where interventions targeted mood and assessed inflammatory outcomes pre- and post-intervention in adults with IBD. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMDs) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401). Findings: 28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (−0.35, 95% CI: −0.48, −0.22, p < 0.001) and medium effects on mood outcomes (−0.50, 95% CI: −0.73, −0.27, p < 0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (−0.19, 95% CI: −0.34, −0.03, p = 0.018) and C-Reactive Protein (−0.29, 95% CI: −0.47, −0.10, p = 0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD ≥0.2) on mood. Interpretation: Treatments which address mood outcomes have beneficial effects on generic inflammation as well as disease-specific biomarkers (faecal calprotectin and C-Reactive Protein). Psychological interventions and interventions with larger treatment effects on mood accentuated the effect on biomarkers. More research is required to understand the biological or behavioural mechanisms underlying this effect. Funding: The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.",

keywords = "Inflammatory Bowel Disease, Depression, Anxiety, Psychological intervention, Meta-analyses, Psychoneuroimmunology",

author = "Natasha Seaton and Joanna Hudson and Sophie Harding and Sam Norton and Valeria Mondelli and Jones, {Annie S.K.} and Rona Moss-Morris",

note = "Funding Information: The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.This research is part-funded by the Medical Research Council. Additionally, this paper represents independent research part funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors gratefully express their appreciation to all study authors who responded to our request for additional data. Funding Information: This research is part-funded by the Medical Research Council . Additionally, this paper represents independent research part funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London . The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors gratefully express their appreciation to all study authors who responded to our request for additional data. Publisher Copyright: {\textcopyright} 2023 The Author(s)",

year = "2024",

month = feb,

doi = "10.1016/j.ebiom.2023.104910",

language = "English",

volume = "100",

journal = "EBioMedicine",

issn = "2352-3964",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease?

T2 - a systematic review and meta-analysis

AU - Seaton, Natasha

AU - Hudson, Joanna

AU - Harding, Sophie

AU - Norton, Sam

AU - Mondelli, Valeria

AU - Jones, Annie S.K.

AU - Moss-Morris, Rona

N1 - Funding Information: The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.This research is part-funded by the Medical Research Council. Additionally, this paper represents independent research part funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors gratefully express their appreciation to all study authors who responded to our request for additional data. Funding Information: This research is part-funded by the Medical Research Council . Additionally, this paper represents independent research part funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London . The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors gratefully express their appreciation to all study authors who responded to our request for additional data. Publisher Copyright: © 2023 The Author(s)

PY - 2024/2

Y1 - 2024/2

N2 - Background: Psychoneuroimmunological mechanisms and the gut-brain axis appear relevant to disease activity and progression in Inflammatory Bowel Disease (IBD). A recent review showed no effect of psychological therapies on self-reported disease activity in IBD. This meta-analysis aims to establish whether interventions targeting mood outcomes (e.g., depression, anxiety and stress) impact inflammation levels in IBD and possible moderators of these effects. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched five electronic databases and included randomised controlled trials where interventions targeted mood and assessed inflammatory outcomes pre- and post-intervention in adults with IBD. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMDs) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401). Findings: 28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (−0.35, 95% CI: −0.48, −0.22, p < 0.001) and medium effects on mood outcomes (−0.50, 95% CI: −0.73, −0.27, p < 0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (−0.19, 95% CI: −0.34, −0.03, p = 0.018) and C-Reactive Protein (−0.29, 95% CI: −0.47, −0.10, p = 0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD ≥0.2) on mood. Interpretation: Treatments which address mood outcomes have beneficial effects on generic inflammation as well as disease-specific biomarkers (faecal calprotectin and C-Reactive Protein). Psychological interventions and interventions with larger treatment effects on mood accentuated the effect on biomarkers. More research is required to understand the biological or behavioural mechanisms underlying this effect. Funding: The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.

AB - Background: Psychoneuroimmunological mechanisms and the gut-brain axis appear relevant to disease activity and progression in Inflammatory Bowel Disease (IBD). A recent review showed no effect of psychological therapies on self-reported disease activity in IBD. This meta-analysis aims to establish whether interventions targeting mood outcomes (e.g., depression, anxiety and stress) impact inflammation levels in IBD and possible moderators of these effects. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched five electronic databases and included randomised controlled trials where interventions targeted mood and assessed inflammatory outcomes pre- and post-intervention in adults with IBD. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMDs) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401). Findings: 28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (−0.35, 95% CI: −0.48, −0.22, p < 0.001) and medium effects on mood outcomes (−0.50, 95% CI: −0.73, −0.27, p < 0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (−0.19, 95% CI: −0.34, −0.03, p = 0.018) and C-Reactive Protein (−0.29, 95% CI: −0.47, −0.10, p = 0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD ≥0.2) on mood. Interpretation: Treatments which address mood outcomes have beneficial effects on generic inflammation as well as disease-specific biomarkers (faecal calprotectin and C-Reactive Protein). Psychological interventions and interventions with larger treatment effects on mood accentuated the effect on biomarkers. More research is required to understand the biological or behavioural mechanisms underlying this effect. Funding: The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.

KW - Inflammatory Bowel Disease

KW - Depression

KW - Anxiety

KW - Psychological intervention

KW - Meta-analyses

KW - Psychoneuroimmunology

UR - http://www.scopus.com/inward/record.url?scp=85184713768&partnerID=8YFLogxK

U2 - 10.1016/j.ebiom.2023.104910

DO - 10.1016/j.ebiom.2023.104910

M3 - Review article

SN - 2352-3964

VL - 100

JO - EBioMedicine

JF - EBioMedicine

M1 - 104910

ER -

Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease? a systematic review and meta-analysis

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