{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:31:55Z","timestamp":1772929915101,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018712","name":"\u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy Cluj-Napoca","doi-asserted-by":"crossref","award":["881\/46\/12 Jan 2022"],"award-info":[{"award-number":["881\/46\/12 Jan 2022"]}],"id":[{"id":"10.13039\/501100018712","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100018712","name":"\u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy Cluj-Napoca","doi-asserted-by":"crossref","award":["772\/37\/11 Jan 2023"],"award-info":[{"award-number":["772\/37\/11 Jan 2023"]}],"id":[{"id":"10.13039\/501100018712","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Inflammatory bowel disease (IBD), mainly encompassing Crohn\u2019s disease (CD) and ulcerative colitis (UC), is strongly linked to psychological comorbidities such as depression, anxiety, and stress. These mental health factors negatively impact disease progression, healthcare utilization, and quality of life (QoL). Methods: Participants completed the Depression\u2013Anxiety\u2013Stress Scale 21 (DASS-21) and EuroQol (EQ-5D-5L) questionnaires. Statistical analyses included multivariate linear regressions to identify predictors of psychological distress. Results: We conducted a cross-sectional case\u2013control study involving 355 participants: 55 with CD, 90 with UC, and 210 healthy controls. Patients with IBD reported significantly higher levels of stress (p &lt; 0.01), anxiety (p = 0.016), and depression (p &lt; 0.01) compared to controls. Severe or very severe symptoms were more prevalent in those with CD and UC. The relative risk for stress was high (RR = 2.1), and the risk for depression was significantly elevated (RR = 1.54) in the IBD population. Quality-of-life analysis revealed lower EQ visual analog scale scores and increased difficulties across all domains, particularly in emotional well-being and pain. Multivariate analysis showed UC diagnosis, female sex, and corticosteroid use as predictors of higher stress and depression scores, while self-reported rest was consistently protective. Conclusions: This study confirms the psychological burden of IBD and underscores the importance of regular screening for stress, anxiety, and depression in clinical care. Self-reported rest emerged as a key protective factor, suggesting potential benefits from interventions targeting sleep quality and emotional support. Future research should explore longitudinal outcomes and personalized psychological interventions in IBD populations.<\/jats:p>","DOI":"10.3390\/jcm15051996","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:19:21Z","timestamp":1772720361000},"page":"1996","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Stress, Anxiety, Depression and Quality of Life in Patients Diagnosed with Chronic Inflammatory Bowel Disease in Romania: A Cross-Section Observational Case-Report Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1115-9650","authenticated-orcid":false,"given":"Oliviu Florentiu","family":"Sarb","sequence":"first","affiliation":[{"name":"Neuroscience Department, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Internal Medicine, 4th Medical Clinic, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana Daniela","family":"Sarb","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Heart Institute, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-8622","authenticated-orcid":false,"given":"Daniel","family":"Leucuta","sequence":"additional","affiliation":[{"name":"Medical Informatics and Biostatistics Department, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4416-2848","authenticated-orcid":false,"given":"Ciprian","family":"Brisc","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, University of Medicine and Pharmacy, 410073 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5975-0779","authenticated-orcid":false,"given":"Alina Ioana","family":"Tan\u021b\u0103u","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Clinic, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jpsychores.2016.06.001","article-title":"Depression and anxiety in patients with inflammatory bowel disease: A systematic review","volume":"87","author":"Neuendorf","year":"2016","journal-title":"J. Psychosom. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1111\/jgh.15855","article-title":"Bidirectional association between inflammatory bowel disease and depression among patients and their unaffected siblings","volume":"37","author":"Zhang","year":"2022","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1093\/ecco-jcc\/jjab191","article-title":"Depression and inflammatory bowel disease: A bidirectional two-sample Mendelian randomization study","volume":"16","author":"Luo","year":"2022","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/ecco-jcc\/jjy145","article-title":"Depression and health care use in patients with inflammatory bowel disease","volume":"13","author":"Wong","year":"2019","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/ajg.2017.423","article-title":"Depression is associated with more aggressive inflammatory bowel disease","volume":"113","author":"Kochar","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1007\/s10620-014-3375-0","article-title":"Treatment with immunosuppressive therapy may improve depressive symptoms in patients with inflammatory bowel disease","volume":"60","author":"Horst","year":"2015","journal-title":"Dig. Dis. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s00384-021-04056-9","article-title":"Burden of depression and anxiety among patients with inflammatory bowel disease: Results of a nationwide analysis","volume":"37","author":"Tarar","year":"2022","journal-title":"Int. J. Color. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S64","DOI":"10.1093\/jcag\/gwad012","article-title":"The 2023 impact of inflammatory bowel disease in Canada: Mental health and inflammatory bowel disease","volume":"6","author":"Graff","year":"2023","journal-title":"J. Can. Assoc. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1093\/ibd\/izy143","article-title":"Influences and impact of anxiety and depression in the setting of inflammatory bowel disease","volume":"24","author":"Navabi","year":"2018","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"17562848211033763","DOI":"10.1177\/17562848211033763","article-title":"Effects of anti-TNF therapy and immunomodulators on anxiety and depressive symptoms in patients with inflammatory bowel disease: A 5-year analysis","volume":"14","author":"Rossel","year":"2021","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_11","first-page":"193","article-title":"Psychological disorders and coping strategies in patients with inflammatory bowel disease: Their impact on health-related quality of life","volume":"116","author":"Ferrer","year":"2024","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Oligschlaeger, Y., Yadati, T., Houben, T., Oliv\u00e1n, C.M.C., and Shiri-Sverdlov, R. (2019). Inflammatory bowel disease: A stressed \u201cgut\/feeling\u201d. Cells, 8.","DOI":"10.3390\/cells8070659"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1080\/00365521.2021.2013527","article-title":"Assessing the repercussions of COVID-19 pandemic on symptoms, disease management, and emotional well-being in patients with inflammatory bowel disease: A multi-site survey study","volume":"57","author":"Saroufim","year":"2022","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bednarikova, H., Kascakova, N., Furstova, J., Zelinkova, Z., Falt, P., Hasto, J., and Travel, P. (2021). Life stressors in patients with inflammatory bowel disease: Comparison with a population-based healthy control group in the Czech Republic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18063237"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Qian, Y., Chen, Y., Liu, L., Wu, T., Chen, X., and Ma, G. (2025). Depression and anxiety in inflammatory bowel disease: Mechanisms and emerging therapeutics targeting the microbiota\u2013gut\u2013brain axis. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1676160"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-U","article-title":"The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behav. Res. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1348\/014466505X29657","article-title":"The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample","volume":"44","author":"Henry","year":"2005","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual. Life Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"EuroQol Group (1990). EuroQol\u2014A new facility for the measurement of health-related quality of life. Health Policy, 16, 199\u2013208.","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Goldi\u0219, A., Lupu\u0219oru, R., Gheorghe, L., Gheorghe, C., Trifan, A., Dobru, D., Cijevschi, C., Tan\u021b\u0103u, A., Constantinescu, G., and Iacob, R. (2019). Geographic distribution, phenotype and epidemiological tendency in inflammatory bowel disease patients in Romania. Medicina, 55.","DOI":"10.3390\/medicina55100704"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1111\/apt.17202","article-title":"Systematic review: The role of psychological stress in inflammatory bowel disease","volume":"56","author":"Black","year":"2022","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"i1621","DOI":"10.1093\/ecco-jcc\/jjae190.1024","article-title":"Managing pain in people with Crohn\u2019s disease: Feasibility testing of an Acceptance and Commitment Group Therapy intervention","volume":"19","author":"Watson","year":"2025","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.25122\/jml-2023-0475","article-title":"The impact of the COVID-19 pandemic on the mental health of patients diagnosed with inflammatory bowel diseases","volume":"16","author":"Filip","year":"2023","journal-title":"J. Med. Life"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S2468-1253(21)00014-5","article-title":"Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: A systematic review and meta-analysis","volume":"6","author":"Barberio","year":"2021","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1053\/j.gastro.2018.01.027","article-title":"Bi-directionality of brain\u2013gut interactions in patients with inflammatory bowel disease","volume":"154","author":"Gracie","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1038\/s41575-022-00634-6","article-title":"Depression and anxiety in inflammatory bowel disease: Epidemiology, mechanisms and treatment","volume":"19","author":"Bisgaard","year":"2022","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"832","DOI":"10.14309\/ajg.0000000000000608","article-title":"Effect of lifestyle factors on outcomes in patients with inflammatory bowel diseases","volume":"115","author":"Rozich","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1093\/ibd\/izaa014","article-title":"Prevalence and risk factors of substance use disorder in inflammatory bowel disease","volume":"27","author":"Carney","year":"2020","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Araki, M., Shinzaki, S., Yamada, T., Arimitsu, S., Komori, M., Shibukawa, N., Mukai, A., Nakajima, S., Kinoshita, K., and Kitamura, S. (2020). Psychologic stress and disease activity in patients with inflammatory bowel disease: A multicenter cross-sectional study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233365"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/MIB.0000000000000620","article-title":"Controversies revisited: A systematic review of the comorbidity of depression and anxiety with inflammatory bowel diseases","volume":"22","author":"Knowles","year":"2016","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Bleibel, L., Soko\u0142owska, P., Henrykowska, G., Owczarek, J., and Wiktorowska-Owczarek, A. (2025). Unveiling the Anti-Inflammatory Effects of Antidepressants: A Systematic Review of Human Studies over the Last Decade. Pharmaceuticals, 18.","DOI":"10.3390\/ph18060867"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1996\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T05:12:30Z","timestamp":1772860350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051996"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051996","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]}}}