Predictors of Stress, Anxiety, Depression and Quality of Life in Patients Diagnosed with Chronic Inflammatory Bowel Disease in Romania: A Prospective Observational Case-Report Study

Background&Aims: Inflammatory bowel disease (IBD), encompassing Crohn's 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: We conducted a cross-sectional case-control study (Nov 2023–Feb 2025) involving 355 participants: 55 with CD, 90 with UC, and 210 healthy controls. Participants completed the Depression Anxiety Stress Scales 21 (DASS-21) and EuroQol (EQ-5D-5L) questionnaires. Statistical analyses included multivariate linear regressions to identify predictors of psychological distress. Results: IBD patients reported significantly higher levels of stress (p< 0.01), anxiety (p=0.016), and depression (p< 0.01) compared to controls. Severe or very severe symptoms were more prevalent in CD and UC. Relative risk for stress was high (RR=2.1) and risk for depression was significantly elevated (RR=1.54) in IBD population. QoL analysis revealed lower EQ-VAS scores and increased difficulties across all EQ-5D-5L 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.