Psychosocial issues in evidence-based guidelines on inflammatory bowel diseases: A review

Table 4 European Crohn’s Colitis Organization guideline statements and recommendations on psychosocial issues in ulcerative colitis[15]

1 There is no conclusive evidence for anxiety, depression and psychosocial stress contributing to risk for UC onset (EL2)

2 Psychological factors may have an impact on the course of UC. Perceived psychological stress (EL2) and depression (EL2) are risk factors for relapse of the disease. Depression is associated with low health-related quality of life (EL3). Anxiety is associated with non adherence with treatment (EL4)

3 Psychological distress and mental disorder are more common in patients with active ulcerative colitis than in population-based controls, but not in patients in remission (EL3)

4 Clinicians should particularly assess depression among their patients with active disease and those with abdominal pain in remission (EL2)

5 The psychosocial consequences and health- related quality of life of patients should be taken into account in clinical practice at regular visits (EL3). Patients' disease control can be improved by combining selfmanagement and patient-centred consultations (EL1b)

6 Physicians should screen patients for anxiety, depression and need for additional psychological care and recommend psychotherapy if indicated (EL2). Patients should be informed of the existence of patient associations (EL 5)

7 Psychotherapeutic interventions are indicated for psychological disorders and low quality of life (EL1)

8 The choice of psychotherapeutic method depends on the psychological disturbance and should best be made by specialists (Psychotherapist, Specialist for Psychosomatic Medicine, Psychiatrist). Psychopharmaceuticals should be prescribed for defined indications (EL5)

UC: Ulcerative colitis; EL: Evidence level.