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

Table 9 German guideline statements and recommendations on psychosocial issues in the management of Crohn’s disease[26]

1 Mental health disorders are the sequelae rather than the cause of CD. Psychological distress is correlated with disease activity and has an impact on health-related quality of life and course of the disease (EL2)

2 Psychosocial factors (personality traits, adverse life events, daily hassles) do not contribute to the etiology of CD (EL4)

3 Depression, anxiety and perceived stress are risk factors for flares. It is not certain whether acute adverse life events trigger flares (EL3). Most patients believe that stress has an impact on the disease (EL4)

4 The psychosocial consequences and health- related quality of life of patients (accounting for gender differences) should be taken into account in clinical practice at regular visits (EL5)

5 Physcians should assess the psychosocial status of patients and their need for psychotherapy. If indicated, psychotherapy should be provided. IBD-centers should provide an integrated psychosomatic care EL2)

6 Patients should be informed on the existence of patient organisations and selfhelp groups (EL5)

7 Psychotherapy is indicated in the case of mental health disorders such as anxiety and depression, reduced health-related quality of life with psychological distress and maladaptive coping (EL2)

8 The choice of a psychotherapeutic method depends on the psychological disturbance and should best be made by a psychotherapist. The choice of psychopharmacotherapy should be at the discretion of a psychiatrist specialist in the case of comorbid mental health disorders (e.g., depression and anxiety) (EL5)

9 The increased risk of a mental health disorder is associated with an early manifestation of the disease. If needed, psychosocial support should be offered to the patient and their families (EL5)

10 Patients using tobacco products should be encouraged to quit smoking (EL2)

CD: Crohn’s disease; EL: Evidence level.