Review for 10.1186/s12876-025-03889-w (2025)

Title: Routine Psychological problems Screening in Hospitalized Inflammatory Bowel Diseases
and Its Effect for Progression-free Survival from Disease Worsening
Version: 1 Date: 05 Mar 2025
Reviewer's report:
This study investigates routine psychological problem screening in hospitalized inflammatory
bowel disease (IBD) patients and its effect on long-term survival from disease worsening. The
findings are interesting and suggest potential benefits of psychological screening in this patient
population. However, several revisions are necessary to enhance the clarity, transparency, and
clinical applicability of the study, making it more valuable to the readers.
1. The lack of details on interventions for patients identified with psychological distress is a
major concern, as it prevents readers from understanding how to improve clinical management
of IBD in practice.
The Results section mentions that some patients who screened positive for depression
and/or anxiety were referred to a psychiatrist. However, it remains unclear what specific
interventions these patients received (e.g., pharmacological treatment, cognitive behavioral
therapy, counseling, or other psychological support).
While the Discussion section references general psychological interventions for IBD patients, it
does not specify which interventions were actually provided in this study.
To enhance the clinical applicability of the findings, the authors should clearly describe the types
of interventions administered to patients with psychological distress in both the Methods and
Results sections.
2. The manuscript reports that patients in the screening cohort had a significantly longer
hospital stay compared to the control cohort. The authors attribute this to psychological distress
worsening IBD symptoms, leading to prolonged hospitalization. However, it appears that no
subgroup analysis was conducted to compare hospital length of stay between patients diagnosed
with psychological disorders and those without a diagnosis within the screening cohort.
Without this analysis, it remains unclear whether the longer hospital stay was actually driven by
psychological distress itself or other confounding factors related to the screening process. The
authors should consider:
Performing a subgroup analysis within the screening cohort to compare hospital stays between
patients diagnosed with a psychological disorder and those without.
Providing this additional analysis would strengthen the argument that psychological distress,
rather than other factors, contributed to prolonged hospitalization.
3. The manuscript states that propensity score matching was performed at a 2:1 ratio between the
screening and control groups. However, it does not specify which baseline variables were used
for matching (e.g., age, sex, disease severity, comorbidities, etc.). This lack of detail affects the
transparency and reproducibility of the study. To address this issue, the authors should clearly
specify the variables used for propensity score matching in the Methods section.
4. The manuscript includes a sample size calculation based on an expected hazard rate reduction,
with a target of 504 patients in the control group and 1008 in the screening group. However,
the actual number of analyzed patients (438 controls and 827 screening cases) does not meet
this estimated sample size.
This discrepancy raises concerns regarding the validity and utility of the sample size calculation.
The authors should address the following points:
Does the reduced sample size still provide sufficient statistical power?
How does this shortfall affect the reliability of the results and conclusions?
Was an interim power analysis performed to confirm the robustness of the findings?
Clarifying these aspects would strengthen the credibility of the study and ensure that the
conclusions drawn are statistically valid.
5. The study does not describe how patients were selected for psychological screening. While it
is stated that all hospitalized IBD patients were eligible, it is unclear whether any patient factors
influenced who received screening versus who did not before propensity score matching.
If psychological screening was performed at the discretion of clinicians, this could introduce
selection bias, where patients perceived to be at higher risk were more likely to be screened.
The authors should clarify how the decision to perform screening was made and whether this
could have biased the results.
6. The expression "the mean of long-term survival from IBDs worsening" is somewhat unclear.
A more natural and precise phrasing would be "the mean of progression-free survival from
IBDs worsening" or "the mean of event-free survival from IBDs worsening." These terms are
commonly used in clinical research and provide a clearer understanding of the period during
which the disease does not progress or an event, such as worsening, does not occur. Therefore,
I recommend revising this phrase for better clarity and accuracy in the context of the study.