Anxiety, depression and distress among irritable bowel syndrome and their subtypes: An epidemiological population based study

Document Type : Original Article

Authors

1 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 CEGIIR-Division of Gastroenterology, Department of Medicine, University of Alberta 7-142 Katz Group Centre for Pharmacy and Health Research Edmonton, Alberta, Canada

4 Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Psychiatric disorders are common in irritable bowel syndrome (IBS). We conducted this study to investigate the relationship of IBS and their subtypes with some of psychological factors.
Materials and Methods: A cross-sectional study was performed among 4763 staff of Isfahan University of Medical Sciences in 2011. Modified ROME III questionnaire and Talley Bowel Disease Questionnaire were used to evaluate IBS symptoms. Hospital Anxiety and Depression Scale and 12-item General Health Questionnaire were utilized to assess anxiety, depression and psychological distress. Logistic regression analysis was used to determine the association of psychological states and IBS in the total subject and both genders.
Results: About, 4763 participants with mean age 36/58 ± 8/09 were included the 2106 males and 2657 females. Three thousand and seven hundred and seventy-six (81.2%) and 2650 (57.2%) participants were married and graduated respectively. Subtype analysis of IBS and its relationship with anxiety, depression and distress comparing the two genders can be observed that: IBS and clinically-significant IBS have higher anxiety, depression symptoms, and distress than the subject without IBS (P < 0.001). Women with IBS, have higher scores than men (P < 0.001). Compared to other subtypes, mixed IBS subtype has a higher anxiety, depression, and distress score.
Conclusion: A high prevalence of anxiety, depression symptoms and distress in our subjects emphasize the importance of the psychological evaluation of the patients with IBS, in order to better management of the patients and may also help to reduce the burden of health care costs.

Keywords

1.
Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology 2002;123:2108-31.  Back to cited text no. 1
    
2.
Portincasa P, Moschetta A, Baldassarre G, Altomare DF, Palasciano G. Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome. World J Gastroenterol 2003;9:2293-9.  Back to cited text no. 2
    
3.
Sperber AD, Shvartzman P, Friger M, Fich A. A comparative reappraisal of the Rome II and Rome III diagnostic criteria: Are we getting closer to the 'true' prevalence of irritable bowel syndrome? Eur J Gastroenterol Hepatol 2007;19:441-7.  Back to cited text no. 3
    
4.
Han SH, Lee OY, Bae SC, Lee SH, Chang YK, Yang SY, et al. Prevalence of irritable bowel syndrome in Korea: Population-based survey using the Rome II criteria. J Gastroenterol Hepatol 2006;21:1687-92.  Back to cited text no. 4
    
5.
Adibi P, Keshteli AH, Esmaillzadeh A, Afshar H, Roohafza H, Bagherian-Sararoudi R, et al. The study on the epidemiology of psychological, alimentary health and nutrition (SEPAHAN): Overview of methodology. J Res Med Sci 2012; 17(Spec 2): S291-S297.  Back to cited text no. 5
    
6.
Cremonini F, Talley NJ. Irritable bowel syndrome: Epidemiology, natural history, health care seeking and emerging risk factors. Gastroenterol Clin North Am 2005;34:189-204.  Back to cited text no. 6
    
7.
Talley NJ. Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil 2008;20:121-9.  Back to cited text no. 7
    
8.
Talley NJ, Gabriel SE, Harmsen WS, Zinsmeister AR, Evans RW. Medical costs in community subjects with irritable bowel syndrome. Gastroenterology 1995;109:1736-41.  Back to cited text no. 8
    
9.
Nyrop KA, Palsson OS, Levy RL, Von Korff M, Feld AD, Turner MJ, et al. Costs of health care for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal pain. Aliment Pharmacol Ther 2007;26:237-48.  Back to cited text no. 9
    
10.
Koloski NA, Talley NJ, Boyce PM. Does psychological distress modulate functional gastrointestinal symptoms and health care seeking? A prospective, community Cohort study. Am J Gastroenterol 2003;98:789-97.  Back to cited text no. 10
    
11.
Gonsalkorale WM, Perrey C, Pravica V, Whorwell PJ, Hutchinson IV. Interleukin 10 genotypes in irritable bowel syndrome: Evidence for an inflammatory component? Gut 2003;52:91-3.  Back to cited text no. 11
    
12.
Budavari AI, Olden KW. Psychosocial aspects of functional gastrointestinal disorders. Gastroenterol Clin North Am 2003;32:477-506.  Back to cited text no. 12
    
13.
Levy RL, Olden KW, Naliboff BD, Bradley LA, Francisconi C, Drossman DA, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006;130:1447-58.  Back to cited text no. 13
    
14.
Guthrie E, Creed F, Fernandes L, Ratcliffe J, Van Der Jagt J, Martin J, et al. Cluster analysis of symptoms and health seeking behaviour differentiates subgroups of patients with severe irritable bowel syndrome. Gut 2003;52:1616-22.  Back to cited text no. 14
    
15.
Yates WR. Gastrointestinal disorders. In: Sadock BJ, Sadock VA, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 8th ed. Philadelphia: Lippincott Williams; 2005. p. 2117-8.  Back to cited text no. 15
    
16.
Jerndal P, Ringström G, Agerforz P, Karpefors M, Akkermans LM, Bayati A, et al. Gastrointestinal-specific anxiety: An important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil 2010;22:646-e179.  Back to cited text no. 16
    
17.
Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006;130:1377-90.  Back to cited text no. 17
    
18.
Drossman DA, Dumitrascu DL. Rome III: New standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis 2006;15:237-41.  Back to cited text no. 18
    
19.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006;130:1480-91.  Back to cited text no. 19
    
20.
Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9:139-45.  Back to cited text no. 20
    
21.
Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): Translation and validation study of the Iranian version. Health Qual Life Outcomes 2003;1:66.  Back to cited text no. 21
    
22.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.  Back to cited text no. 22
    
23.
Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The hospital anxiety and depression scale (HADS): Translation and validation study of the Iranian version. Health Qual Life Outcomes 2003;1:14.  Back to cited text no. 23
    
24.
Noorbala AA, Bagheri Yazdi SA, Yasamy MT, Mohammad K. Mental health survey of the adult population in Iran. Br J Psychiatry 2004;184:70-3.  Back to cited text no. 24
    
25.
Chitkara DK, van Tilburg MA, Blois-Martin N, Whitehead WE. Early life risk factors that contribute to irritable bowel syndrome in adults: A systematic review. Am J Gastroenterol 2008;103:765-74.  Back to cited text no. 25
    
26.
Mohammadi MR, Alavi A, Mahmoodi J, Shahrivar Z, Tehranidoost M, Saadat S. Prevalence of psychiatric disorders amongst adolescents in Tehran. Iran J Psychiatry 2008;3:100-4.  Back to cited text no. 26
    
27.
Eriksson EM, Andrexn KI, Eriksson HT, Kurlberg GK. Irritable bowel syndrome subtypes differ in body awareness, psychological symptoms and biochemical stress markers. World J Gastroenterol 2008;14:4889-96.  Back to cited text no. 27
    
28.
Spiller R. Serotonin and GI clinical disorders. Neuropharmacology 2008;55:1072-80.  Back to cited text no. 28
    
29.
Atkinson W, Lockhart S, Whorwell PJ, Keevil B, Houghton LA. Altered 5-hydroxytryptamine signaling in patients with constipation- and diarrhea-predominant irritable bowel syndrome. Gastroenterology 2006;130:34-43.  Back to cited text no. 29
    
30.
Dunlop SP, Coleman NS, Blackshaw E, Perkins AC, Singh G, Marsden CA, et al. Abnormalities of 5-hydroxytryptamine metabolism in irritable bowel syndrome. Clin Gastroenterol Hepatol 2005;3:349-57.  Back to cited text no. 30
    
31.
Spiller R. Serotonin, inflammation, and IBS: Fitting the jigsaw together? J Pediatr Gastroenterol Nutr 2007;45:S115-9.  Back to cited text no. 31
    
32.
Zijdenbos IL, de Wit NJ, van der Heijden GJ, Rubin G, Quartero AO. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev 2009; 21:CD006442.  Back to cited text no. 32
    
33.
Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: Systematic review and meta-analysis. Gut 2009;58:367-78.  Back to cited text no. 33