Background-Life stress contributes to symptom onset and exacerbation in the majority of patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD); research evidence is conflicting, however, as to the strength of these effects. Aims-To test prospectively the relation of chronic life stress threat to subsequent symptom intensity over time. Patients-One hundred and seventeen consecutive outpatients satisfying the modified Rome criteria for IBS (66% with one or more concurrent FD syndromes) participated. Methods-The life stress and symptom intensity measures were determined from interview data collected independently at entry, and at six and 16 months; these measures assessed the potency of chronic life stress threat during the prior six months or more, and the severity and frequency of IBS and FD symptoms during the following two weeks. Results-Chronic life stress threat was a powerful predictor of subsequent symptom intensity, explaining 97% of the variance on this measure over 16 months. No patient exposed to even one chronic highly threatening stressor improved clinically (by 50%) over the 16 months; all patients who improved did so in the absence of such a stressor. Conclusion-The level of chronic life stress threat predicts the clinical outcome in most patients with IBS/FD. (Gut 1998;43:256-261) Keywords: irritable bowel syndrome; chronic life stress threat; symptom intensityIn irritable bowel (IBS) and functional dyspepsia (FD) syndromes, major life stress situations precede onset and/or exacerbation of symptoms, 1-3 and early observations suggest that symptoms either disappear or improve following resolution of major life stress problems. 4 Furthermore, an impressive and sustained improvement in symptoms occurs following the acquisition of more eVective stress management skills.5-7 In a recent study of patients with functional gastrointestinal disorders (FGID), 8 we showed a significant correspondence between the intensity of chronic life stress threat and the severity and extent of aVective, gastrointestinal, and extraintestinal symptomatology, particularly in patients with IBS-FD syndromes. Despite these observations, the extent to which life stress contributes to the course of IBS and/or FD symptoms remains uncertain. 10To extend our previous cross sectional findings, our aim was to examine, in patients with IBS, group and individual patterns of change in life stress and symptom intensity over time. Specifically we aimed to determine within subject: (1) covariance of life stress and subsequent symptom intensity over three time frames; (2) time lag relations (with and without relevant covariates); (3) the role of personality, age, sex, and emotional distress in the above; (4) the life stress predictors of any improvement or lack of improvement in symptom intensity over time; and (5) the life stress predictors of clinical (50% or more) improvement or no clinical improvement in symptom intensity over time. We hypothesised that: (1) life stress and subsequent symptom intensity will...

Objective To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. Design Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. Setting Population of residential facility in Sydney living in self care units and hostels. Participants 220 depressed residents aged >65 without severe cognitive impairment. Intervention The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care. Main outcome measure Geriatric depression scale. Results Intention to treat analysis was used. There was significantly more movement to "less depressed" levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P = 0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P = 0.0011). Conclusions The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

These results suggest that similar factors might underpin psychological distress and fatigue in MS patients and community-well samples, although MS treatment factors may also be important. These results might assist clinicians in determining which MS patients are at greatest risk of developing anxiety, depression, or fatigue.

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