Anxiety and depression in irritable bowel syndrome: Exploring the interaction with other symptoms and pathophysiology using multivariate analyses

Abstract

Background Anxiety or depression, in other words, psychological distress, are common comorbidities in patients with irritable bowel syndrome (IBS), but their interaction with pathophysiological factors and other symptoms are unclear. Methods Patients with IBS (Rome III criteria), thoroughly characterized regarding pathophysiology (colonic transit time, visceral sensitivity, and autonomic nervous system [ANS] function), symptom profile (IBS severity, somatic symptoms, gastrointestinal [GI]‐specific anxiety and fatigue), and quality of life, were explored for differences regarding pathophysiology and symptoms between patients with and without reported psychological distress in univariate and multivariate analyses (Principal Component Analysis [PCA] with Hotelling's T2 and Orthogonal Partial Least Squares‐Discriminant Analysis [OPLS‐DA]). Key Results When using Hospital Anxiety and Depression Scale score ≥8 as cut‐off score, including both borderline and clinically significant cases, 345 (44.9%) out of 769 IBS patients reported anxiety, and 198 (25.7%) depression. In univariate analyses, patients reporting psychological distress demonstrated more severe GI and non‐GI symptoms, fatigue, GI‐specific anxiety and lower quality of life, and differences for some pathophysiological measures. IBS patients with and without reported psychological distress showed significant differences between the multivariate means in symptom reporting (PCA; both P < 0.001), and in pathophysiological measures in patients with and without anxiety (P = 0.018). Visceral hypersensitivity, altered ANS function, more severe GI‐specific anxiety, fatigue, and higher somatic non‐GI symptoms were the factors that most strongly separated patients with and without psychological distress (OPLS‐DA). Conclusions and Inferences Reported anxiety and depression are common in IBS patients, and our study demonstrates that they are interwoven in the complex pathophysiological and clinical picture of IBS.

Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment

“…However, most started inappropriately interpret the term “functional” as idiopathic or cryptogenic; unfortunately, the patients suffering from this illness were labeled as neurotic, apprehensive, otherwise healthy individuals with an imaginary illness 3 . The psychogenic origin of the condition is largely based on the uncontrolled or case–control studies that showed that the patients with IBS, particularly those with severe symptoms often have more psychological and psychiatric comorbidities and on the fact that these patients also respond to treatment with psychotropic agents though some studies did show IBS including postinfection IBS (PI‐IBS) to develop more often among patients with anxiety and depression 7–9 . However, IBS is a multifactorial condition, and the existing evidences are not enough to incriminate psychological comorbidity to be uniformly the cause for all patients with IBS.…”

The relationship between mucosal inflammatory cells, specific symptoms, and psychological functioning in youth with irritable bowel syndrome

“…IBS is associated with high rates of anxiety and depression in adults which may be associated with visceral hyperalgesia and autonomic nervous system dysfunction 26 . In children with IBS, anxiety and depression correlate with abdominal pain severity 27 .…”

Prevalence of Subthreshold Depression Among Constipation-Predominant Irritable Bowel Syndrome Patients

“…The other two subtypes IBS-M and IBS-D were excluded. Previous study involving 769 IBS patients, demonstrated 25.7% individuals with psychological distress symptom had severe physical manifestation (GI and non-GI symptoms) and lower quality of life than without psychological symptoms ( Cho et al, 2011 ; Midenfjord et al, 2019 ). However, this was not always true.…”

“…The symptoms include significant weight change or change of appetite, sleep disturbance, abnormal physical movements such as agitation or retardation, feeling fatigue and difficulty to concentrate (First, 2013). Approximately 25.7% of IBS patients were reported to have borderline and clinical significant depression based on the Hospital Anxiety and Depression Scale score (Midenfjord et al, 2019). Using the same tool, the percentage was a bit more (38.6%) between Korean patients with IBS compared to healthy controls.…”