Psychosocial risk markers for new onset irritable bowel syndrome – Results of a large prospective population-based study

Abstract

Irritable bowel syndrome (IBS) affects up to 22% of the general population. Its aetiology remains unclear. Previously reported cross-sectional associations with psychological distress and depression are not fully understood. We hypothesised that psychosocial factors, particularly those associated with somatisation, would act as risk markers for the onset of IBS. We conducted a community-based prospective study of subjects, aged 25–65 years, randomly selected from the registers of three primary care practices. Responses to a detailed questionnaire allowed subjects’ IBS status to be classified using a modified version of the Rome II criteria. The questionnaire also included validated psychosocial instruments. Subjects free of IBS at baseline and eligible for follow-up 15 months later formed the cohort for this analysis (n = 3732). An adjusted participation rate of 71% (n = 2456) was achieved at follow-up. 3.5% (n = 86) of subjects developed IBS. After adjustment for age, gender and baseline abdominal pain status, high levels of illness behaviour (odds ratio (OR) = 5.2; 95% confidence interval (95% CI) 2.5–11.0), anxiety (OR = 2.0; 95% CI 0.98–4.1), sleep problems (OR = 1.6; 95% CI 0.8–3.2), and somatic symptoms (OR = 1.6; 95% CI 0.8–2.9) were found to be independent predictors of IBS onset. This study has demonstrated that psychosocial factors indicative of the process of somatisation are independent risk markers for the development of IBS in a group of subjects previously free of IBS. Similar relationships are observed in other “functional” disorders, further supporting the hypothesis that they have similar aetiologies.

Psychological Interventions for Irritable Bowel Syndrome

“…high illness behavior scores, anxiety, sleep problems and somatic symptoms) were six times more likely to develop IBS five months later when compared to those who were exposed to none or only one marker. Among these markers, the illness behavior scale was the stronger predictor of outcome (OR = 5.2, 95%CI 2.5-11.0) [9]. Similar results were reported by a recent study that included 2769 subjects from a screening program, among which 258 had IBS.…”

“…Somatization explains the frequent extra gastrointestinal (GI) symptoms reported by IBS patients: musculoskeletal complaints, urinary and sexual symptoms, headaches and fatigue [8]. Several papers have shown that psychosocial factors indicative of somatization (such as illness behaviour scores, anxiety, sleep problems and somatic symptoms) and somatization are independent risk factors for IBS [7,9,10]. In a large community based study from England, subjects free of IBS that reported all markers of somatization at baseline (i.e.…”

Relative risk of irritable bowel syndrome following acute gastroenteritis and associated risk factors

“…Several studies have examined risk factors for PI-IBS [21,[28][29][30][31][32][33][34]. As found previously, risk of IBS was higher in females and younger age groups, although this was not significant.…”

“…Severity of GE (duration of diarrhoea, presence of blood in stools, abdominal cramps, weight loss), younger age and female gender have been associated with increased risk of PI-IBS [21,[28][29][30][31][32][33][34]. Anxiety, depression and major life events have also been identified as potential risk factors with some hypothesizing that these disorders prolong gut inflammation and heighten sensory perception [22,26,28,29,32,[35][36][37].…”

The Lifetime Prevalence of Anxiety Disorders Among Patients with Irritable Bowel Syndrome

“…The prevalence of IBS in the general population is estimated to be around 10-20% [1,4]. Depending on the predominant symptoms, 3 types of IBS can be distinguished: IBS with constipation, with diarrhea, or with alternating constipation and diarrhea.…”