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

Journal article
Authors Irina Midenfjord
Annikka Polster
Henrik Sjövall
Hans Törnblom
Magnus Simrén
Published in Neurogastroenterology and Motility
Volume 31
Issue 8
ISSN 1350-1925
Publication year 2019
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Language en
Keywords anxiety, depression, irritable bowel syndrome, multivariate analysis, quality-of-life, heart-rate-variability, visceral hypersensitivity, severity, questionnaire, validation, microbiota, system, impact, somatization, Gastroenterology & Hepatology, Neurosciences & Neurology
Subject categories Psychiatry, Gastroenterology and Hepatology


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 T-2 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.

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