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Madva EN, Harnedy LE, Longley RM, Amaris AR, Castillo C, Bomm MD, Murray HB, Staller K, Kuo B, Keefer L, Huffman JC, Celano CM. Positive psychological well-being: A novel concept for improving symptoms, quality of life, and health behaviors in irritable bowel syndrome. Neurogastroenterol Motil 2023; 35:e14531. [PMID: 36650705 PMCID: PMC10033392 DOI: 10.1111/nmo.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/01/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Though a growing body of research suggests that greater positive psychological well-being in irritable bowel syndrome (IBS) may be protective, existing brain-gut behavior therapies primarily target negative psychological factors. Little is known about how positive psychological factors in IBS relate to IBS symptoms, health-related quality of life (HRQoL), or adherence to key health behaviors, such as physical activity and diet modification. Accordingly, per the ORBIT model of behavioral treatment development for chronic diseases, we explored potential connections between psychological constructs and IBS symptoms, health behavior engagement (physical activity and dietary modification), and HRQoL in a qualitative study to inform the development of a novel brain-gut behavior therapy. METHODS Participants with IBS completed self-report assessments and semi-structured phone interviews about relationships between positive and negative psychological constructs, IBS symptoms, health behavior engagement, and HRQoL. KEY RESULTS Participants (n = 23; 57% female) ranged in age from 25 to 79 (mean age = 54). IBS subtypes were similarly represented (IBS-diarrhea [n = 8], IBS-constipation [n = 7], and IBS-mixed [n = 8]). Participants described opposing relationships between positive and negative psychological constructs, IBS symptoms, health behavior engagement, and HRQoL, respectively, such that experiencing positive constructs largely mitigated IBS symptoms, boosted health behavior participation, and improved HRQoL, and negative constructs exacerbated symptoms, reduced health behavior participation, and worsened HRQoL. CONCLUSIONS AND INFERENCES Participants with IBS linked greater positive psychological well-being to moderated IBS symptoms and better HRQoL and health behavior participation. An intervention to cultivate greater well-being may be a novel way to mitigate IBS symptoms, boost health behavior participation, and improve HRQoL in IBS.
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Affiliation(s)
- Elizabeth N. Madva
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren E. Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Regina M. Longley
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Crystal Castillo
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marie D. Bomm
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Helen Burton Murray
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle Staller
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Braden Kuo
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Laurie Keefer
- Mount Sinai Hospital School of Medicine, Psychiatry and Gastroenterology, New York, New York, USA
| | - Jeff C. Huffman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher M. Celano
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Madva EN, Sadlonova M, Harnedy LE, Longley RM, Amonoo HL, Feig EH, Millstein RA, Zambrano J, Rojas Amaris A, Jurayj J, Burton Murray H, Staller K, Kuo B, Keefer L, Huffman JC, Celano CM. Positive psychological well-being and clinical characteristics in IBS: A systematic review. Gen Hosp Psychiatry 2023; 81:1-14. [PMID: 36681019 PMCID: PMC9992118 DOI: 10.1016/j.genhosppsych.2023.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Psychological factors (e.g., depression, anxiety) are known to contribute to the development and maintenance of irritable bowel syndrome (IBS). Less is known, however, about the role of positive psychological well-being (PPWB) in IBS. Accordingly, we completed a systematic review of the literature examining relationships between PPWB and clinical characteristics in IBS. METHOD A systematic review using search terms related to PPWB and IBS from inception through July 28, 2022, was completed. Quality was assessed with the NIH Quality Assessment Tool. A narrative synthesis of findings, rather than meta-analysis, was completed due to study heterogeneity. RESULTS 22 articles with a total of 4285 participants with IBS met inclusion criteria. Individuals with IBS had lower levels of PPWB (e.g., resilience, positive affect, self-efficacy, emotion regulation) compared to healthy populations, which in turn was associated with reduced physical and mental health and health-related quality of life (HRQoL). Limited exploration of potential biological mechanisms underlying these relationships has been described. CONCLUSIONS PPWB is diminished in individuals with IBS compared to other populations, and greater PPWB is linked to superior physical, psychological, and HRQoL outcomes. Interventions to increase PPWB may have the potential to improve IBS-related outcomes. REGISTRATION Prospective Register of Systematic Reviews CRD42022304767.
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Affiliation(s)
- Elizabeth N Madva
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Monika Sadlonova
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Lauren E Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Regina M Longley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, MA, United States of America; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute and Department of Psychiatry, Brigham and Women's Hospitals, Boston, MA, United States of America
| | - Emily H Feig
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rachel A Millstein
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Juliana Zambrano
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Alexandra Rojas Amaris
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jane Jurayj
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Helen Burton Murray
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kyle Staller
- Harvard Medical School, Boston, MA, United States of America; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Braden Kuo
- Harvard Medical School, Boston, MA, United States of America; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Laurie Keefer
- Mount Sinai Hospital School of Medicine, Psychiatry and Gastroenterology, New York, NY, United States of America
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Christopher M Celano
- Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
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Sørensen J, Schantz Laursen B, Drewes AM, Krarup AL. The Incidence of Sexual Dysfunction in Patients With Irritable Bowel Syndrome. Sex Med 2019; 7:371-383. [PMID: 31604682 PMCID: PMC6963115 DOI: 10.1016/j.esxm.2019.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Several studies have suggested that patients with irritable bowel syndrome (IBS) frequently have symptoms of sexual dysfunction. Aim The current study aims to map the current knowledge about the burden of sexual dysfunction in patients with IBS. Methods A literature review was conducted on PubMed and EMBASE using the following search terms or combinations thereof: irritable bowel syndrome; functional colonic disease; sexual function; sexual health; sexual behavior; sexual dysfunction; dyspareunia; erectile dysfunction; quality of life; and questionnaire. Main Outcome Measure Sexual dysfunction. Results 1,273 texts were found, 331 duplicates were removed, and 844 texts were excluded because they did not meet the inclusion criteria, leaving 98 full text articles. These were examined and it was found that 41 fulfilled the criteria. 4 questionnaires were found; Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaire, the Irritable Bowel Syndrome – Quality of Life (IBSQOL) questionnaire, the Irritable Bowel Syndrome-36 question (IBS-36) questionnaire, and the Arizona Sexual Experience Scale. Subscores for sexual relations in IBS-QOL ranged from 37.7−100 (11.9) for patients with IBS and 82.2−100 (6.6) for controls. The IBSQOL and IBS-36 subscores for sexual relations ranged from 49.7−90.5 (9) to 3.9−5.4 (0.8) with no healthy controls for comparison. After interventions were implemented, there was an improvement in subscores (the IBS-QOL mean changed to 10.5%, IBSQOL mean changed to 3.8%, and the IBS-36 mean changed to 40%). The study using Arizona Sexual Experience Scale showed that 51% of patients with IBS had sexual dysfunction and also scored lower on the IBSQOL questionnaire. Conclusion The information about sexual dysfunction in patients with IBS is sparse and emerges primarily from quality of life questionnaires. It seems as though patients with IBS have more sexual problems compared to controls, but further investigation regarding the extent and type of sexual dysfunction is needed. Sørensen J, Schantz Laursen B, Drewes AM, et al. The Incidence of Sexual Dysfunction in Patients With Irritable Bowel Syndrome. Sex Med 2019;7:371–383.
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Affiliation(s)
- Jeanette Sørensen
- Centre of Neurogastroenterologic Research, Clinic Medicine, The North Regional Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark; Centre for Clinical Research, The North Regional Hospital, Denmark
| | - Birgitte Schantz Laursen
- Sexological Research Centre, Department of Clinical Medicine, Aalborg University, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Denmark; MechSense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - Anne Lund Krarup
- Centre of Neurogastroenterologic Research, Clinic Medicine, The North Regional Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark; MechSense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
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Ben-Israel Y, Shadach E, Levy S, Sperber A, Aizenberg D, Niv Y, Dickman R. Possible Involvement of Avoidant Attachment Style in the Relations Between Adult IBS and Reported Separation Anxiety in Childhood. Stress Health 2016; 32:463-471. [PMID: 26033751 DOI: 10.1002/smi.2642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 04/15/2015] [Accepted: 04/19/2015] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) in adults as well as separation anxiety disorder (SAD) and recurrent abdominal pain (RAP) in childhood are associated with anxiety and somatization. Our aim was to examine possible associations between IBS in adulthood and SAD in childhood. Patients with IBS and healthy subjects completed a demographic questionnaire, the Separation Anxiety Symptom Inventory (SASI), the Somatization Subscale of Symptom Checklist-90-R (SCL-90-R), the Attachment Style Questionnaire, and a retrospective self-report questionnaire regarding RAP. Compared with controls, patients with IBS were characterized by an avoidant attachment style and scored higher on the SCL-90-R scale regarding the tendency to somatization (25.35 ± 7.47 versus16.50 ± 4.40, p < 0.001). More patients with IBS (25% versus 7.5%) reported RAP in childhood, but contrary to prediction, also had significantly lower SASI scores. Adults with IBS were characterized by somatization, insecure attachment style and recalled higher rates of RAP and surprisingly less symptoms of SAD in childhood. Based on these results, an etiological model for IBS is suggested, in which an avoidant attachment style and a tendency to somatization play an important role in the development of IBS. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yuval Ben-Israel
- Clinical Psychology Graduate Program, School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | - Eran Shadach
- Clinical Psychology Graduate Program, School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | - Sigal Levy
- Clinical Psychology Graduate Program, School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | - Ami Sperber
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dov Aizenberg
- Department of Psychogeriatrics, Geha Mental Health Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Niv
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Björkman I, Jakobsson Ung E, Ringström G, Törnblom H, Simrén M. More similarities than differences between men and women with irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:796-804. [PMID: 25817301 DOI: 10.1111/nmo.12551] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Differences regarding symptoms, coping abilities, and quality of life (QOL) between men and women with irritable bowel syndrome (IBS) have been reported but data are sparse and sometimes conflicting. The aim of present study was to investigate gender differences in gastrointestinal, extra-intestinal, and psychological symptoms, and sense of coherence (SOC) and QOL in a large group of patients diagnosed with IBS. METHODS We analyzed questionnaire data from 557 patients (152 men) diagnosed with IBS consecutively included in studies at an outpatient clinic for functional bowel disorders between 2002 and 2010. Following questionnaires were included: IBS severity scoring system (IBS-SSS), Hospital Anxiety and Depression Scale (HAD), IBSQOL Scale, Visceral Sensitivity Index (VSI), SOC Scale, Bristol Stool Form Scale (BSFS), and Patient Health Questionnaire (PHQ-15). KEY RESULTS Women had harder stools (FDR-adjusted p-value: q = 0.033), more severe bloating (q = 0.020), higher symptom severity (q = 0.042), higher total somatic symptom burden (q = 0.035), lower SOC (q = 0.042), and lower QOL. Women rated more general anxiety (q = 0.017) and gastrointestinal-specific anxiety (q = 0.042), but there were no group differences in depression, pain, stool frequency, impact on daily life, dissatisfaction with bowel habit, or extra-colonic symptoms. The differences found were small (effect sizes: r < 0.3). CONCLUSIONS & INFERENCES In this study, we demonstrated more similarities than differences between men and women with IBS. The largest difference were seen for QOL which might reflect certain structural stressors to which women in general are more exposed than men.
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Affiliation(s)
- I Björkman
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Jakobsson Ung
- Institute of Health and Care Sciences and the Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - G Ringström
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Törnblom
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Zhu L, Huang D, Shi L, Liang L, Xu T, Chang M, Chen W, Wu D, Zhang F, Fang X. Intestinal symptoms and psychological factors jointly affect quality of life of patients with irritable bowel syndrome with diarrhea. Health Qual Life Outcomes 2015; 13:49. [PMID: 25925746 PMCID: PMC4414422 DOI: 10.1186/s12955-015-0243-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 04/06/2015] [Indexed: 12/15/2022] Open
Abstract
Background Patients with irritable bowel syndrome (IBS) have significantly reduced quality of life (QOL). Although intestinal and extraintestinal symptoms, as well as comorbid psychological disorders, may reduce the QOL of IBS patients, the primary determinant of QOL in these patients remains unclear. This study aimed to identify the main factors affecting QOL in patients with IBS with diarrhea (IBS-D). Methods Consecutive patients meeting the Rome III Diagnostic Criteria for IBS-D were enrolled in this study. Patients with organic diseases were excluded. The intestinal symptoms, psychological states and QOL of these patients were evaluated using IBS-specific symptom questionnaires, the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), and the Chinese version of the IBS-QOL instrument. Overall scores for intestinal symptoms were calculated by frequency and degree. Results This study enrolled 227 IBS-D patients, of mean age 44.68 ± 10.81 years. Their mean overall IBS-QOL score was 71.68 ± 18.54, with the lowest score being for food avoidance (53.71 ± 26.92). Overall IBS-QOL score correlated negatively with overall scores of intestinal symptoms and HAMD and HAMA scores (p < 0.001 each). Overall intestinal symptoms scores correlated negatively with HAMD and HAMA scores (p < 0.001 each). Scores of HAMD, HAMA and structural factors (i.e., anxiety/somatization, cognitive disorder, psychomotor retardation, psychic anxiety, and somatic anxiety) were significantly higher in female than in male patients (p < 0.01). Food avoidance and social reaction scores of female patients were significantly lower than those of male patients (p < 0.05 each). The degree of defecation urgency, frequency of passing mucus and psychomotor retardation were independent factors predicting reduced QOL in IBS-D patients. Conclusion Intestinal symptoms and psychological factors jointly reduce the QOL of IBS-D patients, with gender differences in the impact of both factors on QOL.
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Affiliation(s)
- Liming Zhu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Dan Huang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. .,Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Liexin Liang
- Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Min Chang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Wei Chen
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Dong Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Facan Zhang
- Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
| | - Xiucai Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Björkman I, Dellenborg L, Ringström G, Simrén M, Jakobsson Ung E. The gendered impact of Irritable Bowel Syndrome: a qualitative study of patients' experiences. J Adv Nurs 2013; 70:1334-43. [PMID: 24224642 DOI: 10.1111/jan.12294] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 12/20/2022]
Abstract
AIM The aim of the study was to explore the impact of irritable bowel syndrome on daily life from a gender perspective. BACKGROUND Irritable bowel syndrome is a common functional disorder, characterized by abdominal pain, diarrhoea and/or constipation. Sufferers experience negative emotions due to unpredictable symptoms and sometimes feel trivialized by healthcare professionals. The sufferers' experience of living with this disorder has never been explored from a gender perspective. DESIGN A qualitative, interpretative method was used. METHODS A qualitative, hermeneutic method was applied. Interviews were conducted with 19 patients in 2011 and analysed in a constructionist gender framework. Constructionist gender theory views gender and identity as cultural constructs that develop through interplay between the individual and his/her social context and cultural norms. FINDINGS The main theme to emerge from the interviews was as follows: 'A normative framework of femaleness and maleness leads to suffering for persons with irritable bowel syndrome'. This consists of three interwoven themes: 'Being forced to abandon gender illusions'; 'Being forced to transcend taboos' and 'Reinforced suffering in healthcare encounters'. Men demonstrated masculinity by stressing the importance of being solid family providers while women spoke of nurturing and relational responsibilities in line with traditional notions of femininity. CONCLUSION The experience of living with irritable bowel syndrome differs between men and women due to differing societal expectations, life situation and the everyday construction of gender identities. Gender stereotyping by healthcare professionals perpetuates rather than alleviates the suffering experienced by men and women with irritable bowel syndrome. In healthcare encounters, women risk being trivialized and men risk being overlooked due to the 'female health concern' label attached to irritable bowel syndrome.
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Affiliation(s)
- Ida Björkman
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, and the Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
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Anastasi JK, Capili B, Quinn J, McMahon DJ, Scully C. Irritable bowel syndrome subtype screening characteristics: constipation subtype patient profiles explored. GASTROENTEROLOGY INSIGHTS 2012; 4. [PMID: 29225760 PMCID: PMC5718377 DOI: 10.4081/gi.2012.e16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Irritable bowel syndrome (IBS), a chronic disorder, greatly impacts the lives of those affected. Approximately one quarter of the North American population suffers from this condition that includes abdominal pain, discomfort and alterations in normal bowel function. Constipation-subtype IBS (IBS-C) is often found to be a prevalent subtype; however, a lack of knowledge and effective treatment options remains surrounding this disorder. In the course of an ongoing study conducted by our research team on the use of acupuncture and moxibustion in the management of IBS symptoms, a considerable number of screened patients havemet the widely accepted Rome III criteria for IBS-C.
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Affiliation(s)
- Joyce K Anastasi
- Division of Special Studies in Symptom Management, New York University, New York, NY, USA
| | - Bernadette Capili
- Division of Special Studies in Symptom Management, New York University, New York, NY, USA
| | - Jessica Quinn
- Division of Special Studies in Symptom Management, New York University, New York, NY, USA
| | - Donald J McMahon
- Division of Special Studies in Symptom Management, New York University, New York, NY, USA
| | - Colin Scully
- Division of Special Studies in Symptom Management, New York University, New York, NY, USA
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Does a self-management program change dietary intake in adults with irritable bowel syndrome? Gastroenterol Nurs 2011; 34:108-16. [PMID: 21455043 DOI: 10.1097/sga.0b013e31821092e8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Making dietary changes such as increasing fiber intake is recommended for the management of irritable bowel syndrome symptoms. Few studies have explored the efficacy of education on compliance with recommendations such as increasing fiber, vegetable, and fruit intake in adults with irritable bowel syndrome. This study examined the effect of a multicomponent self-management intervention that included strategies to enhance fiber, vegetable, and fruit intake. Participants with medically diagnosed irritable bowel syndrome were randomized to usual care or individualized comprehensive self-management, delivered either in-person or by telephone. Since previously published analyses show the two delivery modes to be equally effective, the two intervention groups were combined. Of the 188 individuals randomized, 173 participants (113 in the self-management group and 60 in the usual care group; 23 men, 150 women) provided data on at least one of the three follow-up occasions (3, 6, and 12 months postrandomization). Fiber, vegetable, and fruit intakes were measured using the Food Frequency Questionnaire. Participants in the intervention group demonstrated increases (p < .05) in fiber and fruit intake and a trend in vegetable intake at 6 and 12 months postintervention. Improvement in dietary fiber intake following a self-management intervention for IBS continues to 1 year.
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Deechakawan W, Cain KC, Jarrett ME, Burr RL, Heitkemper MM. Effect of self-management intervention on cortisol and daily stress levels in irritable bowel syndrome. Biol Res Nurs 2011; 15:26-36. [PMID: 21765120 DOI: 10.1177/1099800411414047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Self-management programs that include cognitive behavioral strategies have been shown to improve gastrointestinal (GI) symptoms, psychological distress, and quality of life (QoL) in persons with irritable bowel syndrome (IBS). However, less is known about the physiological impact of such a change. As part of a randomized controlled trial using a comprehensive self-management (CSM) intervention (n = 126) compared to usual care (UC; n = 62), cortisol levels were measured in 4 weekly first morning urine samples at baseline and at 3-, 6-, and 12-month follow-up. In addition, diary (28 days) ratings of stress were recorded at baseline, 3, 6, and 12 months. The omnibus test of all three outcome times showed no differences in urine cortisol levels between the CSM and UC groups (p = .400); however, at 3 months the CSM group had significantly higher cortisol levels than the UC group (p = .012). The CSM group reported lower daily stress levels (p = .046 from the omnibus test of all 3 time points) than the UC group, with the effect getting stronger over time. Despite marked improvements in reported stress and previously reported GI and psychological distress symptoms at later follow-ups, the CSM program did not reduce urine cortisol levels in adults with IBS. These results suggest that the first-void urine cortisol levels are not reflective of self-reported daily stress in this patient population.
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Affiliation(s)
- Wimon Deechakawan
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, USA
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