More negative self-esteem and inferior coping strategies among patients diagnosed with IBS compared with patients without IBS--a case-control study in primary care

Exploring the burden of irritable bowel syndrome among university students in Saudi Arabia: A study on prevalence, psychological associations, and well-being

Patients with irritable bowel syndrome (IBS) experience not only a detrimental impact on their physical health but also a significant influence on their psychological well-being. This study aimed to assess the prevalence of IBS among university students, investigating the sociodemographic and lifestyle factors influencing its onset. Furthermore, it explored the potential impact of psychological factors such as depression, anxiety, and overall well-being on the prevalence of IBS. A cross-sectional analytical study was conducted at Saudi Arabian universities in November and December 2023. To collect data, an anonymous, validated, predesigned questionnaire was used. The diagnosis of IBS was carried out using the validated Arabic version of the Rome IV questionnaire. We used the Arabic version of the World Health Organization Well-being Index to assess the participants' well-being. We used the Arabic version of the Hospital Anxiety and Depression Scale (HADS) to identify people who show clinically significant symptoms of anxiety and depression. Our study included a total of 379 university students, 46.7% were female 86.0% of participants resided in urban areas, and 7.2% had been previously diagnosed with IBS. The prevalence of IBS among participants was found to be 31.9%. We observed a significant association between marital status and IBS (χ2 = 3.95, P = .047). Furthermore, the highest prevalence of IBS was observed among students majoring in literary and scientific disciplines (χ2 = 0.952, P = .049). Individuals with IBS demonstrate a significantly higher prevalence of anxiety (71.90% vs 41.09%, P < .001) and depression (64.46% vs 42.64%, P < .001) compared to those without IBS. Furthermore, people with IBS had a slightly higher prevalence of poor well-being (38.84%) compared to those without IBS (33.72%), but this association was not statistically significant. In multivariate analysis, having a family history of IBS [OR = 1.75 (95% CI, 1.06-2.87), P = .029] having borderline anxiety [OR = 7.58, 95% CI (2.12-27.06), P = .012] and anxiety [OR = 16.07, 95% CI (4.57-56.52), P < .001], and depression [OR = 2.97, 95% CI (1.13-7.83), P = .010] were the main significant predictors of IBS among university students. The high prevalence of IBS among university students was associated with a family history of IBS as well as depression and anxiety. Increasing awareness, multidisciplinary support, and access to mental health services is required to ensure university students' well-being.

Assessment of psychological alarms and coping strategies of medical students with irritable bowel syndrome at Zagazig University: A cross-sectional study

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. Medical students tend to report a higher prevalence of IBS since they are under constant stress. Many psychological difficulties are associated with IBS. To cope with IBS, individuals use various strategies which can impact the intensification or alleviation of IBS symptoms. The objective of this study was to assess the prevalence of IBS in medical students as well as psychological alarms and coping strategie employed by IBS sufferers.

MATERIALS AND METHODS

We conducted a cross-sectional study from December 2022 to February 2023. Study participants were first to fifth year medical school students at Zagazig University, Egypt. Data were collected using a structured questionnaire comprising four sections: sociodemographic and clinical data; Rome IV criteria for the diagnosis of IBS; the alarm questionnaire for functional gastrointestinal disorders; and the Coping Strategies Questionnaire (CSQ24). Chi-square test or Fischer's exact test, as appropriate, were used to test for association. Binary logistic regression with a backward stepwise method was used to determine significant risk factors of negative coping with IBS.

RESULTS

Of the studied 221 medical students, 38% had IBS. A statistically significant association was observed between IBS and the feeling of tension, anxiety, nervousness, depression, and frustration in the previous week, severe pain in the past 4 weeks, and the feeling that the bad situation would not get any better. Most of the students in the IBS group coped positively with stress, while 19.0% were negative in coping. Pain affecting the daily activities and the feelings of depression and frustration to the point of self-harm or suicide were the most significant correlates of IBS group's inability to cope.

CONCLUSION

The prevalence of IBS in medical students at Zagazig University was 38%. We recommend psychological intervention and stress management programs to help medical students cope with IBS.

Influence of Coping and Self-Efficacy in Inflammatory Bowel Disease

(1) Background: Coping includes the specific cognitive processes and behaviours that the patient uses when faced with the stress of living with a chronic disease. Self-efficacy is the knowledge that individuals have about their abilities and their confidence to face a problem or cope with a situation (disease). The aim of this study was to explore the role of coping and self-efficacy in inflammatory bowel disease. (2) Materials and Methods: A total of 92 participants were included (33 had been diagnosed with Crohn's disease, 23 with ulcerative colitis and 36 were healthy participants). The Coping Strategies Inventory was used to measure which coping strategies were employed, differentiating them as active or passive. The General Self-Efficacy Scale was used to measure self-efficacy. (3) Results: The results indicate that people with inflammatory bowel disease used strategies related to passive coping more than healthy people (mean of 36.39 ± 13.92 vs. 29.77 ± 10.70, p = 0.017). Additionally, people with inflammatory bowel disease used social withdrawal more than healthy participants (mean of 8.30 ± 5.07 vs. 4.47 ± 4.17, p < 0.001). In addition, there are significant differences in emotion-focused engagement coping strategies. People with inflammatory bowel disease used this strategy less than healthy people (mean of 21.77 ± 7.75 vs. 25.03 ± 7.00, p = 0.044). Finally, healthy participants used the emotion-focused disengagement strategy less than those diagnosed with inflammatory bowel disease (mean of 9.81 ± 7.74 vs. 15.61 ± 10.14, p = 0.004). (4) Conclusions: Actions aimed at the development of active coping strategies and patient socialisation must be included in the treatment of inflammatory bowel disease.

Symptoms and health experience in irritable bowel syndrome with focus on men

BACKGROUND

Irritable bowel syndrome (IBS) is a disorder with a predominance in women; IBS in men is less studied. The present study evaluated symptoms as well as health and social experiences of men with IBS.

METHODS

This cross-sectional study included 293 patients with IBS (64 men) and 363 non-IBS controls (62 men). Gastrointestinal symptom diaries were filled in prospectively, and data on comorbidities and healthcare-seeking behavior were assessed by questionnaires. Men with IBS were compared with men without IBS and women with IBS.

KEY RESULTS

Compared with women with IBS, men with IBS had fewer contacts with the healthcare system, fewer psychiatric comorbidities, fewer sleeping problems, and less chronic pain. Urgency to defecate and nausea were less common, and stool frequency was higher in men with IBS. There was no difference between men with and without IBS in terms of educational level, satisfaction with household economy, or living with a partner. In contrast, women with IBS more often lived alone, were more often dissatisfied with household economy, and had a lower educational level than women without IBS. Men with IBS had the same proportion of full-time employment as men without IBS but in contrast, the proportion of women with IBS in full-time employment was only 34%, compared to 50% of the women without IBS.

CONCLUSION AND INFERENCES

The present study improves the understanding of men's experiences of IBS and suggests that sex and gender may be integrated into the biopsychosocial model of IBS.

Vitamin D Supplementation and Mental Health in Inflammatory Bowel Diseases and Irritable Bowel Syndrome Patients: A Systematic Review

Inflammatory bowel diseases (IBDs) and irritable bowel syndrome (IBS) are associated with decreased quality of life and mental health problems. Among various approaches to supportive therapy that aims to improve mental health in affected individuals, vitamin D supplementation is considered to be an effective method which may also be beneficial in alleviating the symptoms during the course of IBDs and IBS. The aim of the present study was to conduct a systematic review of the literature presenting the data regarding the influence of vitamin D supplementation on mental health in adults with inflammatory and functional bowel diseases, including IBDs and IBS. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020155779). A systematic search of the PubMed and Web of Science databases was performed, and the intervention studies published until September 2021 were included. The human studies eligible to be included in the review should have described any intervention involving vitamin D as a supplement in a group of adult patients suffering from IBDs and/or IBS and should have assessed any component of mental health, but studies presenting the effects of combined supplementation of multiple nutrients were excluded. After eliminating the duplicates, a total of 8514 records were screened and assessed independently by two researchers. Further evaluation was carried out on the basis of title, abstract, and full text. Finally, 10 studies (four for IBDs and six for IBS) were selected for the current systematic review, and their quality was assessed using the Newcastle-Ottawa Scale (NOS). The studies analyzed the influence of various doses of vitamin D on bowel diseases, compared the results of vitamin D supplementation with placebo, or administered specific doses of vitamin D to obtain the required level in the blood. Supplementation was performed for at least 6 weeks. The analyzed mental health outcomes mainly included disease-specific quality of life/quality of life, anxiety, and depression. The majority of studies (including high-quality ones) confirmed the positive effect of vitamin D supplementation on the mental health of IBD and IBS patients, which was proven by all research works evaluating anxiety and depression and by the majority of research works evaluating quality of life. Although the studies followed different dosage regimens and supplementation protocols, the positive influence of vitamin D on mental health was found to be consistent. The number of studies on patients suffering from ulcerative colitis and the availability of trials randomized against the placebo group was low in the current review, which is considered to be a limitation of the present study and could also reflect the final outcome of the analysis. The conducted systematic review established the positive effect of vitamin D supplementation on the mental health of IBD and IBS patients, but this result requires further investigation, particularly in relation to other mental health outcomes.

Electroencephalographic evidence of unconscious and conscious attentional bias in people with functional gastrointestinal disorders: A pilot study

Debate continues as to whether an attentional bias towards threat displayed by sufferers of functional gastrointestinal disorders (FGIDs) is conscious and, thus, more amenable to change through psychological therapy. We compared the amplitudes of early (unconscious) and later (conscious) electroencephalographic (EEG) event-related potentials following silent reading of symptom-related, emotionally neutral, and emotionally negative nouns across two participant groups: 30 female FGID-sufferers who met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, and 30 female healthy controls. Analogous indices based on alpha desynchronization were also examined, as were correlations between the EEG-based indices and a range of psychosocial variables. FGID-sufferers displayed marginally significantly higher occipital EPN amplitudes for all nouns, indicating marginally higher levels of unconscious attention in the task. FGID-sufferers also displayed, for negative as compared to neutral nouns, significantly lower central N400 amplitudes indicative of higher conscious attention. The result was only apparent in post-hoc pairwise comparisons, however. Uniquely among FGID-sufferers, central N400 was strongly negatively correlated with a range of negative psychosocial traits and states. The findings provide preliminary evidence of hypervigilance to general (as opposed to symptom-specific) threat among FGID-sufferers. Amidst concerns over Type I error, recommendations are made for fine-tuning the operationalisation of unconscious and conscious attentional bias in this population.

Irritable Bowel Syndrome and Coping Strategies: A Cross-sectional Study for Identifying Psychological Alarms and Factors Related to Coping in Riyadh, Saudi Arabia

Psychological alarms including severity of pain, functional impairment, depression, and impaired coping strategies have been correlated with (IBS); however, these attributes, particularly coping strategies, have not been well studied. The aim of this study was to assess psychological alarms, life stressors, and coping strategies of adults diagnosed with IBS. A total of 806 participants completed a self-administered survey consisting of socio-demographic data and life stressors, the Rome IV criteria to diagnose IBS, the Psychological Alarm Questionnaire, and the Coping Strategies Questionnaire (CSQ 24). IBS diagnosis was established among 372 (46.15%) participants. Anxiety (OR = 1.81; 95% CI: 1.35-2.45), severe pain (OR = 1.92; 95% CI: 1.42-2.63), financial life stressors (OR = 1.98; 95% CI: 1.33-2.40), and coping strategies such as reinterpretation (OR = 1.92; 95% CI: 1.39-2.68) and diversion (OR = 2.01; 95% CI: 1.05-3.89) were all significantly and independently associated with IBS diagnosis. Giving the chronic nature of IBS, future research should focus on coping as a potential treatment goal for IBS patients.

Infliximab for Crohn's Disease Patients with Perianal Fistulas: Better Image, Better Life

Background

Patients with Crohn’s disease (CD) experience physical impairments, poor quality of life and negative body image. These factors are exacerbated in CD patients with active perianal fistulas.

Material/Methods

Baseline characteristics were compared in retrospectively enrolled CD patients with and without active perianal fistulas. The relationships between improvements in perianal fistulas and quality of life, body image, and self-esteem were determined. The effects of infliximab treatment on improvement of psychological-social status were assessed in CD patients with active perianal fistulas.

Results

Of the 301 CD patients included in our institution’s database. 91 (30.2%) had active perianal fistulas. After adjustment by propensity score matching, CD patients with active perianal fistulas had lower self-esteem and more severe body image dissatisfaction than CD patients without active perianal fistulas (P<0.01 each). Perianal fistula response was closely associated with improvements in quality of life, body image dissatisfaction and self-esteem (P<0.01 each). Patients with perianal fistula treated with infliximab showed a response rate of 68.3%, significantly higher than the rate in patients with perianal fistula not treated with infliximab (P=0.005). Furthermore, improvements of life quality, body image and self-esteem were significantly greater in patients with perianal fistula who were than were not treated with infliximab (P<0.05 each).

Conclusions

CD patients with active perianal fistulas experience body image dissatisfaction, low self-esteem and poor quality of life. Treatment of these patients with infliximab could improve their body image, self-esteem and quality of life.

The Impact of an Individual Educational Program on the Quality of Life and Severity of Symptoms of Patients with Irritable Bowel Syndrome

Background: Irritable bowel syndrome (IBS) is one of the most common functional diseases of the gastrointestinal tract. A typical symptom is changed bowel patterns: diarrhea, constipation, or alternation of the two. Abdominal pains vary in intensity and location, with periods of exacerbation and remission, causing disorganization in everyday life and work. Educational intervention could be one strategy to improve the well-being of IBS patients. Only a few trials have examined this hypothesis. The aim of this study was to examine the effect of an educational program combined with elements of behavioral therapy, individualized for each patient, on quality of life (QOL) and severity of pain of patients with IBS. Methods: In total, 150 IBS patients and 100 healthy persons in the control group were included. QOL (36-Item Short Form Health Survey, SF-36) and pain severity (Visual Analogue Scale) were measured at baseline and six months after education of IBS patients. Results: At baseline, patients with IBS showed highly significantly worse QOL. In the IBS group, significantly higher physical component summary (PCS) and mental component summary (MCS) scores were noted for 35- to 50-year-old patients compared to other patients. Six months after education and behavioral therapy, significant improvement in QOL and a significant decrease in the subjective perception of pain severity were noted compared to values before therapeutic education. Conclusion: An educational program combined with elements of behavioral therapy, individualized for patients with IBS, is an important part of therapy for these patients.

Effects of Irritable Bowel Syndrome on Daily Activities Vary Among Subtypes Based on Results From the IBS in America Survey

BACKGROUND & AIMS

Irritable bowel syndrome (IBS) is associated with significant disease burden and decreased quality of life (QOL). We investigated the effects of IBS on different areas of daily function and compared these among disease subtypes.

METHODS

The Life with IBS survey was conducted by Gfk Public Affairs & Corporate Communications from September through October 2015. Respondents met Rome III criteria for constipation-predominant or diarrhea-predominant IBS (IBS-C and IBS-D, respectively). Data were collected from 3254 individuals (mean age, 47 years; 81% female; and 90% Caucasian) who met IBS criteria.

RESULTS

Respondents who were employed or in school (n = 1885) reported that IBS symptoms affected their productivity an average of 8.0 days out of the month and they missed approximately 1.5 days of work/school per month because of IBS. More than half the individuals reported that their symptoms were very bothersome. Individuals with IBS-C were more likely than with IBS-D to report avoiding sex, difficulty concentrating, and feeling self-conscious. Individuals with IBS-D reported more avoidance of places without bathrooms, difficulty making plans, avoiding leaving the house, and reluctance to travel. These differences remained when controlling for symptom bothersomeness, age, sex, and employment status. In exchange for 1 month of relief from IBS, more than half of the sample reported they would be willing to give up caffeine or alcohol, 40% would give up sex, 24.5% would give up cell phones, and 21.5% would give up the internet for 1 month.

CONCLUSIONS

Although the perceived effects of IBS symptoms on productivity are similar among its subtypes, patients with IBS-C and IBS-D report differences in specific areas of daily function.

Gastrointestinal symptoms - an illness burden that affects daily work in patients with IBS

Background

Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disorder characterised by recurrent abdominal pain and disturbed bowel habits and unclear aetiology. IBS is also associated with psychosocial factors, impaired quality of life and lost work productivity. This study sought to determine whether the association between IBS and lost work productivity might be accounted for by poor coping strategies and loss of confidence in the healthcare system.

Methods

Case–control design was employed sampling IBS and non-gastrointestinal (non-GI) primary healthcare seekers in a defined region in Sweden. Non-GI patients were of similar age and sex distribution to the IBS patients. Questionnaires applied in this study included instruments designed to measure confidence in the social security system and in the community, as well as questions about whether gastrointestinal problems might affect working life and Sense of coherence (SOC) questionnaire. The study’s primary hypothesis was evaluated via an a priori path model.

Results

Statistically significant differences were found between IBS cases (n = 305) and controls (n = 369) concerning abdominal pain or discomfort affecting everyday performance at work (p <  0.0001). IBS cases also showed significantly lower (p = 0.001) confidence in public healthcare. The study’s hypothesis was supported with the finding of a statistically significant indirect association via poor coping strategies, although the indirect associations were lesser in magnitude than the direct association.

Conclusions

This study found a clear association between clinically diagnosed IBS status and interference in work by gastrointestinal symptoms in which sense of coherence might be of importance.

Primary healthcare utilisation and self-rated health among patients with Irritable Bowel Syndrome: What are the impacts of comorbidities, gastrointestinal symptom burden, sense of coherence and stress?

OBJECTIVES

Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disease associated with impaired quality of life and an increased use of healthcare services. Self-ratings of health have proven a powerful predictor of health outcomes. The aim of this study was to evaluate the unique impacts of comorbidities, gastrointestinal symptoms, perceived stress and sense of coherence on the number of healthcare contacts and self-rated health of IBS patients in Swedish primary care.

METHODS

In this cross-sectional study, 186 primary-care IBS patients and 360 non-IBS patients (as a reference group) were administrated a test battery of validated questionnaires. Data on comorbidities and healthcare-seeking frequency were obtained from a registry.

RESULTS

In the reduced multivariable logistic regression model, average days of abdominal pain/week (OR = 0.83, 95% CI = 0.72-0.96), age (OR = 0.95, 95% CI = 0.92-0.97) and sense of coherence (OR = 1.07, 95% CI = 1.03-1.11) remained independent, statistically significant predictors of IBS (and non-IBS) patients reporting good health. Only the number of comorbidities in general (OR = 1.22, 95% CI = 1.14-1.32) and sleep disorders in particular (OR = 5.40, 95% CI = 1.85-15.76) independently predicted high levels of primary healthcare utilisation among IBS patients.

CONCLUSION

Lack of gastrointestinal symptoms, a high sense of coherence and younger age were associated with better self-rated health in both IBS and non-IBS patients. The number of comorbidities in general and sleep disorders in particular were associated with frequent PHC contacts in IBS patients. The association between frequent primary-care contacts and sleep disorders was not seen in the control group, indicating a unique association with IBS patients.

Predictors of Health-related Quality of Life in Irritable Bowel Syndrome Patients Compared With Healthy Individuals

BACKGROUND

Irritable bowel syndrome (IBS) reduces health-related quality of life (HRQOL). It is unclear how having IBS modifies the impact of gastrointestinal (GI), psychosocial, and somatic symptom variables on HRQOL compared with healthy controls (HCs).

AIMS

(1) Determine psychosocial, somatic, and physical status variables most predictive of HRQOL in IBS and HCs and (2) determine if IBS status modifies relationships between predictive factors and HRQOL.

METHODS

IBS patients and HCs completed validated questionnaires measuring GI symptoms, psychosocial/somatic variables, and physical [physical component score (PCS)] and mental [mental component score (MCS)] HRQOL via the Short-Form-36. Associations between these variables and HRQOL were evaluated with multiple linear regressions. Variables were standardized to determine the strongest predictors of HRQOL. Statistical significance level was 0.01.

RESULTS

Mean HRQOL was higher in 417 HCs versus 290 IBS subjects (PCS: 55.6 vs. 48.6, P<0.001; MCS: 53.7 vs. 44.8, P<0.001). The GI symptom measures were negatively associated with PCS in IBS, but only usual severity was associated with MCS (P<0.01). In all subjects, psychosocial and somatic measures were associated with MCS and not PCS excluding GI symptom anxiety, which correlated with both (P<0.01). The strongest predictor of MCS was perceived stress in IBS and depression symptoms in HCs. GI symptom anxiety was the strongest predictor of PCS in both. Greater perceived stress and somatic symptom severity and less mindfulness was linked to larger reductions in HRQOL for IBS compared with HCs (P<0.01).

CONCLUSIONS

GI symptom severity and anxiety correlate with PCS, whereas psychosocial/somatic measures parallel MCS. However, HRQOL is comparable in IBS and HCs when perceived stress, somatic symptom severity, and mindfulness are at optimal levels. These findings may have important implications in the management of IBS.

Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

OBJECTIVES

The low-FODMAP diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). This diet is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorders (EDs) and the risk of developing IBS. The aim of this study was to assess the correlation between compliance with a low-FODMAP diet and the risk of ED behaviours among patients with IBS.

PATIENTS AND METHODS

A single-centre prospective study was carried out among 233 IBS patients (79.8% females) at University College London Hospital, who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6-week programme was measured. At baseline, and at the 6-week follow-up visit, participants completed the validated IBS-Symptom Severity Score, the SCOFF ED screening questionnaire and the Hospital Anxiety and Depression Scale.

RESULTS

Adherence with a low-FODMAP diet was found in 95 (41%) patients. Overall, 54 (23%) patients were classified to be at risk for ED behaviour. Adherence was 57% in the ED group (31/54) versus 35% in the non-ED group (64/179); P<0.05. Adherence with a low-FODMAP diet was highest (51%) in the IBS with diarrhoea subtype and lowest (10%) in IBS with constipation. There was no significant correlation between IBS-Symptom Severity Score and either adherence (P=0.39) or ED behaviour (P=0.28).

CONCLUSION

In this IBS cohort, greater adherence to a low-FODMAP diet is associated with ED behaviour. The implications of our study are important in clinical practice for a clinician to have a high index of suspicion of EDs in IBS patients when a high level of low-FODMAP diet achieved.

Gastrointestinal recall questionnaires compare poorly with prospective patient diaries for gastrointestinal symptoms: data from population and primary health centre samples

BACKGROUND

Clinical understanding of gastrointestinal symptoms is commonly based on patient reports of symptom experience. For diagnosis and treatment choices to be appropriate, symptom reports need to be accurate. We examined the agreement between questionnaire recall and prospective diary enumeration of symptoms relevant to the irritable bowel syndrome.

PATIENTS AND METHODS

Data are reported from a randomly selected general population sample (n=238) and also a primary healthcare centre (PHC) sample (n=503, 10 PHCs). All the patients completed the questionnaires, which included Rome III-qualifying irritable bowel syndrome items and a stool and symptom diary over either 7 or 14 days. Agreement between retrospective questionnaire reports and prospective diaries was evaluated.

RESULTS

Concordance between questionnaires and diaries was highest for the simple construct of the occurrence of abdominal pain, although after adjusting for possible chance, agreement was only moderate in the general population sample. More complex constructs, such as pain relieved by defecation, yielded poorer concordance. In general, concordance was stronger among PHC respondents than in the general population sample.

CONCLUSION

Concordance between questionnaires and diaries was generally poor and related to the complexity of the symptom construct and the type of respondent. The information used to classify individuals based on patient self-report may be unreliable, and therefore, more effort is needed to develop data collection instruments.

Connecting Our Gut Feeling and How Our Gut Feels: The Role of Well-being Attributes in Irritable Bowel Syndrome

Background/Aims

There is a close relationship between the mind and gut in the pathogenesis of functional bowel disorders. Common psychological disturbances such as depression and anxiety are not uncommon in those with irritable bowel syndrome (IBS). There is little research investigating the role of positive psychology and gastrointestinal (GI) conditions. In this pilot study we investigated the well-being attributes in those with and without IBS.

Methods

We used an anonymous online survey and recruited 416 study subjects using social media as the main method of recruitment. We gathered demographic information, GI symptoms, history of mental health issues such as anxiety and depression, assessed several well-being attributes, and finally assessed subjective well-being. We hypothesized that those with GI symptoms and IBS have lower scores in their well-being attributes compared to healthy controls.

Results

We observed that a history of anxiety and depression is significantly associated with GI symptoms and IBS. In addition, sense of subjective well-being and several well-being attributes are negatively associated with GI symptoms and/or IBS. Of interest, the household income showed a negative correlation with the prevalence of GI symptoms and IBS.

Conclusions

Subjective well-being, and several well-being attributes that contribute to the sense of overall contentment, are negatively associated with GI symptoms and IBS. The link between subjective well-being, and GI symptoms and IBS are independent of anxiety and depression. Well-being attributes and sense of subjective well-being may be a contributory factor in clinical expression of GI symptoms or IBS consistent with the biopsychosocial model of the disease.

Functional gastrointestinal diseases and psychological maladjustment, personality traits and quality of life

Background

Chronic abdominal pain is a common worldwide problem and known to be associated with psychological problems. This study evaluated the association between abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs), psychological maladjustment and personality traits in adolescents.

Methods

Adolescents aged 13–18 years were recruited from 5 randomly selected schools in Ampara district of Sri Lanka. AP-FGIDs were diagnosed using Rome III criteria. Translated and validated Rome III questionnaire (Child report form), personality questionnaire (PAQ) and PedsQL (Pediatric Quality of Life) inventory were used in data collection. Written consent was obtained from a parent and assent was obtained from every child recruited. The questionnaire was distributed in an examination setting to ensure confidentiality and privacy. Research assistants were present during data collection to assist on any necessary clarifications.

Results

A total of 1697 subjects were recruited [males 779 (45.9%), mean age 15.1 years, SD 1.6 years]. AP-FGIDs were present in 202 (11.9%). Those with AP-FGIDs had significantly higher mean scores for all personality traits (hostility and aggression, negative self-esteem, emotional unresponsiveness, emotional instability and negative world view), except dependency. Affected children had lower scores for all 4 domains of HRQoL (physical, emotional, social and school functioning), compared to controls (p < 0.05). When the cut off value for Sri Lankan children (89) was used, 66.3% with AP-FGIDs and 48.2% controls had PAQ scores within that of psychological maladjustment (p < 0.001). When the international normative value of 105 was used, these percentages were 27.2% and 14.2% respectively (p < 0.0001). The scores obtained for PAQ negatively correlated with scores obtained for HRQoL (r = − 0.52, p < 0.0001). One hundred and seventeen adolescents with AP-FGIDs (57.9%) had sought healthcare for their symptoms. Healthcare consulters had higher PAQ and lower HRQoL scores (p < 0.05).

Conclusions

Adolescents with AP-FGIDs have more psychological maladjustment and abnormal personality traits than healthy controls. Affected adolescents with higher psychological maladjustments have lower HRQoL. Greater psychological maladjustment and lower HRQoL are associated with healthcare seeking behaviour in adolescents with AP-FGIDs.

Self-Perception of Iranian Patients during their life with Irritable Bowel Syndrome: A Qualitative Study

Background

Irritable bowel syndrome (IBS), as a chronic digestive disorder, impacts extensively on the quality of life, emotional well-being and self-identity. Chronic illness disrupts taken-for-granted notions about self. No qualitative study was found regarding patients’ experience of life with irritable bowel syndrome (IBS) in Iran.

Objective

To explore the self-perception of lived experience of IBS patients.

Methods

A qualitative study with hermeneutic phenomenological approach was conducted on 12 IBS patients who had been referred to three central clinics (2 governmental and 1 private) affiliated to Shiraz University of Medical Sciences. The data were collected through in-depth semi-structured interviews from July 2015 to September 2016 by purposeful sampling. Thematic analysis was carried out using Van Manen’s six-step methodological framework as a guide. In addition, MAXQDA software was used for data management.

Results

In this study, two main themes “the threatened self” and “deep self-knowledge”, emerged during the life of patients with IBS, indicating the meaning of self-perception of such patients. The theme of “the threatened self” consisted of two subthemes of “fear from stigmatization” and “bad sense of self”. The subthemes of “body knowledge”, “self-acceptance” and “personal growth” were related to deep self-knowledge.

Conclusion

The results of the present study could be applied in designing and implementation effective and holistic care of IBS patients.

The role of high expectations of self and social desirability in emotional processing in individuals with irritable bowel syndrome: A qualitative study

OBJECTIVES

Although high levels of distress are associated with the onset and severity of Irritable bowel syndrome (IBS), it is unclear how this relates to emotional processing, particularly in relation to maintenance of symptoms and treatment outcome. This qualitative study embedded within a randomized controlled trial aimed to explore how individuals with refractory IBS experience, express, and manage their emotions after either therapist-delivered cognitive behavioural therapy (TCBT) or Web-based CBT (WBCBT) compared to treatment as usual (TAU).

DESIGN

Cross-sectional qualitative study.

METHODS

Fifty-two semi-structured interviews were conducted at post-treatment with 17 TCBT, 17 WBCBT, and 18 TAU participants. The transcripts were analysed using inductive thematic analysis with grounded theory elements. NVivo 11 was used to compare themes across groups.

RESULTS

Across all groups, high expectations of self was a recurring reason for how participants experienced and expressed their emotions. Three themes with subthemes captured how high expectations related to specific aspects of emotional processing: perceived causes of emotions, strategies for coping with emotions (bottling up, avoiding emotions, and active coping strategies), and the perceived interplay between emotions and IBS symptoms.

CONCLUSIONS

Patients recognized that their IBS symptoms both triggered and were triggered by negative emotions. However, there was a tendency to bottle up or avoid negative emotions for reasons of social desirability regardless of whether patients had CBT for IBS or not. Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions, promoting assertive emotional expression, and encouraging the experience of positive emotions. Statement of contribution What is already known on this subject? High levels of distress are consistently associated with both the onset and maintenance of IBS symptoms. Little is known about how this relates to the concept of emotional processing. Preliminary findings suggest a positive correlation between poor emotional processing and IBS. However, further studies need to confirm its role in relation to aetiology, maintenance of symptoms, and response to treatment. What does this study add? High expectations of self and social desirability seem to be important aspects shaping the way individuals with IBS experience, express, and manage their emotions. Emotional avoidance and bottling up were reported as key strategies to cope with negative emotions. The study revealed that bottling up is not perceived as an all-or-nothing strategy but can be applied selectively depending on the context. Psychological interventions in IBS may benefit from addressing not only illness-related causes of negative emotions but also personal and social triggers of distress.

Self-help guidebook improved quality of life for patients with irritable bowel syndrome

Background

The primary aim of our study was to evaluate the impact of a comprehensive self-help guidebook on the disease related quality of life for patients with irritable bowel syndrome (IBS). The secondary aim was to evaluate whether the guidebook is less effective in IBS patients with depression, somatization disorder or panic disorder as a psychiatric comorbidity.

Methods

Prospective observational study. At baseline (t1), patients filled in the ´Functional Digestive Disorders Quality of Life´ (FDDQL) questionnaire and received the IBS guidebook together with an explanation of its content and use. Depression, anxiety and somatization were evaluated with the Patient Health Questionnaire (PHQ). Three (t2) and six months (t3) later, the questionnaire was sent by mail to the patients for follow-up evaluation. Data were analyzed with repeated measures ANOVA.

Results

71 patients participated (74.6% female). 53 (74.6%) completed the final assessment at t3 after 6 months. The global FDDQL score increased from 49.3 (SD 12.7) at t1 to 64.3 (SD 16.0) at t3 (p < 0.001). There was a significant between-subjects effect on the global FDDQL score related to depression (p = 0.001), anxiety (p = 0.001) and somatization (p = 0.011). Thus, the quality of life of patients with psychosomatic comorbidity was lower at baseline, but showed a similar increase within the following six months.

Conclusion

The self-help guidebook significantly improved measured quality of life for IBS patients. The use of screening questionnaires like PHQ might be valuable to identify patients with more complex problems. This might be helpful for them to intensify and adapt therapy. Further research has to evaluate if patients with psychological comorbidity are treated more effectively when they receive psychotherapy or specific medication in addition to the self-management guidebook.

Shame feeling in the Intensive Care Unit patient's family members

OBJECTIVE

To investigate the levels of internal and external shame among family members of critically ill patients.

RESEARCH METHODOLOGY/ DESIGN

This prospective study was conducted in 2012/2013 on family members of Intensive Care Unit patients using the Others As Shamer Scale and the Experiential Shame Scale questionnaires.

SETTING

Greek university hospital.

RESULTS

Two hundred and twenty-three family members mean-aged (41.5±11.9) were studied, corresponding to 147 ICU patients. Out of these 223, 81 (36.3%) were men and 142 (63.7%) were women, while 79 (35.4%) lived with the patient. Family members who lived with the patient experienced higher internal and external shame compared to those who did not live with the patient (p=0.046 and p=0.028 respectively). Elementary and Junior High School graduates scored significantly higher than the other grades graduates in total Others As Shamer Scale, inferiority and emptiness scale (p<0.001).

CONCLUSION

Intensive Care Unit patients' family members are prone to shame feelings, especially when being of low educational level. Health professionals have to take into consideration the possible implications for the patients and their care.

Depressive Symptoms and Coping Behaviors among Individuals with Irritable Bowel Syndrome in Japan

Objective Irritable bowel syndrome (IBS) is associated with a high prevalence of psychological disorders. Coping, which is used to manage stressful events, can have adaptive or maladaptive effects on a patient's health status. However, these coping behaviors have not been well studied in individuals with IBS. The association between the use of coping behaviors and the reported levels of depressive symptoms was examined in individuals with IBS. Methods Among 993 volunteers (382 men and 611 women) who participated in the Iwaki Health Promotion Project in 2013, we included 58 subjects who fulfilled the Rome III criteria for IBS in our analysis. Coping behaviors were assessed using the Brief Scale for Coping Profile (BSCP). The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the four dimensions of depressive symptoms (depressed affect, somatic symptoms, interpersonal problems, and lack of positive affect) and the prevalence of probable depression using a cut-off score of 16. Results Among the 58 subjects with IBS, 22 (36.1%) exhibited probable depression. After adjustment for confounders, "active solution" was found to be significantly associated with somatic symptoms. Under the same conditions, "avoidance and suppression" was significantly associated with the CES-D total score, depressed affect, somatic symptoms, and (lack of) positive affect. There were no other significant relationships between depressive symptoms and the BSCP sub-scale scores. Conclusion These findings indicate that coping behaviors may influence the experience of depressive symptoms among individuals with IBS. Psychological therapy may reduce depressive symptoms as well as the severity of IBS symptoms. Additional studies are needed to examine the relationships between coping behaviors and depressive symptoms using a longitudinal study design.

Irritable Bowel Syndrome Increases the Risk of Epilepsy: A Population-Based Study

An abnormal interaction in the brain-gut axis is regarded as the cause of irritable bowel syndrome (IBS). We attempted to determine the association between IBS and subsequent development of epilepsy.A total of 32,122 patients diagnosed with IBS between 2000 and 2011 were identified from the Longitudinal Health Insurance Database as the study cohort, and 63,295 controls were randomly selected from the insurants without IBS and frequency-matched according to age, sex, and index year as the comparison cohort. Both cohorts were followed up until the end of 2011 to measure the incidence of epilepsy. We analyzed the risks of epilepsy using Cox proportional hazards regression models.The IBS patients had greater cumulative incidence of epilepsy than the cohort without IBS (log-rank test, P < 0.001 and 2.54 versus 1.86 per 1000 person-years). The IBS cohort had a higher risk of epilepsy after adjusting for age, sex, diabetes, hypertension, stroke, coronary artery disease, head injury, depression, systemic lupus erythematosus, brain tumor, and antidepressants usage (adjusted hazard ratio [aHR]: 1.30, 95% confidence interval [CI]: 1.17-1.45). Stratified by the presence of other risk factors, the relative risk was also greater for patients with (aHR: 1.25, 95% CI: 1.10-1.41) or without other risk factors (aHR: 1.68, 95% CI: 1.35-2.10) in the IBS cohort than for those in the non-IBS cohort. The age-specific relative risk of epilepsy in the IBS cohort was greater than that in the non-IBS cohort for both 35 to 49 age group and 50 to 64 age group (age ≤ 34, aHR:1.31, 95% CI: 0.93-1.85; age 35-49, aHR: 1.43, 95% CI: 1.12-1.83; age 50-64, aHR: 1.56, 95% CI: 1.27-1.91). However, there was no difference between patients > 65 years with IBS and those without IBS (aHR: 1.11, 95% CI: 0.94-1.31).This population-based cohort study revealed that IBS increases the risk of developing epilepsy. However, IBS may be less influential than other risk factors. Further study is necessary to clarify whether IBS is a risk factor or an epiphenomenon for epilepsy development.

Cognitive Functions and Depression in Patients with Irritable Bowel Syndrome

Background. Irritable bowel syndrome (IBS) is associated with depression and depression with impaired cognitive functions. The primary aim was to study associations between depression and cognitive functions in patients with IBS. Methods. IBS (according to the Rome III criteria), cognitive functions (evaluated with a set of neuropsychological tests), and depression (measured with Beck Depression Inventory II and Montgomery-Åsberg Depression Scale) were analysed in patients with idiopathic depression and in patients with unspecified neurological symptoms. Results. 18 and 48 patients with a mean age of 47 and 45 years were included in the "Depression" and "Neurological" group, respectively. In the "Depression" group, the degree of depression was significantly higher in patients with IBS than in those without. Depression was associated with impaired cognitive function in 6 out of 17 neuropsychological tests indicating reduced set shifting, verbal fluency, attention, and psychomotor speed. IBS was statistically significantly associated with depression but not with any of the tests for cognitive functions. Conclusions. IBS was associated with depression but not with impaired cognitive functions. Since the idiopathic depression was associated with cognitive deficits, the findings could indicate that the depression in patients with IBS differs from an idiopathic depression.