Effects of Psychology and Extragastrointestinal Symptoms on Health Care Use by Subjects With and Without Irritable Bowel Syndrome

David T McNaughton; Anna Andreasson; Brjánn Ljótsson; Alissa P Beath; Julia M Hush; Nicholas J Talley; Gunnar Ljunggren; Peter T Schmidt; Lars Agréus; Michael P Jones

doi:10.1016/j.cgh.2019.07.019

Effects of Psychology and Extragastrointestinal Symptoms on Health Care Use by Subjects With and Without Irritable Bowel Syndrome

Clin Gastroenterol Hepatol. 2020 Apr;18(4):847-854.e1. doi: 10.1016/j.cgh.2019.07.019. Epub 2019 Jul 16.

Authors

Affiliations

¹ Department of Psychology, Macquarie University, Sydney, NSW, Australia.
² Department of Psychology, Macquarie University, Sydney, NSW, Australia; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
³ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Health Professions, Macquarie University, Sydney, NSW, Australia.
⁵ Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
⁶ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden.
⁷ Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
⁸ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
⁹ Department of Psychology, Macquarie University, Sydney, NSW, Australia. Electronic address: mike.jones@mq.edu.au.

PMID: 31323378
DOI: 10.1016/j.cgh.2019.07.019

Abstract

Background & aims: There is controversy about whether psychological factors (anxiety and depression) increase health care seeking by patients with irritable bowel syndrome (IBS). We investigated whether psychological factors increase health care seeking by patients with IBS and the effects of extragastrointestinal (extra-GI) symptoms.

Methods: We performed a population-based prospective study of health care use over a 12-year period in Sweden. From 2002 through 2006, 1244 subjects were selected randomly for an examination by a gastroenterologist and to complete questionnaires, including the Rome II modular questionnaire. Psychological factors were measured with the valid Hospital Anxiety and Depression scale and extra-GI symptoms were measured with a symptom checklist. Responses from 1159 subjects (57% female; mean age, 48.65 y) were matched with health records in 2016 (164 were classified as having IBS based on Rome II criteria).

Results: The overall association between depression or anxiety and health care use varied in subjects with and without IBS at baseline. The presence of extra-GI symptoms strengthened the relationship between anxiety and depression and prospective psychiatric visits for subjects with IBS and without IBS (incidence rate ratio, 1.14-1.26). Extra-GI symptoms did not alter the association of anxiety or depression with use of GI or extra-GI health care.

Conclusions: In a population-based study in Sweden, we found that individuals with high baseline anxiety or depression were more likely to seek psychiatric health care, but not GI or extra-GI health care, in the presence of extra-GI symptoms at baseline. Patients with IBS might benefit from more thorough assessments that examine extra-GI and psychological symptoms, to reduce health care utilization.

Keywords: Epidemiology; Functional Gastrointestinal Disorders; Moderation; Somatic Symptoms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety / epidemiology
Female
Humans
Irritable Bowel Syndrome* / epidemiology
Male
Middle Aged
Patient Acceptance of Health Care
Prospective Studies
Surveys and Questionnaires