McNaughton DT¹, Andreasson A², Ljótsson B³, Beath AP¹, Hush JM⁴, Talley NJ⁵, Ljunggren G⁶, Schmidt PT⁷, Agréus L⁸, Jones MP⁹. Clin Gastroenterol Hepatol. 2019 Jul 16. pii: S1542-3565(19)30752-9. doi: 10.1016/j.cgh.2019.07.019. [Epub ahead of print]

Author information

1 Department of Psychology, Macquarie University, Sydney, Australia.

2 Department of Psychology, Macquarie University, Sydney, Australia; Stress Research Institute, Stockholm University; Department of Medicine Solna, Karolinska Institutet.

3 Department of Clinical Neuroscience, Karolinska Institutet.

4 Department of Health Professions, Macquarie University, Sydney, 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, Huddinge, Sweden; Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden.

7 Department of Medicine Solna, Karolinska Institutet.

8 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.

9 Department of Psychology, Macquarie University, Sydney, Australia. Electronic address: mike.jones@mq.edu.au.

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.