Systematic Review With Meta-analysis

The Prevalence of Anxiety and Depression in Patients With Irritable Bowel Syndrome

Mohammad Zamani; Shaghayegh Alizadeh-Tabari; Vahid Zamani

Disclosures

Aliment Pharmacol Ther. 2019;50(2):132-143. 

In This Article

Abstract and Introduction

Abstract

Background: Irritable bowel syndrome (IBS) is a common and potential disabling functional gastrointestinal disorder. Studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Existing systematic reviews have addressed only the levels of anxiety or depression in patients with IBS.

Aim: To investigate systematically the prevalence of anxiety or depression in IBS patients

Methods: A literature search was conducted using the related keywords from the bibliographic databases of Embase, PubMed, Scopus, Web of Science and POPLINE published until 1 January 2019 with no language restriction. Studies reporting the prevalence of anxiety/depressive symptoms/disorders in adult (≥15 years) IBS patients were evaluated. The pooled prevalence, odds ratio (OR) and 95% CI were calculated using STATA software.

Results: A total of 14 926 articles were initially screened, and finally 73 papers were included. The prevalence rates of anxiety symptoms and disorders in IBS patients were 39.1% (95% CI: 32.4-45.8) and 23% (95% CI: 17.2-28.8) respectively. The ORs for anxiety symptoms and disorders in IBS patients compared with healthy subjects were 3.11 (95% CI: 2.43-3.98) and 2.52 (95% CI: 1.99-3.20) respectively. The prevalence estimates of depressive symptoms and disorders in IBS patients were 28.8% (95% CI: 23.6-34) and 23.3% (95% CI: 17.2-29.4) respectively. The ORs for depressive symptoms and disorders in IBS patients compared to healthy subjects were 3.04 (95% CI: 2.37-3.91) and 2.72 (95% CI: 2.45-3.02) respectively.

Conclusion: Patients with IBS have a three-fold increased odds of either anxiety or depression, compared to healthy subjects.

Introduction

Irritable bowel syndrome (IBS) is a prevalent, costly and potentially disabling functional gastrointestinal disorder that presents with abdominal pain accompanied by constipation, diarrhoea and/or bloating.[1] The global prevalence of IBS has been estimated to be 11.2%, but regionally it varies between 1.1% and 45% of the general population,[2] and can impose a major cost burden on the healthcare services and society.[3,4]

The evidence show that IBS is associated with poor quality of life and impaired social function, and some studies also allude to its association with psychological-psychiatric conditions, such as anxiety and depression. Major psychosocial problems have been reported to be observed in 50%-60% of IBS patients.[5,6] Some papers stated that about 20%-40% of IBS patients present with depressive symptoms.[7] Recent meta-analyses showed that the levels of anxiety and depression were significantly higher in IBS patients compared with healthy controls,[7–9] but no meta-analysis exists revealing the prevalence rates of anxiety or depression in IBS patients compared with controls. "Levels" of psychiatric comorbidities in IBS patients do not provide clinical guidance, but only show that the "severity" of the problem is higher or lower than controls. To facilitate early detection and plan appropriate strategies for allocating health care resources and better management of a disease, physicians need to be aware of its "prevalence."

IBS patients who suffer from psychological comorbidities are expected to be at high risk of personal suffering, impaired social function, decreased treatment adherence, poor quality of life and increased risk of suicidal behaviour.[10–12] Therefore, it should be helpful to understand precisely the status of psychiatric problems in patients with IBS. Considering that no systematic analysis exists in this regard, we aimed to perform a comprehensive systematic review and meta-analysis on the prevalence of anxiety and depression in patients with IBS. In the next step, we tried to compare the data between IBS patients and non-IBS healthy controls to assess any potential association between the psychiatric problems and IBS. These data should help better understand and manage patients with IBS, and its psychological comorbidities.

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