The association of irritable bowel syndrome complaints and psychological distress

Introduction: Irritable bowel syndrome (IBS) is a chronic gastro-intestinal disorder with complaints such as abdominal pain, diarrhea or constipation. IBS has a significant negative impact on quality of life, mood and wellbeing. Research has pointed at the involvement of depression, anxiety and stress in the development of IBS symptoms. However, much remains unclear about the relationship between IBS and psychological distress. Aim: The aim of this study was to investigate the association between IBS complaints and depression, anxiety and stress. Methods: Dutch university students, aged 18 to 30 years old, were invited to complete an online survey. The presence and severity of IBS complaints was determined with the Birmingham IBS Questionnaire. This questionnaire includes 11-items that can be rated on a 6-point Likert scale, ranging from 0 (‘none of the time) to 5 (‘all of the time’). A higher total IBS score indicates a greater likelihood of the diagnosis IBS. The questionnaire further consists of three symptom specific scales (diarrhea, constipation, abdominal pain). A higher scale score implies more complaints. Psychological distress was assessed with the Depression Anxiety Stress Scale (DASS). The shortened DASS-21 includes 21 items, which can be divided in subscales for depression, anxiety and stress. Each item is rated on a 4-point Likert scale, ranging from 0 (‘did not apply to them at all’) to 4 (‘apply to them very much, or most of the time’). Higher scores on the DASS reflect a higher degree of severity of depression, anxiety or stress complaints. Nonparametric Spearman's rho correlations were computed to investigate the association between IBS, depression, anxiety and stress. Results: Data from N = 1950 students were included in the analyses (83.6% women). IBS scores were significantly associated with DASS scores of depression (r = 0.239, p = 0.0001), anxiety (r = 0.316, p = 0.0001), and stress (r = 0.336, p = 0.0001). Similar significant correlations were observed for the three IBS subscales, of which those with the abdominal pain subscale was most strong. IBS – constipation complaints were significantly (p