title: Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus.
abstract: OBJECTIVE
  Gastrointestinal (GI) symptoms are common in patients with long-standing diabetes mellitus, but the pathogenesis is controversial. We aimed to determine if GI symptoms are linked to psychological distress in diabetes.
  
  
  METHODS
  A consecutive sample of outpatients with diabetes mellitus (n = 209) and a random sample of community diabetics (n = 892) completed a validated questionnaire measuring GI symptoms, the Hospital Anxiety and Depression (HAD) Scale for anxiety and depression, and the Eysenck short neuroticism scale.
  
  
  RESULTS
  Overall, 42% reported one or more GI symptoms: bloating, abdominal pain, loose stools, and urgency were most common. The mean HAD and neuroticism scores were significantly higher for most GI symptoms (11 of 14, all p < 0.05), and a dose-response relationship was observed. GI symptoms were, in general, approximately twice as frequent in cases with anxiety or depression (HAD > or = 11). Anxiety, depression, and neuroticism were each independently associated with the number of GI symptoms, adjusting for age, gender, duration and type of diabetes, and self-reported glycemic control.
  
  
  CONCLUSIONS
  Increased levels of state anxiety and depression and neuroticism are associated with upper and lower GI symptoms in diabetes mellitus. It is uncertain whether psychological distress is causally linked to symptoms, or whether GI symptoms per se increase levels of anxiety and depression.
authors.affiliation: Department of Medicine, University of Sydney, Nepean Hospital, NSW, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Talley
authors.forename: P
authors.initials: P
authors.lastname: Bytzer
authors.forename: J
authors.initials: J
authors.lastname: Hammer
authors.forename: L
authors.initials: L
authors.lastname: Young
authors.forename: M
authors.initials: M
authors.lastname: Jones
authors.forename: M
authors.initials: M
authors.lastname: Horowitz
mesh_terms: D001007:Anxiety / Q000150:complications; D003863:Depression / Q000150:complications; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009497:Neurotic Disorders / Q000150:complications; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires