title: Why do subjects with irritable bowel syndrome seek health care for their symptoms?
abstract: OBJECTIVE
  Irritable bowel syndrome (IBS) is common in the population, but not all subjects seek professional health care for their symptoms. The aim of this study was to compare consulters in secondary/tertiary care with those in primary care and non-consulters by using questionnaires to investigate factors of importance for health-care seeking in IBS.
  
  
  METHODS
  The study included 218 subjects with IBS: 70 non-consulters, 53 patients from primary care and 95 from secondary/tertiary care. The subjects completed questionnaires on gastrointestinal (GI) and psychological symptoms, coping resources, health-related quality of life (HRQOL) and reasons for not seeking health care.
  
  
  RESULTS
  Consulters (primary and secondary/tertiary care combined) had poorer HRQOL, more severe psychological symptoms, higher levels of GI-specific anxiety and poor coping resources compared with non-consulters, but the GI symptom severity was similar. Mental health and poor social, emotional and physical functioning were independently predictive of being a health-care seeker (r (2)=0.41). Independent predictors for being a consulter in secondary/tertiary care were a high degree of anxiety, low scores on physical functioning, physical role and food (IBSQOL) (r (2)=0.65). Several non-consulters reported mild symptoms and ability to control symptoms as reasons for not seeking health care. Having a close relative with similar symptoms reduced the need to seek health care. Thirty-six non-consulters had sought alternative care or advice from friends and/or relatives about their GI symptoms.
  
  
  CONCLUSIONS
  GI symptom severity alone cannot explain the illness behavior in IBS. HRQOL and psychological symptoms are important for experience of GI symptoms and the health-care seeking pattern in IBS.
authors.affiliation: Department of Internal Medicine, Section of Gastroenterology & Hepatology, Sahlgrenska University Hospital, Göteborg, Sweden. gisela.ringstrom@vgregion.se
authors.forename: Gisela
authors.initials: G
authors.lastname: Ringström
authors.forename: Hasse
authors.initials: H
authors.lastname: Abrahamsson
authors.forename: Hans
authors.initials: H
authors.lastname: Strid
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D017668:Age of Onset; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000145:classification / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010821:Physicians, Family; D011788:Quality of Life; D011795:Surveys and Questionnaires