title: Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C.
abstract: BACKGROUND
  In independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources.
  
  
  METHODS
  Overall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed).
  
  
  RESULTS
  Each of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population.
  
  
  CONCLUSIONS
  Patients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, The Alfred, Level 3, Burnet Tower, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
authors.forename: Antonina A
authors.initials: AA
authors.lastname: Mikocka-Walus
authors.affiliation: School of Psychology, University of Adelaide, Level 4, Hughes Building, Adelaide 5005, SA, Australia.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Turnbull
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Andrews
authors.affiliation: School of Social Work and Social Policy, University of South Australia, Magill Campus, H1-32, Magill 5068, SA, Australia.
authors.forename: Nicole T
authors.initials: NT
authors.lastname: Moulding
authors.affiliation: School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith South DC NSW 1797, Australia.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Wilson
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia.
authors.forename: Hugh Aj
authors.initials: HA
authors.lastname: Harley
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hetzel
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Holtmann