Psychosocial distress and somatic symptoms in community subjects with irritable bowel syndrome: a psychological component is the rule.
OBJECTIVE
Psychosocial factors may drive people with irritable bowel syndrome (IBS) to seek health care, but whether psychological factors are causally linked to IBS is controversial. One hypothesis is that IBS is a heterogeneous syndrome comprising two distinct conditions, one psychological and the other biological. However, it is unclear how many people with IBS in the community have little somatization and minimal psychosocial distress. The aim of our study was to estimate the proportion of people with IBS in a representative US community, who have low levels of somatic and psychological symptoms.


METHODS
The cohort comprised subjects from three randomly selected population studies from Olmsted County, Minnesota. All of them filled out a validated gastrointestinal (GI) symptom questionnaire, the Symptom Checklist-90-R (SCL-90-R), and the Somatic Symptom Checklist (SSC) comprising 11 somatic complaint items. Logistic regression models were used to evaluate the associations between somatic symptoms/psychosocial factors and IBS, adjusting for age and gender.


RESULTS
Of the 501 eligible subjects, 461 (92%) provided complete data (mean age=56 years, 49% female). IBS (Rome II criteria) was associated with both higher SSC and Global Severity Index (GSI of SCL-90-R) scores. Among subjects with high (75th percentile) SSC scores, 43% reported IBS vs. 10% of those with low (<25th percentile) SSC scores. Among those with high (60) GSI scores, 23% reported IBS vs. 6% with low (<40) GSI scores. Specifically, none of the IBS subjects had both low SSC and low GSI scores.


CONCLUSIONS
Psychological factors and somatization are strongly associated with IBS in the community. However, IBS may not be related to low psychological distress and/or somatization.
Choung
Rok Seon
RS
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, USA.
Locke
G Richard
GR
Zinsmeister
Alan R
AR
Schleck
Cathy D
CD
Talley
Nicholas J
NJ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011336:Probability; D011569:Psychiatric Status Rating Scales; D011584:Psychology; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018434:Sickness Impact Profile; D013001:Somatoform Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires