title: A prospective study evaluating emotional disturbance in subjects undergoing defecating proctography.
abstract: OBJECTIVE
  To investigate the prevalence of psychiatric illness in association with functional gastrointestinal disorders using defecating proctography (DP) and validated questionnaires.
  
  
  METHODS
  We prospectively evaluated 45 subjects referred for DP using hospital anxiety and depression scale (HADS), state trait anxiety inventory (STAI), patient health questionnaire 15-item somatic symptom severity scale (PHQ-15), validated questionnaires for sexual or physical abuse; post-traumatic stress disorder questionnaire (PTSD) and ROME-III questionnaires for gastrointestinal complaints. DP results were considered negative if levator ani function was normal, rectoceles (if any) were < 4 cm and there was no evidence of intussusception, rectal prolapse, or other anatomic abnormality demonstrated. Subjects were subsequently divided into those with structural defects seen on DP (DP positive group) and those with a normal defecography study (DP negative group).
  
  
  RESULTS
  Forty five subjects were included in the study of which 20 subjects were classified as DP negative (44.4%). There was a striking prevalence of a history of sexual abuse in DP negative group compared to the DP positive group (n = 9, 5 respectively; P = 0.036). Further, subjects in the DP negative group scored significantly higher on the HADS anxiety (6.60 ± 1.00 vs 4.72 ± 0.40, P = 0.04) and depression scales (5.72 ± 1.00 vs 3.25 ± 0.46, P = 0.01). This correlated well with significantly higher scores on the STAI state anxiety scale (42.75 ± 3.16 vs 35.6 ± 2.00, P = 0.027), PHQ-15 questionnaire (13.15 ± 0.82 vs 10.76 ± 0.97, P = 0.038) and prevalence of PTSD (20% vs 4%, P = 0.045) among DP negative subjects. There was no difference between the groups in terms of STAI trait anxiety.
  
  
  CONCLUSIONS
  The findings of this prospective study demonstrate a significantly high degree of psychiatric ailments in patients with negative findings on DP who should be appropriately screened for a history of sexual abuse and symptoms of psychosocial distress.
authors.affiliation: Department of Medicine, Washington Hospital Center, Washington, DC 20010, United States.
authors.forename: Amit S
authors.initials: AS
authors.lastname: Kashyap
authors.forename: Divyanshoo R
authors.initials: DR
authors.lastname: Kohli
authors.forename: Arnold
authors.initials: A
authors.lastname: Raizon
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Olden
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003107:Colorectal Surgery / Q000379:methods*; D003248:Constipation / Q000503:physiopathology* / Q000523:psychology*; D019841:Defecography / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011584:Psychology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012742:Sex Offenses / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Defecating proctography; Functional gastrointestinal disorders; Post-traumatic stress disorder questionnaire; Sexual abuse