title: The impact of abuse and mood on bowel symptoms and health-related quality of life in irritable bowel syndrome (IBS).
abstract: BACKGROUND
  Irritable bowel syndrome (IBS) is a common abdominal pain disorder without an organic explanation. Abuse histories (physical, sexual, emotional) are prevalent in IBS. While abuse relates to mood disorders (depression and anxiety) also common in IBS, the influence of abuse on gastrointestinal (GI) symptoms and health-related quality of life (HRQOL) and its independence from psychological symptom comorbidity has not been studied.
  
  
  METHODS
  Consecutive GI outpatients completed the ROME III Research Diagnostic Questionnaire and questionnaires on trauma (Life-Stress Questionnaire), mood (Beck Depression/Anxiety Inventories), somatic symptoms (PHQ-12), and HRQOL (SF-36). Current GI symptom severity and bother were assessed using 10-cm Visual Analog Scales.
  
  
  RESULTS
  272 ROME-defined IBS (47.6 ± 0.9 years, 81% female) and 246 non-FGID (51.6 ± 1.0 years, 65% female) subjects participated. IBS patients reported greater rates of physical, sexual, and emotional abuse (p < 0.006 each), and higher depression, anxiety, and somatic symptoms (p < 0.001). Greater bowel symptom bother (7.4 ± 0.2 vs 6.7 ± 0.2, p = 0.040), severity (7.7 ± 0.2 vs 6.5 ± 0.2, p < 0.001), recent symptomatic days (9.8 ± 0.4 vs 8.5 ± 0.3, p = 0.02), and poorer HRQOL (40.9 ± 2.3 vs 55.5 ± 1.7, p < 0.001) were noted in IBS with abuse. Abuse effects were additive, with greater IBS symptom severity and poorer HRQOL noted in cases with multiple forms of abuse. Mediation analyses suggested that abuse effects on GI symptoms and HRQOL were partially mediated by mood.
  
  
  CONCLUSIONS
  Abuse experiences common among IBS sufferers are associated with reports of greater GI symptoms and poorer HRQOL, particularly in those with multiple forms of abuse; this relationship may be partially mediated by concomitant mood disturbances.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: N
authors.initials: N
authors.lastname: Kanuri
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: B
authors.initials: B
authors.lastname: Cassell
authors.affiliation: Center for Trauma Recovery, University of Missouri-St. Louis, St. Louis, MO, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Bruce
authors.affiliation: Center for Trauma Recovery, University of Missouri-St. Louis, St. Louis, MO, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: White
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Gott
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Gyawali
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA. gsayuk@dom.wustl.edu.|Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA. gsayuk@dom.wustl.edu.|Gastroenterology Section, John Cochran Veterans Affairs Medical Center, St. Louis, MO, USA. gsayuk@dom.wustl.edu.
authors.forename: G S
authors.initials: GS
authors.lastname: Sayuk
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D000066550:Physical Abuse / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012742:Sex Offenses / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: abuse; depression; health-related quality of life; irritable bowel syndrome