Abstract
Background>Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls.MethodsGastrointestinal symptoms were assessed with the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS). Depressive symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale- Self assessment (MADRS-S). Trait anxiety was estimated with three of the Swedish universities of Personality (SSP) scales: Somatic trait anxiety, Psychic trait anxiety and Stress susceptibility. Self-ratings were collected from 491 young adult psychiatric outpatients and 85 healthy controls. Gastrointestinal symptom severity was compared between patients with and without current psychotropic medication and controls. Associations between gastrointestinal symptoms, depressive symptoms and trait anxiety were assessed using Spearman’s coefficients and generalized linear models adjusting for possible confounders (sex, body mass index, bulimia nervosa).ResultsPatients, with and without current psychotropic medication, reported significantly more gastrointestinal symptoms than controls. In the generalized linear models, total MADRS-S score (p < 0.001), Somatic trait anxiety (p < 0.001), Psychic trait anxiety (p = 0.002) and Stress susceptibility (p = 0.002) were independent predictors of the total GSRS-IBS score. Further exploratory analysis using unsupervised learning revealed a diverse spectrum of symptoms that clustered into six groups.ConclusionGastrointestinal symptoms are both highly prevalent and diverse in young adult psychiatric outpatients, regardless of current psychotropic medication. Depressive symptom severity and degree of trait anxiety are independently related to the total gastrointestinal symptom burden.
Highlights
The GI tract and the brain are intimately connected via bidirectional neural, endocrine and immune pathways, commonly referred to as the gut-brain axis (GBA) [1]
We aimed to i) compare the severity of gastrointestinal symptoms between psychiatric patients and healthy controls and between patients with and without current psychotropic medication, ii) investigate whether gastrointestinal symptom burden is related to depressive symptom severity and iii) explore the role of trait anxiety in this context
The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008
Summary
The GI tract and the brain are intimately connected via bidirectional neural, endocrine and immune pathways, commonly referred to as the gut-brain axis (GBA) [1]. This complex communication system ensures GI homeostasis and influences motivation and higher cognitive functions. Psychiatric co-morbidity is high in patients with FGIDs, suggesting shared or interacting disease mechanisms, possibly related to the proposed communication between the gut and brain, in which variations of the intestinal microbiome may play an essential role [4, 5]. A model is emerging where uncontrolled sympathetic and poor vagus control interacts with the microbiome and immune system to predispose individuals for psychiatric and gastrointestinal disease [7, 8]
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