Comorbid Depression, Not Symptom Severity or Disease-Specific Quality of Life, Predicts Work Absenteeism in Chronic Constipation

Abstract

Introduction: Chronic constipation is common and has a considerable economic impact. Little is known about the effect of constipation on workplace productivity, specifically employee absenteeism. We sought to determine whether there is an association between clinical features, symptom severity, and comorbid conditions in constipation and employee absenteeism. Methods: We enrolled consecutive patients referred to our center for anorectal manometry (ARM) in the setting of chronic constipation. Patients completed validated constipation-specific questionnaires on symptom severity (PAC-SYM) and constipation-related quality of life (CR-QOL) as well as the Hospital Anxiety and Depression Score inventory (HADS) and the Patient Health Questionnaire 15 (PHQ-15), a measure of somatization. Additionally, patients completed a Rome III constipation questionnaire to determine Rome diagnosis and were asked about missed work days due to constipation symptoms occurring in the last year before enrollment. Multivariable ordinal logistic regression adjusting for confounders defined independent effect of measures of constipation severity and QOL, comorbidities, and demographics on work absenteeism. Results: Our study enrolled 114 patients referred for evaluation of chronic constipation, of whom 68 (59.6%) were employed, 18 (15.8%) were unemployed, 8 (7.0%) were students, and 20 (17.5%) were retired. Of the 75 patients who were employed or students with data on absenteeism (90.7% female, mean age 42.5, 13.3% functional constipation, 42.7% IBS, 44% no Rome diagnosis), 45 (60.0%) did not miss any work or school due to constipation symptoms, 16 (21.3%) missed 30 days (Figure 1). On univariate analysis, depression (P=0.0001), CR-QOL (P=0.0002), anxiety (P=0.003), and PAC-SYM (P=0.006) were all correlated with increased work or school absenteeism (Table 1). After multivariate adjustment, only depression remained an independent predictor of work/school absenteeism (OR=1.24, P=0.01).Figure 1Table 1: Correlations between patient parameters and work/school absenteeismConclusion: Among patients presenting for evaluation of chronic constipation, depression, rather than symptom severity or constipation-related quality of life, predicts work/school absenteeism. Providers should consider screening patients presenting with constipation for depression, which may affect treatment modalities offered.