The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis

Zhichao Hu,Yinshu Wang,Meixuan Li,Linda L D Zhong,Enkang Wang,Fengyun Wang,Zhaoxiang Bian,Jianye Yuan,Kehu Yang,Liang Yao

doi:10.1186/s12876-020-01593-5

Abstract

BackgroundIrritable bowel syndrome (IBS) is a very common functional bowel disorder. However, the difference of depression and anxiety comorbidities among different IBS subtypes is still not well evaluated. This study aims to investigate the difference in the level and prevalence of depression and anxiety among healthy controls and patients with different subtypes of IBS.MethodsPubMed, EMBASE and the Cochrane library were searched systematically until August 17, 2020. Studies that investigated depression and/or anxiety levels or prevalence among different IBS-subtype patients measured at baseline or the same point were included. Network meta-analysis was conducted to analyze standardized mean difference (SMD) of anxiety and depression levels, and single arm meta-analysis was performed for prevalence of anxiety and depression among different IBS subtypes.ResultsEighteen studies involving 7095 participants were included. Network meta-analyses results showed healthy controls had a lower level of depression than IBS with mixed symptoms of constipation and diarrhea (IBS-M) [SMD = − 1.57; 95% confidence interval (CI) − 2.21, − 0.92], IBS with constipation (IBS-C) (SMD = − 1.53; 95% CI − 2.13, − 0.93) and IBS with diarrhea (IBS-D)(SMD = − 1.41; 95% CI − 1.97, − 0.85), while no significant difference was found between IBS unclassified (IBS-U) and healthy controls (SMD = − 0.58; 95% CI − 2.15, 1.00). There was also no significant difference in the level of depression among different IBS subtypes patients. The results of anxiety were similar to depression. Ranking probability showed that IBS-M was associated with the highest level of depression and anxiety symptoms, followed by IBS-C/IBS-D and IBS-U. Single-arm meta-analysis showed IBS-C had the highest prevalence of depression (38%) and anxiety (40%), followed by IBS-D, IBS-M and IBS-U.ConclusionThe results indicated that IBS-M was more likely to be associated with a higher level of depression and anxiety, and the prevalence of depression and anxiety in IBS-C was highest. The psychological screening and appropriate psychotherapy are needed for patients with IBS-C, IBS-D and IBS-M instead of IBS-U.

Highlights

Irritable bowel syndrome (IBS) is a very common functional bowel disorder
Direct pairwise random-effects meta-analyses showed healthy controls had a lower level depression than IBS-M (SMD = − 1.63; 95% confidence interval (CI) − 2.48, − 0.79; P < 0.05), IBS with constipation (IBS-C) (SMD = − 1.67; 95% CI − 2.45, − 0.89; P < 0.05) and IBS with diarrhea (IBS-D) (SMD = − 1.59; 95% CI − 2.18, − 0.99; P < 0.05), while no significant difference was found between IBS unclassified (IBS-U)
The results of the network analysis showed healthy controls had a lower level depression than IBS-M (SMD = − 1.57; 95% CI − 2.21, − 0.92; P < 0.05), IBS-C (SMD = − 1.53; 95% CI − 2.13, − 0.93; P < 0.05) and IBS-D (SMD = − 1.41; 95% CI − 1.97, − 0.85; P < 0.05), while no significant difference was found between IBS-U and healthy controls (SMD = − 0.58; 95% CI − 2.15, 1.00; P > 0.05)

Summary

Introduction

Irritable bowel syndrome (IBS) is a very common functional bowel disorder. The difference of depression and anxiety comorbidities among different IBS subtypes is still not well evaluated. This study aims to investigate the difference in the level and prevalence of depression and anxiety among healthy controls and patients with different subtypes of IBS. Irritable bowel syndrome (IBS) is a prevalent, costly and potentially disabling functional bowel disorder characterized by recurrent abdominal pain or changes in bowel habits [1]. According to a clinic-based study, the prevalence of depression and anxiety in irritable bowel syndrome patients is 37.1 and 31.4% respectively [8]. “Biopsychosocial Conceptual Model” and “Multi-Dimensional Clinical Profile” are emphasized according to the Rome IV criteria, showing that psychosocial factors and physiology states influence the presentation of functional gastrointestinal disorders (FGIDs). As for the biopsychosocial aspects, complex factors such as environmental, psychological and biological factors interactively play an important role in the development and maintenance of FGIDs [9, 10]

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