Psychiatric Morbidity and Quality of Life of Outpatients with Irritable Bowel Syndrome

Introduction Irritable bowel syndrome (IBS) is the commonest functional disorder of the gastrointestinal tract. It is characterised by changes in bowel habits and the presence of abdominal pain. The prevalence of IBS in the Hong Kong Chinese community ranges from 3.7 to 6.6%. (1-3) Psychiatric morbidity is prevalent in outpatients with IBS. The lifetime prevalence of depressive and anxiety disorders is up to 76% and 54% respectively. (4,5) The point prevalences of depressive and anxiety disorders range from 9.6 to 54% and from 1 11.1 to 52.4% respectively 1.1 respectively. (4-14) Though IBS is not usually life-threatening, it has a significant impact on quality of life. Reports indicate that the quality of life for people with IBS is lower than that of the general healthy population, and that of patients with other chronic diseases such as gastro-oesophageal reflux and diabetes. (15-17) In a local population-based survey, men with IBS were found to have significantly lower vitality scores in the 36-short form (SF-36) scale than the controls and women with IBS had significantly lower mental health scores than the controls. 3 Another study found that a significantly higher proportion of IBS subjects (22% versus 6%, p In Hong Kong, the prevalence of psychiatric disorders in outpatients with IBS has not been studied. Previous local studies concerning quality of life mainly targeted on the community samples. The quality of life of IBS outpatients is still to be determined. As understanding of the prevalence of psychiatric morbidity in IBS outpatients can shed light on the integration of medical and psychiatric care, empirical studies on local IBS subjects are clearly warranted. This study focused on the prevalence of psychiatric disorders and quality of life in local IBS outpatients. Methods Using a cross-sectional design, data were collected from 1 March 2008 to 31 August 2008. Subjects with IBS were identified by their attending gastroenterologists using the Rome III diagnostic criteria for IBS. (18) Each was classified into 1 of 4 subtypes: IBS with constipation, IBS with diarrhoea (IBS-D), mixed IBS, or unsubtyped IBS. Recruitment criteria were: being aged from 18 to 65 years and being able to give written informed consent. People with intellectual disabilities, mental retardation, dementia, or severe deficits in comprehension were excluded. All the people with IBS were recruited consecutively from 2 gastroenterology clinics at the Prince of Wales ales Hospital (PWH) and the Alice Ho Miu Ling Nethersole Hospital (AHNH). Clinical notes were reviewed for verification of the socio-demographic and clinical data. Ethical approval was obtained from the Clinical Research Ethics Committee of the Chinese University of Hong Kong and the New Territories East Cluster. Data Collection Socio-demographic data, clinical characteristics of the IBS, and medical and psychiatric history were recorded. The socio-demographic data included age, sex, current occupation, monthly family income, number of years of education, and marital status. The clinical characteristic of the IBS included the age of onset, duration of the illness, and any family history of IBS. Clinical notes were reviewed for past and current treatment for IBS. Any history of other significant physical illnesses was recorded. The psychiatric history was explored--including any history of outpatient or inpatient treatment; any consultations with psychiatrists, clinical psychologists or general practitioners; any current use of psychotropic medications; and any family history of mental illness. Assessment Tools After reading the appropriate manuals and watching the training video tapes, the first author administered the Chinese-Bilingual Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders--4th Edition, Axis I, Patient version (CB-SCID-I/P). …