Journal of Science and today's world 2013, volume 2, issue 5, pages: Mental Health Levels in IBS, IBD and Healthy People: a Comparative Study

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1 Scholar Journal Available online: Journal of Science and today's world ISSN X Research Article Mental Health Levels in IBS, IBD and Healthy People: a Comparative Study Majid Mahvi-Shirazi 1, Ebrahim Ahmadi 1, Masoumeh Shir Ali 2 1 Department of Psychology, Buinzahra Branch, Islamic Azad University, Buinzahra, Iran 2 Department of English Language, Buinzahra Branch, Islamic Azad University, Buinzahra, Iran Received: 10 January 2013 / Accepted: 24 May 2013 / Published: 29 May 2013 Copyright 2013 Majid Mahvi-Shirazi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Irritable bowel syndrome (IBS) is one of the most common disorders of digestive system, which is more connected to socio-psychosocial factors than the other digestive system disorders like inflammatory bowel disease (IBD). As a matter of fact, this study has been conducted with the aim to compare the mental health levels of patients suffering from IBS and IBD and healthy people. In the current research, the first population includes all patients who referred to Baqiyatallah Hospital in Tehran and diagnosed with above diseases during The second population group includes employed healthy people and healthy attendants of digestive patients referring to the same hospital during the same period of time. The proposed sample comprised of 90 people (30 with IBS, 30 with IBD and 30 healthy persons). Sampling was made through first-hand information and data collection devices including ROME-II scale and psychological symptoms checklist (SCL-90-R) as well as demographic information Correspondence should be addressed to Majid Mahvi-Shirazi, Department of Psychology, Buinzahra Branch, Islamic Azad University, Buinzahra, Iran; mshitu7357@gmail.com. 549 P a g e

2 questionnaires. The acquired data were analyzed through the mean, standard deviation and analysis of one-way variance (ANOVA). The results showed that the mental health levels in IBS patients, in all aspects, were lower than those of IBD patients or healthy persons. But mental health level of IBS patients was insignificant in half of the aspects in comparison with IBD patients. Comparative analysis of IBS and IBD patients also showed significant difference (p<0.01) so far as scales of somatization, anxiety, phobia and psychosis are concerned. The results acquired from comparison of mental health levels in IBS patients and normal individuals also showed a significant difference (p<0.01) in all aspects except in paranoid thoughts. It seems that the lower levels of mental health in IBS patients on one hand, indicates the role of psychological factors in developing this disease, on the other it shows the need of psychological treatments including behavioral - cognitive treatments. Keywords: Mental health, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) 1. Introduction Irritable bowel syndrome (IBS) is a functional disorder of digestive system that is diagnosed clinically with symptoms like change in bowel movement, pain and feeling of abdomen distention. Being prevalent in about 10 to 20 percent of the general population, it is considered to be the most common digestive disorder, and is more linked to psychosocial factors in comparison with other digestive disturbances like inflammatory bowel disease (IBD). IBS is a problem that mainly involves the colon (that is a part of digestive system), which produces and stores the feces. IBS causes obstruction, belching, passing gas, diarrhea and constipation. On the other hand, IBD is an inflammatory disease of the bowel that includes chronic inflammatory disorders with unknown cause involving digestive system and is divided into two groups of ulcerative colitis and chrown disease, which manifest with signs and symptoms like bloody diarrhea, fever, abdominal pain, weight loss and else. Relapse of disease in spite of surgery is common among patients with inflammatory bowel disease and although they live normal lives, they generally have shorter life-span. Some studies show that IBS becomes severe with some aggravating psychological factors like anxiety, mood disorders, depression, and tensions arising from neurological stimulations. Therefore, mental levels of IBS patients involve particular specialties. It also seems that irritable bowel syndrome has a direct relation with anxiety. In the light of the previous researches, it can be said that psychological and psychiatric disturbances are more common in IBS patients and these variables play significant roles in increasing and decreasing the signs of this syndrome. The available information shows that psychological disturbances probably contribute in developing this syndrome to a greater extent than what has already been proved. And according to recent studies, 50 to 90 percent of patients with irritable bowel syndrome have experienced on of the psychological factors like major depression disorder (MDD), somatization disorders and post-traumatic stress disorder (PTSD) throughout their lives [10]. Irritable bowel syndrome is remarkably associated with generalized anxiety disorder ( GAD 550 P a g e

3 ) and since a functional cerebro-intestinal intervention plays an important role in this syndrome and since the disturbances related to psychological factors are among the probable influential factors over cerebro-intestinal interactions, thus, these factors have been suggested as the probable causes of irritable bowel syndrome [3]. Nevertheless, in some studies, no cause and effect relationship has been found between psychosocial factors and progression of IBS [7]. In a survey on the evaluation and estimation of IBS in the age group of 18 to 45 years, effectiveness of drug therapy of irritable bowel syndrome in comparison with healthy people was investigated. The researcher distributed the questionnaires to 5000 samples randomly via post and 58 percent people responded to this questionnaire. The acquired results showed that 4.7 percent of men and 13.3 percent of women suffering from IBS and were under medical care showed more severe signs and symptoms. In general, the results revealed that IBS was associated with more psychological stresses and the patient's continually seeking treatment, showed more severe clinical signs and symptoms [1]. In another study, it was showed that 60 percent of IBS patients had psychological disorders including 29% depression and 19% anxiety. Of 29 patients showing abnormal endoscopic results, 9 had gastric ulcer disease and 21% psychological disorders, whereas, in patients with normal endoscopic findings, 74% had psychological disorders [2]. Yet in another survey of 321 IBS patients (238 women and 83 men), women showed considerably more signs of anxiety compared to men [13]. With regard to the previous studies, the present study has been conducted with the aim to evaluate health status of IBS patients and then compare with IBD patients and healthy people in Iran. 2. Materials and Methods This is a scientific-comparative study. The statistical population of the present study includes IBS and IBD patients referred to Baqiyatallah Hospital for digestive disorders during as well as healthy employed people. The second population includes employed healthy people and healthy attendants of digestive patients referred to the same hospital. With respect to standards (17-58 year age group, no experience of mental and bodily diseases) the present study selected 90 samples (30 with IBS, 30 with IBD and 30 healthy persons). Samples were selected by using the first-hand information and data collection devices including ROME-II scale and psychological symptoms checklist (SCL-90-R) as well as questionnaire based on demographic information. Based on clinical diagnostic criteria ROME-II questionnaire (IBS symptoms index) was prepared with the help of a gastroenterologist that includes questions related to the presence or the absence of IBS symptoms. A high score shows the severity of the disease. This questionnaire contains 14 yes/no questions, where a patient gets one point for each of the positive responses approved by a gastroenterologist. Rest of the questions is multiple choice and patients score one point if they choose a particular choice related to IBS. Finally, the collection of scores determines the severity of the disease. The higher the score is, the more probable the diagnosis and the severity of the IBS are. For instance, in the question 1 (Are you evaluating patient for IBS?), if the response is positive, the patient receives one point. Or in the question 4 (Is there any change in the appearance or the consistency of stool?), if the gastroenterologist 551 P a g e

4 approves it, the patient receives one point. It is noteworthy that ROME-II questionnaire must be filled by a gastroenterologist during the examination. The psychological symptoms checklist (SCL-90-R) contains 90 questions, which involve 9 different aspects of somatic complaints, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, aggression, phobia, paranoid thoughts and psychosis. Scoring and interpretation of the questionnaire are obtained on the basis of three co-efficient indexes: general symptom index (GSI), discomfort index and collective. The first draft of this questionnaire was introduced by Dragoits et al and was revised a decade later on the basis of clinical experiences and psychometric analysis [5, 6]. This questionnaire has been used repeatedly inside and outside the country and its reliability is 0.72 to 0.90 and its validity is between 0.36 and Further, its sensitivity, specificity and efficiency have been reported 94%, 98% and 96% respectively. The demographic questionnaire includes age, gender, occupation, education level, type of the disease diagnosed by a digestive system sub-specialist, treatment record, beginning of treatment and severity of signs and symptoms. The collected data were analyzed by using descriptive and inferential statistical indices like mean, standard deviation and analysis of one-way variance. 3. Results Of total 90 samples evaluated in the present study, 50 (55.6%) were women and 40 (44.4%) were men. Age-wise, 35 (38.9%) belong to 17 to 27 age group, 27 (30%) in 28 to 38 age group, 22 (24.4%) in 39 to 48 age group, and 6 (6.7%) in 49 to 58 age group. From occupation point of view, 38.9% of them were office employees. And from educational point of view, 38.9% were high school graduates (Table 1). 552 P a g e

5 Table 1. Demographic information of the evaluated samples Variables Frequency Percent Age 17 to 27 years to 38 years to 48 years to 58 years Gender Female Male Occupation Self employed Office employee Housekeeper Unemployed Retired Student Not answered Education Guidance's school (9th grade) High school Diploma Bachelor's degree Master's degree 9 10 Doctorate degree Not answered In order to determine the mental health levels in IBS and IBD patients as well as healthy people, one-way analysis of variance test was applied on the basis of psychological symptoms checklist (SCL-90-R). Table2. Analysis of variance to compare mental health in IBS and IBD patients and healthy people SCL-90-R scales Groups Mean Standard deviation Somatic 1. IBS complaints 2. IBD Healthy Obsessive- 1. IBS compulsive 2. IBD disorder 3. Healthy Interpersonal 1. IBS P a g e F Sig. Touky test results and 2 3

6 sensitivity 2. IBD and Healthy Depression 1. IBS IBD and Healthy Anxiety 1. IBS IBD and Healthy Aggression 1. IBS IBD and Healthy Phobia 1. IBS IBD and 3 3. Healthy Paranoid 1. IBS thoughts 2. IBD Healthy Psychosis 1. IBS IBD and 3 3. Healthy GSI 1. IBS IBD and Healthy Results of analysis of variance reveal significant differences between IBS and IBD patients and healthy people in all aspects except paranoid thoughts. Results of follow-along touky test also revealed significant differences in the mean sub-scale of somatic complains, anxiety, phobia and psychosis among IBS and IBD patients and healthy people. That is, the mean values of somatic complaints, anxiety, phobia and psychosis scales were higher in IBS patients than in IBD patients and normal subjects. Results of follow-along touky tests in IBS and IBD patients and healthy people also showed that the mean values for all items of the SCL-90-R, except paranoid thoughts, were higher in IBS patients compared to IBD patients and healthy people. 4. Discussion The present study showed that the psychosocial health levels were lower in IBS and IBD patients than the normal subjects e.g. mean depression index in IBS patients was 1.72, while the same index in IBD patients and normal subjects were 1.40 and 0.63 respectively. In respect with anxiety, the mean scores for IBS patients, IBD patients and normal subjects were 1.67, 1.11, and 554 P a g e

7 0.39 respectively. These results reveal that IBS patients suffer from anxiety and depression more than in IBD patients as well as normal subjects. However, it must be noted that among IBS and IBD patients in some aspects, differences are insignificant. Much of the above results have been observed in previous researches [16, 12, 17, 21, 15, 8, 9, 18]. As a whole, it seems these results indicate that IBS patients have shown much depression and agitation compare to IBD patients or normal people. According to Suny and Sping [17], all aspects of psychosocial disturbances in IBS patients are significantly higher than the control group (IBD patients) and it can result in this assumption that the psychosocial disturbances give rise to development of IBS signs and symptoms. Garakani and Wayne [8] suggest that 70 to 90 percent of IBS patients have mood disorders and anxiety, 29 percent are inflicted with major depression and 46 percent are involved with panic disorders. Hazleh and Grask [9] also suggest that IBS is associated with considerable anxiety and depression, which cause absenteeism of the patients from their work places. Further, in the somatic complaints and somatization perspective IBS patients showed higher complaints than IBD patients and normal subjects, with the mean scores 1.72, 1.25 and 0.58 respectively. This finding was in congruence with the research of Solmaz et al [16]. In respect with obsession, the mean scores for IBS, IBD patients and normal subjects were 1.71, 1.51 and 0.85 respectively. As the figures show, obsession mean score is also greater in IBS patients. No considerable research results were found in this regard. In respect with sensitivity in interpersonal relationship, the mean scores for three groups were 1.45, 1.27 and 0.72 respectively. This finding was in congruence with the research of Poulinger and Anderson; They suggest that the altered pattern of brain response to auditory stimulus in the affective stimulus processing areas indicates that processing of altered senses in IBS patients is not limited to visceral senses, rather can involve emotional sensitivities too, which is probably caused by psychological disturbances associated with IBS. In aggression dimension, the mean scores for IBS, IBD patients and normal subjects were 1.60, 1.31 and 0.57 respectively. In this relation, or finding was congruent with the research of Polusky. He suggested that the presence and severity of distinct and explicit aggressive behaviors are related with irritable bowel syndrome significantly. In respect with phobia, the mean scores for IBS, IBD patients and normal subjects were 1.01, 0.57 and 0.28 respectively. This finding was also in congruence with the research of Solmaz and Kavok [16]. They claimed that the prevalence of phobia was 2.5 percent in IBS patients and zero in both IBD patients and normal subjects. In relation with paranoid thoughts, the mean scores were 1.58, 1.38 and 1.17 respectively. It seems that IBS patients have more paranoid thoughts, although the related differences are not so great. So far, no considerable researches have been carried out in this regard. The mean scores reveal that normal subjects also do have some amounts of paranoid thoughts, which indicates the essence of more serious researches. With respect to psychosis, the mean scores for IBS, IBD patients and normal subjects were 1.35, 0.97 and 0.65 respectively, which show a greater value for IBS patients. In this relation, Garakani and Wayne [8] stated that the prevalence of IBS in patients under treatment was relatively high as 19 percent of schizophrenic patients suffered from IBS [8]. Comparison of GSI in the three groups revealed higher mean scores for IBS patients, with for IBS, for IBD and 5.89 for normal 555 P a g e

8 people. Considering the results, it can be said that the mental health levels in all 9 aspects of the SCL90-R in IBS patients were lower than IBD patients and normal subjects, because their scores in GSI have been reported higher than those of IBD patients and normal subjects. Taylor [18] suggests that the health level qualities in both IBS and IBD patients show similar reductions and the severity of psychological signs and symptoms were not significantly different both groups. But, one can say that at least in some instances, health level reduction and mental disorder were more severe in IBS patients. 5. Conclusion It seems that signs and symptoms of IBS arising from psychological conditions including neurotic conditions and all manifestations are in 9 dimensional domain of SCL-90-R, as people with this syndrome appear to stay at lower mental health level. It also seems that IBD, in spite of being an organic and inflammatory, can function as a precursor for developing psychological signs and symptoms that lead to severity of signs and symptoms of the disease as well. These results reveal the roles of psychological factors in developing the above-mentioned disease hence; necessity of psychological treatments alongside drug therapy. References [1] Alderman, J., Managing irritable bowel syndrome. Adv Nurse Pract; 7(1): [2] Austerberg, E., L. Blomquist., I. Krakau., R. Weinryb., M. Asberg., and R.A. Hulterantz., Population study on irritable bowel syndrome and mental health, Journal of psychosomatic Research. 35(3): [3] Berveh, L., R. Falsetti and S. A. Article., Experience with anxiety and depression treatment studies: Implications for designing irritable bowel syndrome clinical traits, The American journal of Gastroenterology, 95, 9: 229. [4] Derogates, L.R., SCL-90- R: Administration, Scoring and Procedures Manual II. Baltimore: Clinical Psychometric Research; [5] Derogatis, L.R., R.S. Lipman, and L. Covi., SCL- 90-R: An outpatient psychiatric rating scale preliminary report. Psychopharmacology Bulletin, 9 (1): [6] Derogatis, L.R Symptom Checklist 90 - R, Minneapolis National Computer System. Inc. p: [7] Farhad, A., K. Bruning., S. J. Field., and A. Keshavarzian., Irritable bowel syndrome: An update on therapeutic modalities. Expert Opin Investing Drug., 10(7): P a g e

9 [8] Garakani, A., and T. Wayne., Co morbidity of IBS in psychiatric patients, Am J Ther., 10(1):61-7. [9] Hazleh, S.H., and M.G.Graske., Prevalence of IBS among university students and visceral anxiety, J Psychosomatic., 55(6): [10] Himan, R., I. Arnold., C. Florin., S. Herda., and H. Melfsen., The combination of medical treatment plus multi component behavioral therapy in IBS., Am J Gastroenterology., 95(4): [11] Latimer.p, (1979) A critical appraisal of IBS, psycho physiologic Disorder, Psychological Medicine, 9,71-8. [12] Lidiard, RB., Irritable bowel syndrome, anxiety, and depression: what are the links? J Clinical Psychiatry 62: [13] Malia, G. O., W.K. Wongapeter., M. Kroenkecurt., J. Roya and K.H. Wonga., The value of screening for psychiatric disorders prior to upper endoscopes. Journal of Psychosomatic Research., 55, (4): [14] Mayer, E., M.G. Craske., and B.D. Naliboff., Depression, anxiety, and the gastrointestinal system. J Clinical Psychiatry. 62: [15] Pintosi, C., Level of stress full life events in IBS, J Association Physicians, 48(6): [16] Solmaz, M., I. kavok, and k. Sayar., Psychological factors in the IBS., European Journal of Medical Research, 8: [17] Sani M. spirg, (2006) IBS and psychological disorders in university students scientific Journal of the Iranian Association of gastroenterology and herpetology, vol.11,no.1, [18] Taylor, F., Psychological distress in IBS, Scanavian Journal of Gastroenterology, 38 (10): [19] Tomas, Z PavloskI., Psychological factor of IBS, Psychiatry and Neurology, 15, 2. [20] Vivela, A., and A. Poellinger., Cerebral processing of auditory stimuli in patients with IBS, World Journal of Gastroenterology. 557 P a g e

10 [21] Velatimer, P., A critical appraisal of IBS, psycho physiologic disorder, Psychological Medicine, 9: [22] Zendedel, M., IBS and psychological disorders in university students. Scientific Journal of the Iranian Association of Gastroenterology and Hematology, 11(1): P a g e