Background & Aims

There is controversy about whether psychological factors (anxiety and depression) increase health care seeking by patients with irritable bowel syndrome (IBS). We investigated whether psychological factors increase health care seeking by patients with IBS and the effects of extragastrointestinal (extra-GI) symptoms.

Methods

We performed a population-based prospective study of health care use over a 12-year period in Sweden. From 2002 through 2006, 1244 subjects were selected randomly for an examination by a gastroenterologist and to complete questionnaires, including the Rome II modular questionnaire. Psychological factors were measured with the valid Hospital Anxiety and Depression scale and extra-GI symptoms were measured with a symptom checklist. Responses from 1159 subjects (57% female; mean age, 48.65 y) were matched with health records in 2016 (164 were classified as having IBS based on Rome II criteria).

Results

The overall association between depression or anxiety and health care use varied in subjects with and without IBS at baseline. The presence of extra-GI symptoms strengthened the relationship between anxiety and depression and prospective psychiatric visits for subjects with IBS and without IBS (incidence rate ratio, 1.14–1.26). Extra-GI symptoms did not alter the association of anxiety or depression with use of GI or extra-GI health care.

Conclusions

In a population-based study in Sweden, we found that individuals with high baseline anxiety or depression were more likely to seek psychiatric health care, but not GI or extra-GI health care, in the presence of extra-GI symptoms at baseline. Patients with IBS might benefit from more thorough assessments that examine extra-GI and psychological symptoms, to reduce health care utilization.

中文翻译：

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心理和胃肠外症状对肠易激综合征患者和非肠易激综合征患者医疗保健使用的影响

背景与目标

关于心理因素（焦虑和抑郁）是否会增加肠易激综合征 (IBS) 患者就医的次数存在争议。我们调查了心理因素是否会增加 IBS 患者就医的次数以及胃肠道外 (extra-GI) 症状的影响。

方法

我们在瑞典进行了一项为期 12 年的基于人群的医疗保健使用前瞻性研究。从 2002 年到 2006 年，随机选择了 1244 名受试者接受胃肠病学家的检查并完成问卷，包括罗马 II 模块问卷。心理因素用有效的医院焦虑和抑郁量表测量，胃肠道外症状用症状清单测量。1159 名受试者（57% 女性；平均年龄 48.65 岁）的反应与 2016 年的健康记录相匹配（根据罗马 II 标准，164 名被归类为 IBS）。

结果

在基线时患有和不患有 IBS 的受试者中，抑郁或焦虑与医疗保健使用之间的总体关联各不相同。胃肠道外症状的存在加强了 IBS 和非 IBS 受试者的焦虑和抑郁与预期精神病就诊之间的关系（发生率比，1.14-1.26）。胃肠道外症状不会改变焦虑或抑郁与使用胃肠道或胃肠道外保健的关联。

结论

在瑞典的一项基于人群的研究中，我们发现基线焦虑或抑郁程度高的人更有可能寻求精神科医疗保健，但在基线时存在额外胃肠道症状的情况下，则更有可能寻求精神科医疗保健，而不是胃肠道或额外胃肠道医疗保健。IBS 患者可能会受益于更彻底的评估，检查额外的 GI 和心理症状，以减少医疗保健的利用率。