The Increased Level of Depression and Anxiety in Irritable Bowel Syndrome Patients Compared with Healthy Controls: Systematic Review and Meta-analysis

Abstract

Background/aims: Irritable bowel syndrome (IBS) patients commonly experience psychiatric disorders, such as depression and anxiety. This meta-analysis sought to compare depression and anxiety levels between IBS patients and healthy controls.

Methods: We searched major electronic databases (PubMed, EMBASE, MEDLINE, and Cochrane library) to find comparative studies on IBS patients and healthy controls. The primary outcome was a standardized mean difference (SMD) of anxiety and depression levels; sub-group analyses were conducted according to IBS-subtypes.

Results: In total, 2293 IBS patients and 4951 healthy controls from 27 studies were included. In random effect analysis, depression and anxiety levels were significantly higher in IBS patients (pooled SMD = 0.76; 95% CI, 0.62-0.90; P < 0.001; I² = 77.2% and pooled SMD = 0.84; 95% CI, 0.67-1.01; P < 0.001; I² = 85.6%, respectively). Both analyses' funnel plots showed symmetry. In meta-regression analysis, heterogeneity was due to the studied region and questionnaire type for both depression and anxiety. In sub-group analyses of IBS-subtype, the pooled SMDs of depression and anxiety levels (IBS with predominant constipation: 0.83 and 0.81, IBS with predominant diarrhea: 0.73 and 0.65, and IBS with mixed bowel habits: 0.62 and 0.75; P < 0.001, respectively) were significantly higher in all IBS-subtypes.

Conclusions: The present meta-analysis showed depression and anxiety levels to be higher in IBS patients than in healthy controls, regardless of IBS-subtype. However, the gender effect on psychological factors among IBS patients could not be determined and should be evaluated in prospective studies.

Keywords: Anxiety; Depression; Irritable bowel syndrome; Meta-analysis.

Figure 1

PRISMA flow diagram of the meta-analysis. IBS, irritable bowel syndrome.

Figure 2

Forest plot and funnel plot of depression levels in irritable bowel syndrome (IBS) patients. (A) Forest plot of depression levels in IBS patients, divided by the type of questionnaire assessing depression levels. (B) Funnel plot of depression levels in IBS patients, divided by the type of questionnaire assessing depression levels. SMD, standard mean difference; BDI, Beck Depression Inventory; HADS, Hospitalization Anxiety and Depression Scale; SDS, Self-Rating Depression Scale; Others included sphere and Symptom Checklist-90; SE, standard error.

Figure 3

Forest plot and funnel plot of anxiety levels in irritable bowel syndrome (IBS) patients. (A) Forest plot of anxiety level in IBS patients, divided by the type of questionnaire assessing anxiety levels. (B) Funnel plot of anxiety levels in IBS patients, divided by the type of questionnaire assessing anxiety levels. SMD, standard mean difference; STAI, State and Trait Anxiety Inventory; HADS, Hospitalization Anxiety and Depression Scale; SAS, Self-Rating Anxiety Scale; Others included sphere, Symptom Checklist-90 and BAI; SE, standard error.

Figure 4

Forest plot and funnel plot of depression levels in subtypes of irritable bowel syndrome (IBS). (A) Forest plot of depression levels in IBS-subtype patients (B) Funnel plot of depression levels in IBS-subtype patients. SMD, standard mean difference; IBS-C, IBS with predominant constipation; IBS-D, IBS with predominant diarrhea; IBS-M, IBS with mixed bowel habits; SE, standard error.

Figure 5

Forest plot and funnel plot of depression levels in subtypes of irritable bowel syndrome (IBS). (A) Forest plot of anxiety levels in IBS-subtype patients. (B) Funnel plot of anxiety levels in IBS-subtype patients. SMD, standard mean difference; IBS-C, IBS with predominant constipation; IBS-D, IBS with predominant diarrhea; IBS-M, IBS with mixed bowel habits; SE, standard error.