Resilience is decreased in irritable bowel syndrome and associated with symptoms and cortisol response

Abstract

Background: Irritable bowel syndrome (IBS) is a stress-sensitive disorder associated with early adverse life events (EALs) and a dysregulated hypothalamic-pituitary-adrenal (HPA) axis. Resilience is the ability to recover and adapt positively to stress but has not been well studied in IBS. The aims of this study are to compare resilience in IBS and healthy controls (HCs) and to assess its relationships with IBS symptom severity, quality of life (QOL), EALs, and HPA axis response.

Methods: Two hundred fifty-six subjects (154 IBS, 102 HCs) completed questionnaires for resilience (Connor-Davidson Resilience Scale [CD-RISC] and Brief Resilience Scale [BRS]), IBS symptoms, IBS-QOL, and EALs. Ninety-six of these subjects had serial serum adrenocorticotropic hormone (ACTH) and cortisol levels to exogenous corticotrophin-releasing hormone (CRH) and ACTH measured. The relationship between IBS status, resilience, and other variables of interest was assessed by regression analysis after adjusting for demographics and neuroticism, a predictor of resilience.

Key results: Resilience was significantly lower in IBS compared to HCs (CD-RISC: 72.16±14.97 vs 77.32±12.73, P=.003; BRS: 3.29±0.87 vs 3.93±0.69, P<.001); however, only BRS was significant after controlling for neuroticism (P=.001). Lower BRS scores were associated with greater IBS symptom severity (P=.002), poorer IBS-QOL (P<.001), and a higher number of EALs (P=.01). There was a significant interaction between BRS resilience and IBS status for ACTH-stimulated cortisol response (P=.031); more resilient IBS subjects had lower cortisol response, and more resilient HCs had higher cortisol response.

Conclusions and inferences: Lower resilience is associated with IBS status, worse IBS symptom severity, lower IBS-QOL, greater EALs, and stress hyperresponsiveness.

Keywords: cortisol; early adverse life events; irritable bowel syndrome; quality of life; resilience.

Figure 1. IBS patients have lower resilience scores compared to healthy controls

Differences in resilience scores between IBS and HCs are shown after adjusting for sex, age, and education. (A) CD-RISC resilience in IBS (72.16 ± SD 14.97) vs. HCs (77.32 ± SD 12.73); (p=0.003). (B) BRS resilience in IBS (3.29 ± SD 0.87) vs. HCs (3.93 ± SD 0.69); (p<0.001).

Figure 2. Resilience is associated with lower IBS usual severity

IBS usual severity scored on a 1–5 scale (1-none, 2- mild, 3-moderate, 4-severe, 5- very severe). Compared to healthy controls, resilience scores as measured by A) CD-RISC (p=0.008) and B) BRS (p=0.002) were lower in IBS patients.

Figure 3. Resilience is positively correlated with quality of life in IBS

Higher resilience scores were positively associated with IBS-QOL using CD-RISC (p<0.001) and BRS (p<0.001).

Figure 4. Association of resilience scores and EALs

IBS subjects have significantly lower resilience scores compared to HCs when ETI-SR scores are controlled for with CDRISC (p=0.019) and BRS (p<0.001).

Figure 5. A greater cortisol response was associated with lower BRS resilience in IBS

There was a significant interaction between BRS resilience scores and IBS status with AUCi for ACTH stimulated cortisol response (p=0.031). Less resilient HCs had a lower cortisol response to ACTH stimulation.