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. 2023 Jan;35(1):e14465.
doi: 10.1111/nmo.14465. Epub 2022 Sep 25.

Economic living standard and abdominal pain mediate the association between functional gastrointestinal disorders and depression or anxiety

Simon M H  1   2 , Heenan P E  1   3 , Frampton C  1 , Bayer S  1   3 , Keenan J I  3   4 , Boer de N K  2 , Roy N C  3   5 , Talley N J  6   7 , Gearry R B  1   3
Affiliations

Economic living standard and abdominal pain mediate the association between functional gastrointestinal disorders and depression or anxiety

Simon M H et al. Neurogastroenterol Motil. 2023 Jan.

Abstract

Background: Functional gastrointestinal disorders (FGIDs) are common and cause significant morbidity. Psychiatric comorbidities associated with FGIDs include anxiety and depression. However, little is understood about the factors that modulate this association. The aim of this study was to examine the association between FGIDs and depression and anxiety, and to determine the covariates influencing this association in a New Zealand cohort.

Methods: The Christchurch IBS cOhort to investigate Mechanisms FOr gut Relief and improved Transit (COMFORT) study is an observational case-control study that recruited FGID cases and healthy controls between 2016 and 2018. In addition to the collection of a wide range of biological samples, participants completed questionnaires concerning socioeconomic status, physical activity, smoking, alcohol intake, anxiety, and depression (the latter two measured using the Hospital Anxiety and Depression Score [HADS]). A multivariate analysis was performed using the significant covariates from the univariate analyses to test whether their effect was independently significant on anxiety and depression.

Key results: A total of 315 participants (57 with diarrhea-predominant IBS (IBS-D), 30 with constipation-predominant IBS (IBS-C), 41 with mixed-IBS (IBS-M), 16 with functional diarrhea (FD), 42 with functional constipation (FC), and 129 controls); mean age 53 years (range 18-70 years), 221 (70%) female) completed the questionnaires. Anxiety (odds ratio [OR] 2.85 [95% confidence interval [CI] 1.64-4.94, p < 0.01) and depression (OR 3.40 [95% CI 1.35-8.55, p = 0.01]) were strongly associated with FGID cases versus controls. Lower economic living status (p < 0.01) was an independent covariate associated with depression, while lower economic living status (p < 0.005) and abdominal pain (p = 0.005) were both independently associated with anxiety.

Conclusions & inferences: In addition to the established associations between FGIDs and anxiety and depression, we have shown that the economic standard of living, pain, and IBS phenotype are significant independent covariates. This study demonstrates the range of lifestyle and demographic factors that modulate morbidity associated with FGIDs and may provide targets for intervention.

Keywords: anxiety; depression; economic standard of living; irritable bowel syndrome.

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Conflict of interest statement

NKH de Boer has served as a speaker for AbbVie and MSD and has served as consultant and principal investigator for TEVA Pharma BV and Takeda. He has received a (unrestricted) research grant from Dr. Falk, TEVA Pharma BV, MLDS, and Takeda. All outside the submitted work. RBG: Dr Gearry reports receiving research support from Atmo, Zespri, Comvita, Goodman‐Fielder, AbbVie and Janssen. He has served on advisory boards for Janssen, AbbVie, Zespri. He has served as a speaker for Janssen, AbbVie, Zespri and Takeda. NR: Dr Roy reports receiving research support from Atmo, Zespri, Comvita, Goodman‐Fielder, NIG Nutritionals, Wakatū Incorporation. NJT: Dr. Talley reports personal fees from Allakos (gastric eosinophilic disease) (2021), Bayer [IBS] (2020), Planet Innovation (Gas capsule IBS) (2020), twoXAR Viscera Labs, (USA 2021) (IBS‐diarrhea), Dr Falk Pharma (2020) (EoE), Sanofi‐aventis, Glutagen (2020) (Celiac disease), IsoThrive (2021) (esophageal microbiome), BluMaiden (microbiome advisory board) (2021), Rose Pharma (IBS) (2021), Intrinsic Medicine (2022) (human milk oligosaccharide), Comvita Mānuka Honey (2021) (digestive health), Astra Zeneca (2022), outside the submitted work; In addition, Dr. Talley has a patent Nepean Dyspepsia Index (NDI) 1998, Biomarkers of IBS licensed, a patent Licensing Questionnaires Talley Bowel Disease Questionnaire licensed to Mayo/Talley, a patent Nestec European Patent licensed, and a patent Singapore Provisional Patent “Microbiota Modulation Of BDNF Tissue Repair Pathway” issued, “Diagnostic marker for functional gastrointestinal disorders” Australian Provisional Patent Application 2,021,901,692. Committees: OzSage, Australian Medical Council (AMC)1; Australian Telehealth Integration Programme; NHMRC Principal Committee (Research Committee) Asia Pacific Association of Medical Journal Editors. Boards: Rome V Working Team Member (Gastroduodenal Committee), International Plausibility Project Co‐Chair (Rome Foundation funded), COVID‐19 vaccine forum member (by invitation only). Community group: Advisory Board, IFFGD (International Foundation for Functional GI Disorders), AusEE. Editorial: Medical Journal of Australia (Editor in Chief), Up to Date (Section Editor), Precision and Future Medicine, Sungkyunkwan University School of Medicine, South Korea, Med (Journal of Cell Press). Dr. Talley is supported by funding from the National Health and Medical Research Council (NHMRC) to the Centre for Research Excellence in Digestive Health and he holds an NHMRC Investigator grant. MHS, PEH, CF, SB, JIK have no competing interests.

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