Constipation among workers with depression/anxiety: a retrospective study using a claims database and survey data in Japan

Abstract

Objectives: To investigate the prevalence, associated factors, treatment status and burden of constipation in workers with depression or anxiety.

Study design: This was a retrospective observational study using a pre-existing database.

Setting: Claims data from October to November 2022 and data from the survey conducted in November 2022 were extracted from the database.

Participants: This study included self-reported workers who completed the survey, after excluding those with major mental disorders diagnosed as distinct from depression or anxiety and constipation due to organic diseases identified by International Classification of Diseases (ICD-10) codes.

Outcome measures: The subjects were divided into three groups: treated depression/anxiety, untreated depression/anxiety and no depression/anxiety. The prevalence of constipation, factors associated with constipation and medications prescribed for constipation were analysed. Work productivity and quality of life (QOL) were compared between three subgroups based on constipation status: treated constipation, untreated constipation and no constipation subgroup.

Results: Of the 18 585 respondents in the analysis population, 950 respondents (5.1%) were classified into the treated depression/anxiety group, 6035 respondents (32.5%) into the untreated depression/anxiety group and the remaining respondents into the no depression/anxiety group (11 600 (62.4%)). The prevalence of constipation was 22.5% in the treated group, 22.3% in the untreated group and 10.4% in the no depression/anxiety group, respectively. Depression and anxiety severity were independently associated with an increased risk of constipation. In all groups, the most commonly prescribed drug class was osmotic laxatives. Work productivity and QOL tended to indicate a greater burden in the untreated constipation subgroup than in the treated or no constipation subgroups.

Conclusions: The prevalence of constipation was twice as high if workers had depression/anxiety. Considering that the comorbidity of constipation with mental disorders may increase multiple burdens, appropriate medical interventions are required to treat both mental (depression/anxiety) and physical (constipation) conditions. This should be widely recognised by physicians and employers.

Keywords: Anxiety disorders; Depression & mood disorders; Functional bowel disorders; GASTROENTEROLOGY; Patient Reported Outcome Measures; Quality of Life.

Figure 1. Participant disposition.

Figure 2. Prevalence of constipation. OTC, over-the-counter. The figure shows the prevalence of constipation and its breakdown by definition, excluding duplicate counts. Bold numbers indicate the percentage of constipation (Definitions 1, 2 and 3) overall and in each participant group.

Figure 3. Work productivity and activity impairment with indirect cost (a) and quality of life (b). ¹Constipation subgroups were defined as follows: (1) treated constipation (prescription and/or OTC) (‘Treated’ in the figure), (2) untreated constipation (‘Untreated’) and (3) no constipation subgroups (‘None’). ²Calculated by multiplying the total work hours missed and spent with reduced productivity by the average hourly wage (male: 1631 yen, female: 1290 yen as of June 2021). The mean (SD) of each score and cost, and p values for comparisons between treated versus untreated constipation, untreated constipation versus no constipation and treated constipation versus no constipation (Wilcoxon rank-sum test) are displayed. *Indicates p<0.05. WPAI score: a higher score indicated greater impairment in work productivity and daily activities. EQ-5D-5L, EuroQol 5 dimensions 5-level; JPY, Japanese yen; WPAI, Work Productivity and Activity Impairment Questionnaire: General Health.