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Irritable Bowel Symptoms and the Development of Common Mental Irritable bowel symptoms and the development of common mental disorders and functional somatic syndromes identified in secondary care a long-term, population-based study Poulsen, Chalotte Heinsvig; Eplov, Lene Falgaard; Hjorthøj, Carsten; Eliasen, Marie; Skovbjerg, Sine; Dantoft, Thomas Meinertz; Schröder, Andreas; Jørgensen, Torben Published in: Clinical Epidemiology DOI: 10.2147/CLEP.S141344 Publication date: 2017 Document version Publisher's PDF, also known as Version of record Document license: CC BY-NC Citation for published version (APA): Poulsen, C. H., Eplov, L. F., Hjorthøj, C., Eliasen, M., Skovbjerg, S., Dantoft, T. M., Schröder, A., & Jørgensen, T. (2017). Irritable bowel symptoms and the development of common mental disorders and functional somatic syndromes identified in secondary care: a long-term, population-based study. Clinical Epidemiology, 9, 393-402. https://doi.org/10.2147/CLEP.S141344 Download date: 23. Sep. 2021 Journal name: Clinical Epidemiology Article Designation: ORIGINAL RESEARCH Year: 2017 Volume: 9 Clinical Epidemiology Dovepress Running head verso: Poulsen et al Running head recto: Prognosis of the irritable bowel syndrome open access to scientific and medical research DOI: http://dx.doi.org/10.2147/CLEP.S141344 Open Access Full Text Article ORIGINAL RESEARCH Irritable bowel symptoms and the development of common mental disorders and functional somatic syndromes identified in secondary care – a long-term, population-based study Chalotte Heinsvig Objective: Irritable bowel syndrome (IBS) is associated with mental vulnerability, and half of Poulsen1,2 patients report comorbid somatic and mental symptoms. We aimed to investigate the relation- Lene Falgaard Eplov2 ship between an IBS symptom continuum and the subsequent development of common mental Carsten Hjorthøj2 disorders (CMDs) and functional somatic syndromes (FSSs). Marie Eliasen1 Methods and study design: A longitudinal population-based study comprising two 5-year follow-up studies, Dan-MONICA 1 (1982–1987) and Inter99 (1999–2004), recruited from Sine Skovbjerg1 the western part of Copenhagen County. The total study population (n = 7,278) was divided Thomas Meinertz Dantoft1 For personal use only. into symptom groups according to the degree of IBS definition fulfillment at baseline and/or 3 Andreas Schröder follow-up and was followed until December 2013 in Danish central registries. Cox regression 1,4,5 Torben Jørgensen was used for the analyses, adjusting for age, sex, length of education and cohort membership. 1Research Centre for Prevention and In a subsequent analysis, we adjusted for mental vulnerability as a risk factor for both CMDs Health, Capital Region of Denmark, and FSSs, including IBS. Glostrup, 2Copenhagen University Hospital, Mental Health Centre Results: Over a 5-year period, 51% patients had no IBS symptoms, 17% patients had IBS Copenhagen, Hellerup, 3Research symptoms without abdominal pain, 22% patients had IBS symptoms including abdominal pain Clinic for Functional Disorders and and 10% patients fulfilled the IBS definition. IBS and IBS symptoms including abdominal Psychosomatics, Aarhus University Hospital, Aarhus, 4Department of pain were significantly associated with the development of CMDs and other FSSs identified Public Health, Faculty of Health in secondary care. When adjusting for mental vulnerability, IBS and IBS symptoms includ- and Medical Sciences, University ing abdominal pain were no longer associated with CMDs, but the significant relationship to Clinical Epidemiology downloaded from https://www.dovepress.com/ by 130.225.178.2 on 19-Jan-2018 of Copenhagen, Copenhagen, 5The Faculty of Medicine, Aalborg other FSSs remained. University, Aalborg, Denmark Conclusion: In a clinical setting, the perspective should be broadened to individuals not ful- filling the symptom cluster of IBS but who report frequent abdominal pain. Additionally, it is important to combine symptom-based criteria of IBS with psychosocial markers such as mental vulnerability, because it could guide clinicians in decisions regarding prognosis and treatment. Keywords: functional gastrointestinal symptoms, abdominal pain, comorbidity, somatization, neuroticism Introduction Correspondence: Chalotte Heinsvig With a prevalence of 11–16%,1,2 “irritable bowel syndrome” (IBS) is a common Poulsen ~ Research Centre for Prevention and functional gastrointestinal disorder that is associated with substantial costs for patients, Health, The Capital Region of Denmark, health care systems and society.3 Approximately half of IBS patients report additional Nordre Ringvej 57, Building 84/85, 2600 Glostrup, Denmark mental and somatic symptoms.4 In a Norwegian population-based study, the pres- Tel +45 3863 3275 ence of comorbid symptoms beyond IBS symptoms was associated with a higher Email chalotte.heinsvig.poulsen@ 5 regionh.dk functional impairment, more psychological distress and increased health care use. submit your manuscript | www.dovepress.com Clinical Epidemiology 2017:9 393–402 393 Dovepress © 2017 Poulsen et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work http://dx.doi.org/10.2147/CLEP.S141344 you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Poulsen et al Dovepress Thus, IBS patients have an increased prevalence of mental Methods and study design disorders, especially anxiety and depression.6 Moreover, The study design has previously been presented as a longi- IBS has a significant symptom overlap with other functional tudinal study consisting of two population-based cohorts, gastrointestinal disorders such as dyspepsia and functional Dan-MONICA 1 (1982–1987) and Inter99 (1999–2004), somatic syndromes (FSSs), eg, fibromyalgia and chronic both examined twice with 5-year interval.14 The two cohorts fatigue syndrome.4,7 These findings illustrate the need for were followed until December 2013 in Danish central more knowledge about the prognosis of IBS, eg, the poten- registries. tial development of mental and functional comorbidities. This knowledge could guide clinicians and policy makers Study populations in decisions regarding treatment, disease prevention and The two study populations have previously been described in health-promoting strategies. detail.21,22 They were drawn as age- and sex-matched samples Most of the literature in this field has certain method- from the Danish Civil Registration System (CRS) using ological limitations such as cross-sectional design, selected computer-generated random numbers. Both study popula- patient populations and uncertainties in delimitation of the tions were recruited from the western part of Copenhagen FSSs including IBS.4,6,7 Recently, IBS has been defined as a County, which constitutes 7% of the total Danish population disorder of gut–brain interaction;8 that is why studies focusing and is representative of Danes living in the suburbs. In brief, on IBS and subsequent development of mental and functional the Dan-MONICA 1 study population comprised 4,807 men comorbidities have become of increasing interest.9–12 Never- and women of ages 30, 40, 50 and 60 years.21 All individuals theless, the focus is on IBS and “non-IBS” cases, although were invited for a general health examination conducted in other population-based studies have shown the importance 1982–1984. Individuals not of Danish nationality (n = 226) of broadening the perspective to individuals not fulfilling the were excluded, reducing the sample to 4,581. Of them, 3,608 symptom cluster of IBS.2,13,14 Additionally, other population- (79%) individuals participated in the baseline study. At the based studies have shown that mental vulnerability, illness 5-year follow-up, 3,498 individuals were accessible for invi- For personal use only. anxiety and somatic symptom burden predict development of tation to a similar health examination. Among them, 2,987 IBS.15,16 These results indicate the need for addressing both (85%) individuals participated. Individuals not responding somatic and psychological factors in the early examination were re-invited twice.23 The Inter99 study population com- of individuals with IBS. Mental vulnerability represents both prised 13,016 men and women of ages 30, 35, 40, 45, 50, 55 a symptom state related to somatization and a personality and 60 years.22 Eligible individuals (n = 12,934) were invited trait related to neuroticism.17 Neuroticism has been shown for a health screening program conducted in 1999–2001, to be a risk marker in the development of common mental and 6,906 (53%) individuals turned up for the examination. disorders (CMDs).18 In addition, both neuroticism and soma- Individuals with linguistic barriers, alcoholism or drug tization have been linked to the development of IBS and other abuse were excluded, leaving 6,784 (52.5%) participants Clinical Epidemiology downloaded from https://www.dovepress.com/ by 130.225.178.2 on 19-Jan-2018 FSSs.19,20 Therefore, long-term population-based studies in the baseline study. The Inter99 study was designed
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