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The Impact of Physical Complaints, Social Environment, and Psychological Functioning on IBS Patients’ Health Perceptions: Looking Beyond GI Symptom Severity

Lackner, Jeffrey M PsyD1; Gudleski, Gregory D PhD1; Thakur, Elyse R MA2; Stewart, Travis J BA1; Iacobucci, Gary J BS1; Spiegel, Brennan MR MD3 Representing the IBS Outcome Study Research Group

American Journal of Gastroenterology: February 2014 - Volume 109 - Issue 2 - p 224–233
doi: 10.1038/ajg.2013.410

OBJECTIVES: In the absence of a reliable biomarker, clinical decisions for a functional gastrointestinal (GI) disorder like irritable bowel syndrome (IBS) depend on asking patients to appraise and communicate their health status. Self-ratings of health (SRH) have proven a powerful and consistent predictor of health outcomes, but little is known about how they relate to those relevant to IBS (e.g., quality of life (QOL), IBS symptom severity). This study examined what psychosocial factors, if any, predict SRH among a cohort of more severe IBS patients.

METHODS: Subjects included 234 Rome III-positive IBS patients (mean age=41 years, female=78%) without comorbid organic GI disease. Subjects were administered a test battery that included the IBS Symptom Severity Scale, Screening for Somatoform Symptoms, IBS Medical Comorbidity Inventory, SF-12 Vitality Scale, Perceived Stress Scale, Beck Depression Inventory, Trait Anxiety Inventory, and Negative Interactions Scale.

RESULTS: Partial correlations identified somatization, depression, fatigue, stress, anxiety, and medical comorbidities as variables with the strongest correlations with SRH (rvalues=0.36–0.41,Pvalues <0.05). IBS symptom severity was weakly associated with SRH (r=0.18,P<0.05). The final regression model explained 41.3% of the variance in SRH scores (F=8.49,P<0.001) with significant predictors including fatigue, medical comorbidities, somatization, and negative social interactions.

CONCLUSIONS: SRH are associated with psychological (anxiety, stress, depression), social (negative interactions), and extraintestinal somatic factors (fatigue, somatization, medical comorbidities). The severity of IBS symptoms appears to have a relatively modest role in how IBS patients describe their health in general.

1 Behavioral Medicine Clinic, Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, New York, USA

2 Department of Psychology, Wayne State University, Detroit, Michigan, USA

3 David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

Correspondence: Jeffrey M. LacknerPsyD, Behavioral Medicine Clinic, Department of Medicine, University at Buffalo School of Medicine, SUNY, ECMC, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:

Received 5 July 2013; accepted 22 September 2013

published online 14 January 2014

© The American College of Gastroenterology 2014. All Rights Reserved.
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