Learning Objective #1: Understand the relationship between psychological distress and irritable bowel syndrome

Learning Objective #2: Explore the knowledge related to irritable bowel syndrome

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Purpose: Irritable bowel syndrome (IBS) is a prevalent and costly health condition that can impair health-related quality of life (HRQOL) in adults. The cause of IBS remains unknown, but psychological distress has been studied. The aims of this review are 1) examine the relationship between psychological distress and IBS, 2) explore the relationship between stress and psychological distress, and 3) examine tools of psychological distress and HRQOL in IBS studies. Methods: To identify the publications used in this review, Medline and CINALE were searched. The key words “IBS”, “psychological distress”, “anxiety”, “depression”, “abuse”, and “HRQOL” were used. Articles published between 1990 and 2004 written in English were included. Results: Numerous studies demonstrated that IBS patients increased rates of: depression, anxiety, a history of abuse, number of stressful events and health care seeking behavior relative to healthy subjects and those with organic gastrointestinal (GI) disorders. Also, IBS patients with psychological distress have been found to have more severe and long-lasting IBS symptoms and poorer functional status than both healthy controls and controls with organic GI disorders. Of IBS patients, psychological distress is more prevalent in women than in men. However, most studies typically use only female subjects in their samples, so there have been a limited number of studies that have examined the relationship between gender differences and psychological distress. In addition, most studies failed to use both subjective measurement and physiological indicators. Moreover, the questionnaires on psychological distress and disease-specific HRQOL questionnaires have not been rigorously validated or reliable. Also, these questionnaires are not available in a variety of languages. Implications: Further studies are needed that use a larger sample size, include both genders, use proper methodological design and questionnaire(s), quantify both psychological and physiological data, classify different subgroups, and conduct primary care level or community based prospective studies.