The risk factors for self-reported Irritable Bowel Syndrome with prior psychiatric disorder: The Lifelines cohort study

Background/aims: The role of psychiatric disorder in irritable bowel syndrome (IBS) is not clear. This study aims to assess whether individuals who have psychiatric disorder prior to IBS onset differ in their risk factors from the remainder.

Methods: The prospective, population-based Lifelines cohort study includes 132 922 adults without prior IBS or taking IBS medication at baseline. Baseline data included socio-demographic status, physical and psychiatric disorders, psycho-social and behavioral variables. At follow-up (mean 2.4 years later) new onsets of IBS were recorded by self-report. The predictors of new onsets of IBS were assessed using logistic regression; participants with and without prior psychiatric disorders were analyzed separately.

Results: At follow-up 1507 (1.1%) participants reported new onset IBS. Of these, 27% reported prior psychiatric disorder. Predictors of IBS in this group were: 2 or more psychiatric disorders (OR, 2.74; 95% CI, 1.3-5.6), female sex, proton pump inhibitors, numerous bodily symptoms, impaired sleep, low BMI and negative health perception. These variables, except psychiatric disorders and BMI, also predicted IBS in those without prior psychiatric disorder but, in this group, gallstones, asthma, fibromyalgia, reported allergies, impairment through bodily pain, and frequent healthcare were also predictors.

Conclusions: Despite its limitations this study suggests that prior psychiatric disorder is an important risk factor in a quarter of IBS onsets. Negative health perception and multiple bodily symptoms are associated with all IBS onsets in line with the cognitive-behavior model of IBS. Prior psychiatric disorder may predict an optimal response to psychiatric treatment. Further studies could usefully study mechanisms linking IBS to prior psychiatric disorder.

Keywords: Anxiety; Depression; Epidemiology; Irritable bowel syndrome; Risk factors.