Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C

Antonina A Mikocka-Walus^*¹ , Deborah A Turnbull^*² , Jane M Andrews^*³ , Nicole T Moulding^*⁴ , Ian G Wilson^*⁵ , Hugh AJ Harley^*³ , David J Hetzel^*³ and Gerald J Holtmann^*³

¹Department of Epidemiology & Preventive Medicine, Monash University, The Alfred, Level 3, Burnet Tower, 89 Commercial Rd, Melbourne 3004, VIC, Australia

²School of Psychology, University of Adelaide, Level 4, Hughes Building, Adelaide 5005, SA, Australia

³Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia

⁴School of Social Work and Social Policy, University of South Australia, Magill Campus, H1-32, Magill 5068, SA, Australia

⁵School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith South DC NSW 1797, Australia

author email corresponding author email* Contributed equally

Clinical Practice and Epidemiology in Mental Health 2008, 4:15doi:10.1186/1745-0179-4-15


Published:	23 May 2008

Abstract

Background

In independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources.

Methods

Overall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed).

Results

Each of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population.

Conclusion

Patients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.