Psychosocial distress and somatic symptoms in community subjects with irritable bowel syndrome: a psychological component is the rule.
Psychosocial distress and somatic symptoms in community subjects with irritable bowel syndrome: a psychological component is the rule.
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DOI：
10.1038/ajg.2009.239
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发表时间：
2009-07
影响因子：
9.8
通讯作者：
Talley, Nicholas J.
中科院分区：
文献类型：
--
作者：
Choung, Rok Seon;Locke, G. Richard, III;Zinsmeister, Alan R.;Schleck, Cathy D.;Talley, Nicholas J.
心理因素可能促使肠易激综合征（IBS）患者寻求医疗保健，但心理因素是否与IBS有因果关系尚无定论。一种假设是肠易激综合征是一种异质性综合征，包括两种不同的情况，一种是心理上的，另一种是生物学上的。然而，目前尚不清楚社区中有多少肠易激综合征患者没有躯体化和最小的社会心理困扰。我们研究的目的是估计在一个具有代表性的美国社区中，有低水平躯体和心理症状的肠易激综合征患者的比例。该队列包括从明尼苏达州奥姆斯特德县随机选择的三个人口研究对象。所有患者均填写了经验证的胃肠道（GI）症状问卷、症状检查表-90- r （SCL-90-R）和躯体症状检查表（SSC），其中包括11个躯体抱怨项目。采用Logistic回归模型评估躯体症状/心理社会因素与肠易激综合征之间的关系，并对年龄和性别进行调整。在501名符合条件的受试者中，461名（92%）提供了完整的数据（平均年龄= 56岁，49%为女性）。IBS （Rome II标准）与较高的SSC和全球严重程度指数（SCL-90-R的GSI）得分相关。在SSC得分高（bb0 - 75百分位）的受试者中，43%的人报告了IBS，而SSC得分低（<25百分位）的受试者中只有10%报告了IBS。在GSI评分高（bbb60）的患者中，23%的患者报告了IBS，而GSI评分低（<40）的患者中有6%报告了IBS。具体来说，没有一个IBS受试者同时具有低SSC和低GSI得分。在社区中，心理因素和躯体化与肠易激综合征密切相关。然而，肠易激综合征可能与低心理困扰和/或躯体化无关。
Psychosocial factors may drive people with irritable bowel syndrome (IBS) to seek health care, but whether psychological factors are causally linked to IBS is controversial. One hypothesis is that IBS is a heterogeneous syndrome comprising two distinct conditions, one psychological and the other biological. However, it is unclear how many people with IBS in the community have little somatization and minimal psychosocial distress. The aim of our study was to estimate the proportion of people with IBS in a representative US community, who have low levels of somatic and psychological symptoms. The cohort comprised subjects from three randomly selected population studies from Olmsted County, Minnesota. All of them filled out a validated gastrointestinal (GI) symptom questionnaire, the Symptom Checklist-90-R (SCL-90-R), and the Somatic Symptom Checklist (SSC) comprising 11 somatic complaint items. Logistic regression models were used to evaluate the associations between somatic symptoms/psychosocial factors and IBS, adjusting for age and gender. Of the 501 eligible subjects, 461 (92%) provided complete data (mean age = 56 years, 49% female). IBS (Rome II criteria) was associated with both higher SSC and Global Severity Index (GSI of SCL-90-R) scores. Among subjects with high (>75th percentile) SSC scores, 43% reported IBS vs. 10% of those with low (<25th percentile) SSC scores. Among those with high (>60) GSI scores, 23% reported IBS vs. 6% with low (<40) GSI scores. Specifically, none of the IBS subjects had both low SSC and low GSI scores. Psychological factors and somatization are strongly associated with IBS in the community. However, IBS may not be related to low psychological distress and/or somatization.
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