Journal of Neurogastroenterology and Motility 2020; 26(2): 289-290  https://doi.org/10.5056/jnm19191
Psychosocial Factors Linked and Associated to Irritable Bowel Syndrome
Min Chen* and Xujun Ye
Department of Geriatrics, Zhongnan Hospital, Wuhan University, Hubei, China
Published online: April 30, 2020.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

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TO THE EDITOR: Irritable Bowel Syndrome (IBS) is a diagnosis of exclusion, which means that doctors diagnose this issue after eliminating all the other possibilities such as problems from celiac, organic, alcoholic, endocrinal, cardiac, pharmacological sources, etc. Then, doctors evaluate patient’s symptoms whether they interacted with the multi-factors such as diet, psychiatric, microbiologic, autonomic, etc, since IBS patients have normal bloodwork and other tests. It seems that, in addition to the Rome criteria, psychosocial factors evidently exposed to subjects can be clinically important.

A study of “Psychosocial factors associated with irritable bowel syndrome development in Chinese college freshmen” published recently is the first comprehensive investigation focusing on the psychosocial factors of IBS in subjectively representing a population of Chinese college students.1 The research group led by Dr Tao Bai and Dr Xiaohua Hou randomly selected 2449 freshmen with questionnaires to which there were responded by 2053.1 The data of the demographics and psychosocial risks were analyzed by ordinal and multiple logistic regression, the characteristics being classified in comparing among 3 groups of non-discomfort, chronic abdominal discomfort, and IBS. They revealed a high likelihood of IBS associated with experience of abuse and suicidal intention, and chronic abdominal discomfort associated with depression (Table 1).1 This finding is consistent with other studies.2 What was commonly thought of IBS as a civilized issue with respect to the residency did not show significant difference in China. Unexpectedly, another characteristic factor among students as “not only one child” was not significantly different to the “only one child” in which more information is probably needed, or probably those populations who were not “only one child” might be stressed differently under the policy of “only one child” at that time in China. Similarly, ANOVA did not show the difference between “Yes” and “No” in terms of “single parent.” It is necessary to know that a “single parent” occurred at what age of the child because the “hurt” is drastically different upon when the parent was deprived of the child according to animal model studies.3 It may be necessary in future studies to compare among the groups of infant and toddler (< 3 years), preschool (3-7 years), a school-age (7-12 years), and an adolescent (12-18 years) at the time of parental divorce, to reveal the correlation between parental divorce and development of IBS in children. In addition, children of divorced parents were divided into groups according to living with a father or a mother, to analyze the possible risk factors for IBS related with a single parent, and the conditions associated with developing IBS in children.

In ordinal logistic regression analysis with risk factors for IBS development (Table 2), authors observed IBS distributions in sex, the experience of abuse, and suicidal intention that are consistent with ANOVA analysis as in Table 1, and consistent to the observations performed by other groups.4,5 What relatively harmful intertwined influence hidden in ANOVA is our interest to see if possibly discerned by logistic regression analysis. Here, P-value and odds ratio (OR) “not consistent” with each other could be seen in Education as an example, in which P was 0.012 in ANOVA (Engineering > Medicine > Art to IBS), but OR was closer or no association on either of project study to IBS. An OR of 1 in this study would mean no association between the factor and IBS. When the 95% CI of the OR does not include 1, we conclude it is a significant association. Thus, in this context ORs < 1 are protective, > 1 are harmful. Thus an OR of 1.39 in Single parent seems signifying a P-value 0.197 in “Yes” vs “No” group, this expresses the harm of “Yes” vs to “No,” which is more intuitive to interpret: the odds of those on Single parent “Yes” having IBS is a slightly greater than that of “No.”

Most of our IBS patients are with more psychosocial stress than the general population. It is possible to be either an independent variable because they are stressed people, or dependent on variables because another variable such as inflammation activates the stress pathway causing physiological stress. Therefore, IBS characteristic factors from psychosocial stress remain a complicated mystery beyond the descriptions of P-value and OR.

Footnotes

Financial support: None.

Conflicts of interest: None.

Author contributions: Min Chen: designed the study and wrote the manuscript; and Xujun Ye: performed data analysis.

Tables

General Characteristics of Participants According to Irritable Bowel Syndrome Development (Adapted From Jiang et al1)

Characteristics Non-discomfort group Abdominal discomfort group IBS group P-value
Sex < 0.001
Females 574 (32.0) 108 (61.4) 49 (59.8)
Males 1221 (68.0) 68 (38.6) 33 (40.2)
Education 0.012
Engineering 1175 (65.5) 103 (58.5) 42 (51.2)
Liberal arts 125 (7.0) 17 (9.7) 12 (14.6)
Medicine 495 (27.5) 56 (31.8) 28 (34.1)
Residence 0.655
City 827 (46.1) 84 (47.7) 43 (52.4)
Rural area 567 (31.6) 58 (33.0) 21 (25.6)
Town 401 (22.3) 34 (19.3) 18 (22.0)
Only child 0.594
Yes 1060 (59.1) 103 (58.5) 53 (64.6)
No 735 (40.9) 73 (41.5) 29 (35.4)
Single parent 0.235
No 1693 (94.4) 161 (91.5) 76 (92.7)
Yes 100 (5.6) 15 (8.5) 6 (7.3)
Anxiety 0.007
No 1752 (97.6) 171 (97.2) 75 (91.5)
Yes 43 (2.4) 5 (2.8) 7 (8.5)
Depression < 0.001
No 1727 (96.2) 172 (97.7) 69 (84.1)
Yes 68 (3.8) 4 (2.3) 13 (15.9)
Experience of abuse 0.001
No 1767 (98.4) 174 (98.9) 75 (91.5)
Yes 28 (1.6) 2 (1.1) 7 (8.5)
Suicidal intention 0.001
No 1747 (97.3) 169 (96.0) 75 (91.5)
Yes 48 (2.7) 7 (4.0) 7 (8.5)

IBS, irritable bowel syndrome.

Values were expressed as n (%).


Ordinal Logistic Regression Analysis Wish Risk Factors for Irritable Bowel Syndrome Development (Adapted from Jiang et al1)

Characteristics Estimate SE WALS P-value OR (95% CI)
Education
Engineering –0.0 0.1 0.0 0.948 0.99 (0.73-1.34)
Liberal arts 0.1 0.2 0.4 0.540 1.15 (0.72-1.86)
Medicine 1
Single parent
No 1
Yes 0.3 0.2 1.7 0.197 1.39 (0.84-2.32)

WALS, weighted-average least squares.


References
  1. Jiang C, Xu Y, Sharma S, et al. Psychosocial factors associated with irritable bowel syndrome development in Chinese college freshmen. J Neurogastroenterol Motil 2019;25:233-240.
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  3. Liu L, Li Q, Sapolsky R, et al. Transient gastric irritation in the neonatal rats leads to changes in hypothalamic CRF expression, depression- and anxiety-like behavior as adults. PLoS One 2011;6:e19498.
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  4. Tayama J, Nakaya N, Hamaguchi T, et al. Maladjustment to academic life and employment anxiety in university students with irritable bowel syndrome. PLoS One 2015;10:e0129345.
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  5. Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 1982;83:529-534.
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