Prevalence of irritable bowel syndrome among university students: The roles of worry, neuroticism, anxiety sensitivity and visceral anxiety

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Abstract

Objective

Relationships between presence of irritable bowel syndrome (IBS) and generalized anxiety disorder (GAD), chronic worry, neuroticism, anxiety sensitivity and anxiety about visceral sensations were examined among university students.

Methods

College student participants were administered self-report diagnostic measures of IBS and GAD, the Penn State Worry Questionnaire (PSWQ), the Neuroticism subscale of the Eysenck Personality Questionnaire, the Anxiety Sensitivity Index (ASI) and five additional items designed to measure visceral anxiety.

Results

The prevalence of IBS and its associated characteristics among students were similar to previous community survey studies, with the exception of lower symptom severity in the university sample. IBS was associated with a higher frequency of GAD and greater worry, neuroticism, anxiety sensitivity and visceral anxiety. Logistic regression analyses further showed that the measure of anxiety specific to visceral sensations was the strongest predictor of IBS diagnostic status.

Conclusion

While various aspects of anxiety appear related to IBS, specific anxiety about visceral sensations appears to be the most significant factor. Implications of the associations between anxiety-related variables, particularly anxiety about visceral sensations, are discussed.

Introduction

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects 10–20% of the general population at any one time [1], [2]. Both in population and in clinical samples, women are almost twice as likely as men to meet diagnostic criteria for IBS in Western countries [3], [4]. Several investigations demonstrate a high prevalence of comorbid psychiatric conditions, especially anxiety and mood disorders, among those suffering from IBS [5], [6]. Panic disorder and generalized anxiety disorder (GAD), in particular, have been linked to IBS and gastrointestinal distress [7], [8], [9], [10], [11], [12]. Consistent with developmental theories of IBS, we have suggested that anxiety about visceral sensations and fear conditioning to visceral interoceptive cues may play a key role in the development of the full syndrome [5]. Investigations of the developmental course of IBS show that symptoms often appear in early adulthood [13] but that children with recurrent abdominal pain may be at a heightened risk for developing IBS especially in response to stress [14]. Despite this hypothesized developmental course of IBS, little is known about the prevalence and nature of IBS in young adults or its association with psychological symptoms such as anxiety. Gick and Thompson [15] demonstrated that undergraduates with IBS reported higher trait anxiety than asymptomatic control students and a 37% prevalence of IBS. Only a single self-report anxiety symptom measure was included. In another study of a small sample (n=127) of college students [16], less than 16% were identified with any bowel disorder and only 6.3% were identified with IBS using Rome I criteria. This small literature therefore provides an uncertain estimate of the prevalence of IBS in young adults and not enough data to evaluate if there is a similar overlap of IBS with anxiety symptoms as found in adults. The purpose of the current study was to explore the prevalence and nature of IBS in a young adult population and to identify relationships between IBS and specific anxiety measures.

Section snippets

Participants

A total of 1021 university students (331 men, 618 women and 72 unspecified) from three undergraduate psychology classes (n=569, 322 and 130, respectively) completed the questionnaire packet. While these psychology classes are among the most widely attended of all undergraduate classes, regardless of major area of study, the gender distribution (approximately 65% female) includes a somewhat higher proportion of females than the UCLA undergraduate population as a whole (45% male, 55% female). The

Sample characteristics

Approximately 91% of students enrolled in the undergraduate psychology classes involved with mass testing elected to participate. Of the original 1021 participants, 905 (88.6%) fully completed the IBS questionnaire, allowing for determination of IBS diagnostic status. All analyses were therefore limited to this final sample. IBS was detected in 99 of these 905 participants (10.9%). An additional 29 participants (3.2%) endorsed continuous or repeated lower abdominal discomfort or pain for the

Discussion

Approximately 11% of this college student sample currently met diagnostic criteria for IBS, falling between the 6.3% reported by Norton et al. [16] and the 37% reported by Gick and Thompson [15] in previous university student investigations. Although the newer Rome II diagnostic criteria were used for the current study, this 11% IBS prevalence rate is comparable to the 13.5% reported for 15–34-year-old participants in the U.S. household survey [4], which utilized the original Rome I criteria,

References (30)

  • WG Thompson et al.

    Irritable bowel syndrome: guidelines for the diagnosis

    Gastroenterol Int

    (1989)
  • DA Drossman et al.

    U.S. householder survey of functional gastrointestinal disorders

    Dig Dis Sci

    (1993)
  • EA Mayer et al.

    Depression, anxiety, and the gastrointestinal system

    J Clin Psychiatry

    (2001)
  • RB Lydiard

    Irritable bowel syndrome, anxiety, and depression: what are the links?

    J Clin Psychiatry

    (2001)
  • RB Lydiard et al.

    Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area Project

    Am J Psychiatry

    (1994)
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