Original articlesGastrointestinal symptoms in primary care: Prevalence and association with depression and anxiety
Introduction
Gastrointestinal (GI) symptoms are common in primary health care, accounting for about 1 in 12 consultations [1]. For example, abdominal pain accounts for more than 10 million clinical visits annually in the United States [2]. At the same time, about 30% of primary care patients suffer from the two most frequent mental health problems in primary care, that is, depression and anxiety [3], [4], [5], [6], [7], [8], [9]. In patients with unexplained GI complaints undergoing upper endoscopy, psychiatric disorders were detected in 60% of patients [10]. Data from the general population suggest that there is a strong association between GI symptoms, depression, and specific anxiety disorders, such as agoraphobia and panic disorder [11], [12], [13]. In addition, a recent general population study found that GI diseases were significantly associated with anxiety disorders [14]. However, there is only limited knowledge on the association of GI symptoms, anxiety, and depression in medical settings, and primary care studies investigating this issue are completely lacking.
In unselected primary care patients, several studies identified the number of physical complaints as predictor of psychiatric comorbidity [15], [16], [17], [18], [19]. Based on this finding, we hypothesized that GI symptoms are associated with elevated rates of depression and anxiety in primary care. Given that the recognition of mental health problems in primary care is often difficult [20] and that depression and anxiety often go unrecognized [8], [21], [22], the knowledge of the co-occurrence with GI symptoms can help to enhance physicians' attention toward the presence of anxiety and depression in patients with GI symptoms and to initiate treatment as appropriate.
To investigate the relationship between GI symptoms, anxiety, and depression, we sought to answer the following questions: First, what is the prevalence of self-reported GI symptoms in the primary care setting? Second, do patients with GI symptoms differ from those without GI symptoms in terms of demographic characteristics, health-related quality of life (HRQoL), depression, and anxiety? Third, is there a higher risk of current depression and anxiety in patients with GI symptoms? Fourth, are specific GI symptoms related with specific types of anxiety disorders and is the number of GI symptoms associated with the presence of specific anxiety disorders?
Section snippets
Patient sample
This study was part of the first phase of the Patient Health Questionnaire (PHQ) Anxiety Study that was conducted to develop a short self-administered measure for generalized anxiety disorder [8], [23]. Patients were enrolled from a research network of 15 primary care sites (13 family practices, 2 internal medicine) located in 12 states in the United States and administered centrally by Clinvest, Inc., from November 2004 to June 2005. To minimize sampling bias, we approached consecutive
Patient characteristics and prevalence of GI symptoms
Of the 2149 patients, 31 (1.4%) did not complete the PHQ-15 items on GI complaints, and of these 31, 8 belong to the telephone interviewed subgroup. These patients were excluded from further data analysis. The mean age of the remaining 2118 patients was 47.1 years (S.D.=15.4, range=18–95 years). Sixty-six percent of the patients were women, 81% were non-Hispanic White, and 64% were married. Regarding education, 63% had some college education or were college graduates. Patients reported a mean
Discussion
This is the first study that investigates the relationship between GI symptoms, anxiety, and depression in primary health care. With 18% of patients being bothered substantially by at least one GI symptom, our results support conclusions from earlier studies in that GI symptoms are a major problem in primary health care [1], [2]. The clinical relevance of this finding is underlined by the fact that patients with GI symptoms were significantly more impaired with respect to disability days,
Acknowledgments
Collection of data in this study was supported by an unrestricted educational grant from Pfizer, Inc., for the development of the Generalized Anxiety Disorder Screener (GAD-7). The authors have no conflict of interest in connection with this article.
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