Original ArticlesDo psychosocial factors define symptom severity and patient status in irritable bowel syndrome?
Section snippets
Do psychosocial factors distinguish patients with IBS from patients with no IBS?
Most patients with IBS do not see physicians,7, 8 and most who seek medical care are cared for in the primary care sector. It is only a very small proportion of patients with IBS with severe or refractory symptoms who get referred to major medical centers,2, 3 and it is these patients who receive most of the clinical investigation at significant financial cost.9
An important question is whether it is the severity of the symptoms per se or the mediating effects of psychosocial factors on symptom
Do psychosocial difficulties predict poorer health outcome?
Given that psychosocial factors predict patient status, we can now address their effect on other health outcomes. The research model we have used over the last 10 years to conceptualize and study this issue is shown in Figure 4. Early life factors (e.g., genetic predisposition and environmental factors) influence later psychosocial factors, physiologic functioning, their interaction via the CNS–enteric nervous system (ENS) axis and susceptibility to developing IBS. The combined and integrated
Do patients with more severe IBS have greater psychosocial difficulties than patients with less severe IBS?
The final question addresses whether psychosocial factors discriminate patients with severe IBS from those with less severe IBS. If this is true, then clinical trials evaluating a medication targeted to the gut may need to adjust for psychosocial factors or exclude patients with severe illness, because psychosocial disturbances will confound the results.
To address this from a research standpoint, we must do the following: (1) define and clinically categorize illness severity, (2) develop a
Summary and implications
In summary, multiple lines of evidence suggest that for patients with IBS, psychological difficulties are strongly related to symptom severity and patient status. This has important implications for clinical practice, because optimal patient care requires that the physician identify and address the psychosocial determinants of the clinical condition and its outcome.
There are also implications with regard to pharmaceutical treatment trials. First, the recruitment method (e.g., by advertising or
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