To investigate the effects of anxiety and depression on the quality of life (QOL) in patients with irritable bowel syndrome with diarrhea (IBS-D) and the difference in gender.

IBS-D patients met the Rome Ⅲ diagnostic and subtyping criteria were consecutively enrolled. The intestinal symptoms, psychological status, and QOL of patients were evaluated using IBS-specific symptom questionnaires, the Hamilton anxiety scale (HAMA), the Hamilton depression scale (HAMD), and the Chinese Version of IBS-QOL instrument. The data were analyzed by chi-square test variance analysis, t test or Spearman rank correlation analysis.

A total of 155 IBS-D patients were enrolled. Among them, 115 were complicated with anxiety and/or depression. The number of male and female with comorbid psychological disorders was 69 cases(71.13%) and 46 cases(79.31%), respectively, and the difference was not statistically significant (χ²=1.267, P=0.26). Compared with 40 patients without anxiety or depression, there was no statistically significant difference (F=1.143, P>0.05) in the scores of intestinal symptoms in 59 patients with comorbid anxiety alone and 56 patients with anxiety and/or depression (20.85±5.84 vs. 21.71±7.47 vs. 22.87±6.09). The total IBS-QOL score of the 155 patients was 71.61±19.22. There was negative correlation between IBS-QOL score and HAMA, HAMD scores(r=-0.262 and -0.268, both P=0.001). The total IBS-QOL score of patients with comorbid anxiety and depression or depression were lower than that of patients without anxiety or depression (66.05±22.88 vs 77.22±15.35, F =4.412, P=0.005). Except health worrying and sexual, the scores in six dimensions(including dysphoria, interference with activity, body image, food avoidance and social reaction) were all significantly decreased (F=3.309, 3.279, 4.177, 3.765, 6.041 and 3.830, P=0.013, 0.012, 0.013, 0.007, 0.001 and 0.010). In male patients, the total score of IBS-QOL and the scores of dysphoria, body image and social reaction of patients with anxiety and depression or depression were lower than those of patients without anxiety and depression (t=2.143, 2.110, 2.279, 3.061; P=0.036, 0.039, 0.027, 0.003). In female patients, the score of food avoidance domain significantly decreased (t=2.812, P=0.008). The scores of IBS-QOL and six dimensions (including dysphoria, interference with activity, body image, food avoidance and social reaction) of patients with history of severe mental disorders and being abused were even lower than those patients without such histories (t=3.241, 3.433, 2.499, 2.296, 2.514, 3.413 and 2.601; P=0.001, 0.001, 0.014, 0.023, 0.013, 0.001 and 0.010).

The QOL of patients with IBS-D was significantly affected by psychological factors with gender differences. The approaches to improve the psychological status of IBS patients were helpful to enhance the efficacy of comprehensive therapy.

Irritable bowel syndrome with diarrhea; Anxiety; Depression; Quality of life; Gender