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Chronic diarrhea, constipation more common in patients with depression
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Mood likely has an impact on a person’s specific bowel habits, according to study results.
Sarah Ballou, PhD, of the department of medicine at Beth Israel Deaconess Medical Center, and colleagues wrote that the bilateral relationship of the brain-gut axis means that gastrointestinal symptoms and mental health issues are often intertwined.
“Patients with diagnosed depression report significantly more frequent gastrointestinal symptoms compared to individuals without depression, with bowel-related symptoms highly associated with depression severity scores,” they wrote. “Although the relationship between mood and gastrointestinal comorbidities has been well established, there is less data evaluating the relationship between mood and specific bowel habits (ie, constipation or diarrhea).”
Researchers analyzed data from the National Health and Nutrition Examination Survey to study the link between depression and bowel habits. They identified 495 individuals diagnosed with depression between 2009 and 2010 and 4,709 individuals without depression who completed a bowel health questionnaire.
Investigators found that more individuals with depression reported disordered bowel habits compared with individuals without depression (24.6% vs. 12.6%). Specifically, chronic diarrhea was more prevalent among patients with depression (15.53%; 95% CI, 11.34%–20.9%) compared with individuals without depression (6.05%; 95% CI, 5.24%–6.98%; P = .0001).
Ballou and colleagues also found that chronic constipation was also more common in individuals with depression (9.1%; 95% CI, 7.02%–11.69% vs. 6.55%; 95% CI, 5.55%–7.7%; P = .003). Mean depression scores in patients with chronic diarrhea or chronic constipation were higher than those among patients who reported normal bowel habits (P < .001).
Although moderate and severe depression were linked to chronic diarrhea, they were not associated with chronic constipation, and only mild depression was significantly associated with chronic constipation.
Ballou and colleagues wrote that gastroenterologists need to be comfortable with screening patients for concerns involving low mood and working with mental health professionals to help treat patients. They also wrote that the field of psychogastroenterology needs to be explored more deeply.
“These therapies are typically short-term and problem-focused interventions (such as cognitive behavioral therapy or gut-focused hypnotherapy) that are distinct from traditional psychotherapy treatments for depression or anxiety,” they wrote. “There is a need for additional research regarding the specific impact of psychogastroenterology treatment on bowel function and mood in order to further understand the complex relationship between depression and bowel habits.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Linda Nguyen, MD
These results highlight the importance of asking about a patient’s mood when caring for someone with chronic bowel symptoms. In addition to finding that depression was more common among patients with chronic constipation or diarrhea, the authors found that those with depression and chronic bowel symptoms had higher depression scores than those without bowel symptoms. However, the study does not address cause and effect.
I caution people to not interpret these results as depression is the cause of a person’s diarrhea or constipation. We do not know whether the depression came first and triggered the bowel symptoms, or if it was the presence of chronic bowel symptoms that precipitated the depression.
All we can really say is that diarrhea and constipation are associated with depression.
What this study does highlight is that the brain and the gut are interconnected; thus, serves as a reminder that we have to take care of the whole person by treating both the brain and the gut simultaneously. Patients with chronic digestive disorders should be screened for overlapping mood disorders and referred for appropriate mental health services.
My biggest concern with these results is the potential for misinterpretation. There is a lot of fear among patients that this study will further stigmatize patients with chronic bowel symptoms, suggesting that their digestive issues are a result of the depression and that if they somehow stopped being depressed, everything would be fine. This does not mean that physicians should shy away from screening and addressing mood disorders in our patients. It means that we must recognize the brain-gut connection, help our patients understand the link between physical and mental health, and partner with our mental health colleagues to provide optimal care for our patients.
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