IBS: Mental Health Factors and Comorbidities

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, affects up to 10% of the global population.¹ Psychological symptoms often are associated with IBS, increasing its burden and affecting quality of life.^1-3 About one third of patients with IBS experience anxiety or depression.¹ Multidisciplinary care, involving gastroenterologists, psychologists, and dietitians, is crucial to address both physical and emotional symptoms in patients with IBS.¹

Effective clinical pathways vary by patient profile. Some patients may have maladaptive cognitive processes that affect coping with IBS (e.g., avoidance behaviors and symptom-related anxiety) but do not meet criteria for a psychiatric disorder.² For these patients, referral to brain-gut behavior therapy (BGBT) is advised.² BGBTs can include cognitive behavioral therapy (CBT), gut-directed hypnotherapy, and mindfulness-based interventions, among others.³ These approaches can improve not only mental health symptoms and symptom-related stress but also gastrointestinal (GI) symptoms.⁴ For patients with psychiatric illnesses, referrals to psychiatrists or psychologists specialized in the patient’s specific comorbid condition are recommended.² It is also helpful for GI professionals to familiarize themselves with a few antidepressant medications for symptom-specific anxiety or mood symptoms when a psychiatrist is unavailable.^5,6 Some antidepressants, called central neuromodulators, also improve IBS symptoms.^5,6

Access to integrated IBS care remains a challenge. The number of GI psychologists is limited. Most digital applications aiming to bridge this gap have limitations, such as nonpersonalized approaches and problems with engagement.⁷ Other options to provide care for patients with IBS and psychological symptoms include support groups or nurse-led self-management programs, education, patient advocacy organizations, and placement of educational material in clinic waiting areas.³