Introduction
IBS patients are often high healthcare utilizers. Symptom frequency, as well as psychological factors like neuroticism, anxiety, and depression, impact healthcare seeking. Bothersomeness, i.e., how distressing or disruptive symptoms are to a person’s daily life, is a potential treatment-seeking motivator in IBS. We aimed to evaluate symptom bothersomeness in IBS and its potential influence on healthcare utilization.
Aims & Methods
Adults in 9 countries (Canada, China, Germany, Japan, Mexico, Poland, Romania, Spain, United States) completed an online survey that included IBS Rome IV Diagnostic Questions, lifetime healthcare utilization (HCU) for IBS (Yes/No); depression and anxiety; negative emotionality/neuroticism (NE), or a person’s tendency to experience anxiety, anger, frustration, pessimism, or depressed mood; demographic questions and the question “Is the [symptom] bothersome to you?” (yes/no) for each: abdominal pain, hard/lumpy stools, and soft/mushy stools. Three separate binary logistic regression models assessed the symptom's frequency, depression, anxiety, NE, sex, and age as predictors of bothersomeness for each of the key IBS symptoms. Three additional regression models evaluated each symptom's bothersomeness and frequency, depression, anxiety, NE, sex, and age as predictors of HCU.
Results
Of 17,663 participants, 1,389 (7.9%) met Rome IV criteria for IBS (mean age 41.6 (SD 14.7) years, 62.3% female; IBS sub-types: 32% C, 29% D, 36% M, 4% U). Of those with IBS, 65.7% had ever visited a doctor because of bowel problems. Abdominal pain was rated bothersome by 93% of people with IBS, hard stools by 80%, and mushy/watery stools by 78%, with no sex differences. Older people (ages 65+) reported only hard stools as more bothersome (t(1236) = -3.40, 95%CI: -5.54 to -1.49, p<.001) than people of ages 18-39 or 40-64. Bothersomeness (yes/no) was predicted in regression analyses by higher frequencies of abdominal pain [Odds Ratio (OR) and 95% CI: 2.00 (1.46-2.74)], hard stools [1.33 (1.24-1.43)], and mushy stools [(1.24 (1.16-1.31)], but not by age, sex, or psychological variables. People with IBS were significantly more likely (χ2) to have ever visited a doctor for bowel problems if they rated their pain (p = .003), hard stools (p = .020), and mushy stools (p < .001), as bothersome. Finding pain and mushy stools bothersome (yes/no) increased the odds of HCU for pain and mushy stools, but not for hard stools in the regression models (Table 1). Higher frequency of pain and hard stools (but not mushy stools) also increased HCU odds, and older people were more likely to consult for all 3 symptoms. Psychological variables and sex were not significant predictors of HCU.
Table 1. Binary regression analyses for predicting IBS lifetime doctor consulting for bowel symptoms
| | Dependent variable: Ever sought care for this symptom (yes/no) |
| | 1. Abdominal pain | 2. Hard/lumpy stools | 3. Mushy/watery stools |
| Predictors: | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p |
| Symptom bothersomeness | 1.82 (1.18-2.79) | .006 | 1.24 (0.92-1.67) | .160 | 1.81 (1.37-2.40) | <0.01 |
| Symptom Frequency | 1.16 (1.03-1.32) | .019 | 1.06 (1.00-1.11) | .036 | | .254 |
| Age | 1.02 (1.01-1.02) | <.001 | 1.01 (1.01-1.02) | .002 | 1.02 (1.01-1.03) | <.001 |
| Sex | | .725 | | .507 | | .510 |
| Anxiety Score (PHQ-4) | | .423 | | .562 | | .489 |
| Depression Score (PHQ-4) | | .974 | | .977 | | .717 |
| Negative Emotionality Score | | .135 | | .258 | .96 (.94-1.00) | .040 |
Conclusion
For persons with IBS, subjective experience of how bothersome symptoms are is strongly associated with symptom reporting and a driving factor to HCU regardless of gender, psychological distress, or negative emotionality. Providers need to assess symptom bothersomeness in their clinical decision-making.
