Original articles
Suicidal ideation in patients with irritable bowel syndrome

https://doi.org/10.1016/S1542-3565(04)00545-2Get rights and content

Background & Aims: Irritable bowel syndrome (IBS) traditionally is considered as more of a nuisance than having especially serious consequences. However, this is not the picture witnessed in tertiary care where we have encountered some tragic cases, prompting an assessment of suicidal ideation in such patients. Methods: One hundred follow-up, tertiary care IBS (tIBS) patients were compared with 100 secondary IBS (sIBS), 100 primary IBS (pIBS) care patients, and 100 patients with active inflammatory bowel disease (IBD). Patients were asked if they had either seriously contemplated or attempted suicide specifically because of their bowel problem as opposed to other issues. The hospital anxiety depression score was recorded, as were other clinical details on all patients. Results: A total of 38% of tIBS patients had contemplated suicide because of their symptoms compared with 16% and 4% in the sIBS and pIBS groups (tIBS vs. sIBS vs. pIBS, P = .002, P < .001). The figure for IBD was 15% (tIBS v. IBD, P < .001). Five tIBS and 1 IBD patient had attempted suicide for gastrointestinal reasons. Mean depression scores did not exceed threshold (10) in the sIBS group contemplating suicide (9.7), but were increased in the equivalent tIBS group (11.7). Hopelessness because of symptom severity, interference with life, and inadequacy of treatment were highlighted as crucial issues for all IBS patients. Conclusions: IBS has the potential for a fatal outcome from suicide with depression not accounting for all the variance in suicidal ideation. Our observations emphasize the level of hopelessness felt by these patients and the need for improvement in the services provided to them.

Section snippets

Methods

Questionnaires were distributed by 1 of 2 researchers (V.M., L.H.) consecutively to follow-up IBS patients during their attendance at our tertiary and secondary care clinics and to patients in primary care who had never been referred to a hospital specialist for their gastrointestinal problem. In the UK hospital care system, tertiary care patients are defined as those who have been referred from other specialists for a further opinion as opposed to secondary care referrals, who initially come

Results

All patient groups were comparable in terms of their demography with the exception of age and unemployment caused by their disease. With regard to unemployment, there was a stepwise increase in this parameter in the IBS patients, with values of 0%, 13%, and 25% for the pIBS, sIBS, and tIBS groups, respectively (P < .001). The value for the IBD group was 17%. With respect to age, the pIBS patients were slightly younger than the other groups, but adjusting all the comparisons for age made no

Discussion

This study clearly shows that tIBS patients have an extraordinarily high rate of suicidal ideation, which is far in excess of that observed in a comparable group of patients suffering from active IBD. Even secondary care IBS patients are troubled by this problem as much as individuals with active IBD. Symptom severity and interference with life as a result of the inadequacy of treatment seem to be important factors leading to this situation.

There is considerable debate about the relationship

References (26)

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