Abstract
Irritable Bowel Syndrome (IBS) is a chronic recurring disorder with variable illness episodes that may continue for many years. Diagnosis is based on symptoms such as abdominal pain and irregular bowel habits. These symptoms, plus the influence of psychological factors and extraintestinal symptoms, adversely affect the health-related quality of life (HRQoL) of individuals with IBS. This paper summarizes publications relating to the characteristics of IBS and associated HRQoL. Significantly lower scores on both the physical and mental health scales of the Short Form-36 are reported for individuals with IBS symptoms as compared with asymptomatic controls and US norms. IBS negatively affects general health, vitality, social functioning, bodily pain, diet, sexual function, sleep, and is associated with lost time from work. IBS-specific instruments that incorporate many of these domains have recently become available. HRQoL appears to correlate with IBS symptom severity and influences decisions to seek medical care. Psychosocial problems are also linked with IBS in relation to health care utilization. However, the full burden of this painful illness is still unknown since only 25–60% of individuals suffering from IBS symptoms see a physician for their illness.
Similar content being viewed by others
References
Heaton KW, O'Donnell LJ, Braddon FE, Mountford RA, Hughes AO, Cripps PJ. Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology 1992; 102: 1962-1967.
Jones R, Lydeard S. Irritable bowel syndrome in the general population. Br Med J 1992; 304: 87-90.
Longstreth GF, Wolde-Tsadik G. Irritable bowel type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates. Dig Dis Sci 1993; 38: 1581-1589.
Agreus L, Svardsudd K, Nyren O, Tibblin G. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology 1995; 109: 671-680.
Kay L, Jorgensen T, Jensen KH. The epidemiology of irritable bowel syndrome in a random population: prevalence, incidence, natural history and risk factors. J Int Med 1994; 236: 23-30.
Schlemper RJ, van der Werf SD, Vandenbroucke JP, Biemond I, Lamers CB. Peptic ulcer, non-ulcer dyspepsia and irritable bowel syndrome in The Netherlands and Japan. Scand J Gastroenterol Suppl 1993; 200: 33-41.
Drossman DA, Li Z, Andruzzi E, et al. US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38: 1569-1580.
O'Keefe EA, Talley NJ, Zinsmeister AR, Jacobsen SJ. Bowel disorders impair functional status and quality of life in the elderly: a population-based study. J Gerontol A Biol Sci Med Sci 1995; 50: 184-189.
Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 1991; 101: 927-934.
Zuckerman MJ, Guerra LG, Drossman DA, Foland JA, Gregory GG. Comparison of bowel patterns in Hispanics and non-Hispanic whites. Dig Dis Sci 1995; 40: 1763-1769.
Talley NJ, O'Keefe EA, Zinsmeister AR, Melton LJ. Prevalence of gastrointestinal symptoms in the elderly: a population-based study. Gastroenterology 1992; 102: 895-901.
Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978; 2: 653-654.
Drossman DA. Irritable bowel syndrome: the role of psychosocial factors. Stress Medicine 1994; 10: 49-55.
Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 1997; 112: 2120-2137.
Drossman DA. Irritable bowel syndrome. Gastroenterologist 1994; 2: 315-326.
Drossman DA. Presidential address: gastrointestinal ill-ness and biopsychosocial model. Psychosom Med 1998; 60: 258-267.
Dinan TG, O'Keane V, O'Boyle C, Chua A, Keeling PW. A comparison of the mental status, personality profiles and life events of patients with irritable bowel syndrome and peptic ulcer disease. Acta Psychiatr Scand 1991; 84: 26-28.
Masand PS, Kaplan DS, Gupta S, Bhandary AN. Irritable bowel syndrome and dysthymia. Is there a relationship? Psychosomatics 1997; 38: 63-69.
Lydiard RB, Fossey MD, Marsh W, Ballenger JC. Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics 1993; 34: 229-234.
Lydiard RB. Anxiety and the irritable bowel syndrome: psychiatric, medical, or both? J Clin Psychiatry 1997; 58: 51-58.
Walker EA, Gelfand AN, Gelfand MD, Katon WJ. Psychiatric diagnoses, sexual and physical victimization, and disability in patients with irritable bowel syndrome or inflammatory bowel disease. Psychol Med 1995; 25: 1259-1267.
Walker EA, Katon WJ, Jemelka RP, Roy-Bryne PP. Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) Study. Am J Med 1992; 92: 26-30.
Drossman DA, McKee DC, Sandler RS, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology 1988; 95: 701-708.
Kettell J, Jones R, Lydeard S. Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. British J Gen Pract 1992; 42: 459-461.
Whitehead WE, Bosmajian L, Zonderman AB, Costa PT, Schuster MM. Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology 1988; 95: 709-714.
Smith RC, Greenbaum DS, Vancouver JB, et al. Psychosocial factors are associated with health care seeking rather than diagnosis in irritable bowel syndrome. Gastroenterology 1990; 98: 293-301.
Naliboff BD, Balice G, Mayer EA. Psychosocial moderators of quality of life in irritable bowel syndrome. Eur J Surg Suppl 1998; Suppl 583: 57-59.
Dancey CP, Whitehouse A, Painter J, Backhouse S. The relationship between hassles, uplifts and irritable bowel syndrome: a preliminary study. J Psychosom Res 1995; 39: 827-832.
Whitehead WE, Crowell MD, Robinson JC, Heller BR, Schuster MM. Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 1992; 33: 825-830.
Levy RL, Cain KC, Jarrett M, Heitkemper MM. The relationship between daily life stress and gastrointestinal symptoms in women with irritable bowel syndrome. J Behav Med 1997; 20: 177-193.
Delvaux M, Denis P, Allemand H. Sexual abuse is more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicentre inquiry. French Club of Digestive Motility. Eur J Gastroenterol Hepatol 1997; 9: 345-352.
Walker EA, Katon WJ, Roy-Byrne PP, Jemelka RP, Russo J. Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease. Am J Psychiatry 1993; 150: 1502-1506.
Talley NJ, Boyce PM, Jones M. Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study. Gut 1998; 42: 47-53.
Talley NJ, Fett SL, Zinsmeister AR. Self-reported abuse and gastrointestinal disease in outpatients: association with irritable bowel-type symptoms. Am J Gastroenterol 1995; 90: 366-371.
Talley NJ, Fett SL, Zinsmeister AR, Melton LJ. Gastro-intestinal tract symptoms and self reported abuse: a population based study. Gastroenterology 1994; 107: 1040-1049.
Mayer EA, Fass R, Fullerton S. Intestinal and extraintestinal symptoms in functional gastrointestinal disorders. Eur J Surg Suppl 1998; 583: 29-31.
Maxton DG, Morris J, Whorwell PJ. More accurate diagnosis of irritable bowel syndrome by the use of ‘non-colonic’ symptomatology. Gut 1991; 32: 784-786.
Jones R, Lydeard S. Irritable bowel syndrome in the general population. Br Med J 1992; 304: 87-90.
Whorwell PJ, McCallum M, Creed FH, Roberts CT. Non-colonic features of irritable bowel syndrome. Gut 1986; 27: 37-40.
Orr WC, Crowell MD, Lin B, Harnish MJ, Chen JD. Sleep and gastric function in irritable bowel syndrome: derailing the brain-gut axis. Gut 1997; 41: 390-393.
Goldsmith G, Levin JS. Effect of sleep quality on symptoms of irritable bowel syndrome. Dig Dis Sci 1999; 38: 1809-1814.
Moldofsky H, Lue FA. Disordered sleep, pain, fatigue, and gastrointestinal symptoms in fibromyalgia, chronic fatigue and irritable bowel syndromes. In: Mayer EA, Raybould HE (eds), Basic and clinical aspects of chronic abdominal pain. Elsevier Science Publishers BV, 1993; 249-255.
Fass R, Fullerton S, Naliboff B, Hirsh T, Mayer EA. Sexual dysfunction in patients with irritable bowel syndrome and non-ulcer dyspepsia. Digestion 1998; 59: 79-85.
Cukier JM, Cortina-Borja M, Brading AF. A case control study to examine any association between idiopathic detrusor instability and gastrointestinal tract disorder, and between irritable bowel syndrome and urinary tract disorder. Br J Urol 1997; 79: 865-878.
Monga AK, Marrero JM, Stanton SL, Lemieux MC, Maxwell JD. Is there an irritable bladder in the irritable bowel syndrome? Br J Obstet Gynaecol 1997; 104: 1409-1412.
Magatti F, Quadri G, Tenore AC, Belloni C, Terruzzi V, Minoli G. Bladder dysfunction and irritable bowel syndrome. Urogynaecologia Int J 1992; 6: 105-111.
Sivri A, Cindas A, Dincer F, Sivri B. Bowel dysfunction and irritable bowel syndrome in fibromyalgia patients. Clin Rheumatol 1996; 15: 283-286.
Agreus L. Socio-economic factors, health care consumption and rating of abdominal symptom severity. A report from the abdominal symptom study. Fam Pract 1993; 10: 152-163.
Taub E, Cuevas JL, Cook EW, Crowell M, Whitehead WE. Irritable bowel syndrome defined by factor analysis. Gender and race comparisons. Dig Dis Sci 1995; 40: 2647-2655.
Talley NJ, Boyce P, Jones M. Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut 1998; 42: 690-695.
Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community based study. J Pediatr 1996; 129: 220-226.
Thomson S, Dancey CP. Symptoms of irritable bowel in school children: prevalence and psychosocial effects. J Pediatr Health Care 1996; 10: 280-285.
Thompson WG. Irritable bowel syndrome: prevalence, prognosis and consequences. Can Med Assoc J 1986; 134: 111-113.
Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 1992; 136: 165-177.
Stevens JA, Wan CK, Blanchard EB. The short-term natural history of irritable bowel syndrome: a time-series analysis. Behav Res Ther 1997; 35: 319-326.
Talley NJ, Zinsmeister AR, Melton LJ. Irritable bowel syndrome in a community: symptom subgroups, risk factors, and health care utilization. Am J Epidemiol 1995; 142: 76-83.
Glise H, Wiklund I, Hallerback B. Burden of illness in functional gastrointestinal disorder-the consequences for the individual and society. Eur J Surg Suppl 1998; 583: 67-72.
Talley NJ, Boyce PM, Jones M. Predictors of health care seeking for irritable bowel syndrome: a population based study. Gut 1997; 41: 394-398.
Scheuner S, Mahmood Z, Gomborone JE, Lavin F, O'Donnell LJD. Consultation patterns in the irritable bowel syndrome. Proc Dig Dis Week 1997; A-1069.
Fullerton S, Naliboff B, Mayer EA. Gender specific predictors of health care utilization for patients with irritable bowel syndrome. Gastroenterology 1998; 114: A14.
Talley NJ, Gabriel SE, Harmsen WS, Zinsmeister AR, Evans RW. Medical costs in community subjects with irritable bowel syndrome. Gastroenterology 1995; 109: 1736-1741.
Hahn BA, Saunders WB, Maier WC. Differences between individuals with self-reported irritable bowel syndrome (IBS) and IBS-like symptoms. Dig Dis Sci 1997; 42: 2585-2590.
Patrick DL, Drossman DA, Frederick IO, DiCesare J, Puder KL. Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci 1998; 43: 400-411.
Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Gast-roenterology 1982; 83: 529-534.
Drossman DA. A questionnaire for functional bowel disorders. Ann Int Med 1989; 111: 627-629.
Agreus L, Svardsudd K, Nyren O, Tibblin G. Reproducibility and validity of a postal questionnaire. The abdominal symptom study. Scand J Prim Health Care 1993; 11: 252-262.
Agreus L. The Epidemiology of Functional Gastrointestinal Disorders. Eur J Surg 1998; 164: 60-66.
Talley NJ, Phillips SF, Melton LJ, Wiltgen CM, Zinsmeister AR. A patient questionnaire to identify bowel disease. Ann Int Med 1989; 111: 671-674.
Talley NJ, Phillips SF, Wiltgen CM, Zinsmeister AR, Melton LJ. Assessment of functional gastrointestinal disease: the bowel disease questionnaire. Mayo Clin Proc 1990; 65: 1456-1479.
Talley NJ, Boyce PM, Owen BK, Newman P, Paterson KJ. Initial validation of a bowel symptom questionnaire and measurement of chronic gastrointestinal symptoms in Australians. Aust NZ J Med 1995; 25: 302-308.
Colwell LJ, Prather CM, Phillips SF, Zinsmeister AR. Effects of an irritable bowel syndrome educational class on health-promoting behaviors and symptoms. Am J Gastroenterol 1998; 93: 901-905.
O'Keefe EA, Talley NJ, Tangalos EG, Zinsmeister AR. A bowel symptom questionnaire for the elderly. J Gerontol 1992; 47: M116-M121.
Glia A, Lindberg G. Quality of life in patients with dif-ferent types of functional constipation. Scand J Gastroenterol 1997; 32: 1083-1089.
Svedlund J, Sjodin I, Dotevall G. GSRS-a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988; 33: 129-134.
Wiklund I. Aspects of quality of life in gastrointestinal disease: some methodological issues. Scand J Gastroenterol 1995; 30: 129-132.
Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther 1997; 11: 395-402.
Drossman DA, Li Z, Toner BB, et al. Functional bowel disorders. A multicenter comparison of health status and development of illness severity index. Dig Dis Sci 1995; 40: 986-995.
Drossman DA, Patrick DL, Whitehead WE, et al. Responsiveness of the IBS-QOL: further validation of a disease specific quality of life questionnaire for IBS. Gastroenterol 1999; 116(4): A988
Wong E, Guyatt GH, Cook DJ, Griffith LE, Irvine EJ. Development of a questionnaire to measure quality of life in patients with irritable bowel syndrome. Eur J Surg Suppl 1998; 583: 50-56.
Hahn BA, Kirchdoerfer LJ, Fullerton S, Mayer E. Evaluation of a new quality of life questionnaire for patients with irritable bowel syndrome. Aliment Pharmacol Ther 1997; 11: 547-552.
Hahn BA, Kirchdoerfer LJ, Fullerton S, Mayer E. Patient perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life. Aliment Pharmacol Ther 1997; 11: 553-559.
Hahn BA, Yan S, Strassels S. Impact of irritable bowel syndrome on quality of life and resource use in the United States and United Kingdom. Digestion 1999; 60: 77-81.
Chassany O, Marquis P, Scherrer B, et al. Validation of a specific quality of life questionnaire for functional digestive disorders. Gut 1999; 44: 527-533.
Marquis P. Development and validation of a disease-specific quality of life instrument in functional digestive disorders. Quality of Life Research 1997; 6: 434.
Chassany O, Geneve J, Abitbol JL, Scherrer B, Dapoigny M, Fraitag B. Specific quality of life questionnaire in irritable bowel syndrome. Effect of fedotozine. Gastroente-rology 1995; 108: A581.
Chassany O, Bergmann JF. Quality of life in irritable bowel syndrome, effect of therapy. Eur J Surg Suppl 1998; 583: 81-86.
Chassany O, Marquis P, Scherrer B, Sapede C, Geneve J, Fraitag B. Health status survey questionnaire (SF-36) in dyspepsia and irritable bowel syndrome. Quality of Life Research 1997; 6: 454.
Toner BB, Stuckless N, Ali A, Downie F, Emmott S, Akman D. The development of a cognitive scale for functional bowel disorders. Psychosom Med 1998; 60: 492-497.
Toner BB, Segal ZV, Emmott S, et al. Cognitive-behavioral group therapy for patients with irritable bowel syn-drome. Int J Group Psychother 1998; 48: 215-243.
Whitehead WE, Burnett CK, Cook EW, Taub E. Impact of irritable bowel syndrome on quality of life. Dig Dis Sci 1996; 41: 2248-2253.
Strassels SA, Hahn BA. Short-Form 36 (SF-36) scores in patients with irritable bowel syndrome (IBS) compared with US norms. Proc Dig Dis Week 1997; A-1068.
Depew W, Vanner S, Paterson W, et al. Development and validation of a quality of life (QOL) tool for irritable bowel syndrome (IBS). Gastroenterology 1998; 114: A10.
Mangel AW, Hahn BA, Heath AT, et al. Adequate relief as an endpoint in clinical trials in irritable bowel syndrome. J Int Med Res 1998; 26: 76-81.
O'sullivan M, Mahmud N, Lovett E, Kelleher D, O'Morain CA. Impaired quality of life in irritable bowel syndrome as compared to organic bowel disease. Proc Dig Dis Week 1997; A1071.
McGee HM, O'Boyle CA, Hickey A, O'Malley K, Joyce CR. Assessing the quality of life of the individual: the SEIQoL with a healthy and a gastroenterology unit pop-ulation. Psychol Med 1991; 21: 749-759.
Rose JD, Troughton AH, Harvey JS, Smith PM. De-pression and functional bowel disorders in gastrointestinal outpatients. Gut 1986; 27: 1025-1028.
Schwarz SP, Blanchard EB, Berreman CF, et al. Psychological aspects of irritable bowel syndrome: comparisons with inflammatory bowel disease and nonpatient controls. Behav Res Ther 1993; 31: 297-304.
Flynn L, Davidson P, Davidson J, Vanner S. Marital intimacy and psychological factors in irritable bowel syndrome (IBS) patients: new insights. Proc Dig Dis Week 1997; A-1069.
Lembo T, Fullerton S, Diehl D, et al. Symptom duration in patients with irritable bowel syndrome. Am J Gastroenterol 1996; 91: 898-905.
Saba L, Mayer EA, FitzGerald L, Fullerton S, Naliboff B. Empirically derived psychological subgroups of IBS patients differ on symptoms and quality of life. Proc Dig Dis Week 1997; A1071.
Talley NJ, Boyce P, Owen BK. Psychological distress and seasonal symptom changes in irritable bowel syndrome. Am J Gastroenterol 1995; 90: 2115-2119.
Goldberg DP, Cooper B, Eastwood M, Kedward H, Shepherd M. A psychiatric interview suitable for using in community surveys. Br J Prevent Med 1970; 24: 18-26.
Corney RH, Stanton R, Newell R, Clare A, Fairclough P. Behavioural psychotherapy in the treatment of irritable bowel syndrome. J Psychosom Res 1991; 35: 461-469.
Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther 1997; 11: 395-402.
Zigmond AS, Snaith RP. The hospital anxiety and de-pression scale. Acta Psychiatr Scand 1983; 67: 361-370.
Guthrie E, Creed FH, Whorwell PJ. Severe sexual dysfunction in women with the irritable bowel syndrome: comparison with inflammatory bowel disease and duodenal ulceration. Br Med J 1987; 295: 577-578.
Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther 1997; 11: 1019-1030.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Luscombe, F.A. Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: A review. Qual Life Res 9, 161–176 (2000). https://doi.org/10.1023/A:1008970312068
Issue Date:
DOI: https://doi.org/10.1023/A:1008970312068