Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The Zurich Study: XXII

Epidemiology of gastrointestinal complaints and comorbidity with anxiety and depression

  • 63 Accesses

  • 40 Citations


A representative cohort of Swiss adults recruited at age 20 years and interviewed at ages 23, 28 and 30 years was studied regarding the symptomatology, prevalence and longitudinal course of functional gastrointestinal symptoms and their association with psychiatric syndromes. A functional gastrointestinal complaint was identified if a proband reported symptoms at least eight times in the past year or for a duration of at least 2 weeks without medical explanation and with a moderate degree of distress. Of the population, 9.4–17.7% was found to suffer from functional stomach complaints and 4.9–16% from functional intestinal complaints. Women reported functional gastrointestinal complaints two to three times more often than men, and increasingly so with age. The overlap of stomach and intestinal complaints was modest with 2.0–6.7%. Cross sectionally, functional stomach complaints were significantly associated with major depression (DSM-III-R), recurrent brief depression (RBD), subthreshold RBD and dysthymia, and with subthreshold panic disorder, agoraphobia, social phobia and recurrent brief anxiety. Functional intestinal complaints showed a consistently significant association with RBD, dysthymia, major depression, subthreshold RBD, panic disorder, subthreshold panic disorder, agoraphobia, simple and social phobia and generalized anxiety disorder. Individuals who at younger ages suffered from functional gastrointestinal complaints did not show an increased risk for a subsequent development of an anxiety or depressive disorder. Functional gastrointestinal complaints reflect an unspecific concomitant vegetative disturbance common to depression and anxiety; they do not reflect a risk factor for the development of a specific anxiety or depressive disorder.

This is a preview of subscription content, log in to check access.


  1. Agréus L, Svärdsudd K, Nyrén O, Tibblin G (1994) The epidemiology of abdominal symptoms: prevalence and demographic characteristics in a Swedish adult population. Scand J Gastroenterol 29:102–109

  2. Almy TP (1951) Experimental studies on the irritable colon. Am J Med 10:60–67

  3. Almy TP (1973) The gastrointestinal tract in man under stress. In: Sleisenger MH, Fordtran JS (eds) Gastrointestinal disease. Saunders, Philadelphia

  4. Angst J, Hochstrasser B (1994) Recurrent brief depression: the Zurich Study. J Clin Psychiatry 55 (Suppl):3–9

  5. Angst J (1992) Recurrent brief psychiatric syndromes of depression, hypomania, neurasthenia, and anxiety from an epidemiological point of view. Neurol Psychiatry Brain Res 1:5–12

  6. Angst J, Dobler-Mikola A, Binder J (1984a) The Zurich Study—a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. I: Problem, methodology. Eur Arch Psychiatry Neurol Sci 234:13–20

  7. Angst J, Dobler-Mikola A (1984b) The Zurich Study: II. The continuum from normal to pathological depressive mood swings. Eur Arch Psychiatry Neurol Sci 234:21–29

  8. Angst J, Dobler-Mikola A (1984c) The Zurich Study: III. Diagnosis of depression. Eur Arch Psychiatry Neurol Sci 234:30–37

  9. Angst J, Dobler-Mikola A (1985) The Zurich Study: a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. IV. Recurrent and nonrecurrent brief depression. Eur Arch Psychiatr Neurol Sci 234:408–416

  10. Angst J, Wicki W (1992) The Zurich Study: XIII. Recurrent brief anxiety. Eur Arch Psychiatry Clin Neurosci 241:296–300

  11. Berman PM, Kirsner JB (1972) The aging gut. II. Diseases of the colon, pancreas, liver and gallbladder, functional bowel disease, and iatrogenic disease. Geriatrics 27:117–124

  12. Binder J, Dobler-Mikola A, Angst J (1981) An epidemiological study of minor psychiatric disturbances. A field study among 20 year-old females and males in Zurich. Soc Psychiatry 16: 31–41

  13. Bockus HL, Bank J, Wilkinson S (1929) Neurogenic mucous colitis. Trans Am Gastroenterol Assoc 31:307–322

  14. Chaudhary N, Truelove SC (1961) Human colonic motility: a comparative study of normal subjects, patients with ulcerative colitis, and patients with the irritable colon syndrome. Gastroenterology 40:1–17, 18–26, 27–36

  15. Graig TKJ, Brown GW (1984) Goal frustration and life events in the aetiology of painful gastrointestinal disorder. J Psychosom Res 29:411–421

  16. Da Costa JM (1871) Membranous enteritis. Am J Med Sci 62: 321–335

  17. Derogatis LR (1977) SCL-90. Administration, scoring and procedures. Manual I for the R (revised) version and other instruments of the Psychopathology Rating Scale Series. Johns Hopkins University School of Medicine, Baltimore

  18. Drossman Da, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, Burger AL (1988) Psychosocial factors in the irritable bowel syndrome. A multivariant study of patients with irritable bowel syndrome. Gastroenterology 95:701–708

  19. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E, Richter JE, Koch GG (1993) U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Digest Dis Sci 38 (9):1569–1580

  20. Fahrenberg J, Selg H (1978) Das Freiburger Persönlichkeits Inventar (FPI) Handanweisung für die Durchführung und Auswertung. Hogrefe, Göttingen

  21. Fahrländer H (1972) Funktionelle Beschwerden des Magen-Darm-Kanals. Dtsch Med J 23:162–167

  22. Ferguson A, Sircus W, Eastwood MA (1977) Frequency of “functional” gastrointestinal disorders. Lancet ii:613–614

  23. Fielding JF (1977) A year in outpatients with irritable bowel syndrome. Ir J Med Sci 146:162–166

  24. Folks DG, Kinney FC (1992) The role of psychological factors in gastrointestinal conditions. A review pertinent to DSM-IV. Psychosomatics 33:257–270

  25. Ford MJ, Miller PM, Eastwood J et al. (1987) Life events, psychiatric illness and the irritable bowel syndrome. Gut 28:160–165

  26. Fossey MD, Lydiard RB (1990) Anxiety and the gastrointestinal system. Psychiatr Med 8:175–186

  27. Fowlie S, Eastwood MA, Prescott R (1992a) Irritable bowel syndrome: assessment of psychological disturbance and its influence on the response to fibre supplementation. J Psychosom Res 36 (2):175–180

  28. Fowlie S, Eastwood MA, Ford MJ (1992b) Irritable bowel syndrome: the influence of psychological factors on the symptom complex. J Psychosom Res 36 (2):169–173

  29. Heerlein A, Parra G de la, Aronsohn S, Lolas F (1984) Affective expression in organic and functional gastrointestinal disease. Psychother Psychosom 42:152–155

  30. Hill OW, Blendis L (1967) Physical and psychological evaluation of “non-organic” abdominal pain. Gut 8:221–229

  31. Illes P (1982) Validierung des Fragebogens “SPIKE” an Diagnosen der Krankengeschichten des sozialpsychiatrischen Dienstes Oerlikon (Kinik Hard). Dissertation, Medizinische Fakultät, Zürich

  32. Jones R, Lydeard S (1992) Irritable bowel syndrome in the general population. Br Med J 304:87–90

  33. Kellow JE, Langeluddecke PM, Eckersley GM, Jones MP, Tennant CC (1992) Effects of acute psychologic stress on small-intestinal motility in health and the irritable bowel syndrome. Scand J Gastroenterol 27:53–58

  34. Kumar D, Pfeffer J, Wingate DL (1990) Role of psychological factors in the irritable bowel syndrome. Digestion 45:80–87

  35. Laemmle K (1991) Psychosomatic considerations in dysphagia. Ther Umsch 48:193–197

  36. Liss JL, Alpers D, Woodruff RA (1973) The irritable colon syndrome and psychiatric illness. Dis Nerv Syst 34:151–157

  37. Lydiard RB, Greenwald S, Weissman MM, Johnson J, Drossman DA, Ballenger JC (1994) Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area Project. Am J Psychiatry 151 (1):64–70

  38. Manning AP, Thompson WG, Heaton KW, Morris AT (1978) Towards a positive diagnosis of the irritable bowel. British Medical J, pp 653–654

  39. McDonald AJ, Bouchier IAD (1980) Non-organic gastrointestinal illness: a medical and psychiatric study. Br J Psychiatry 136: 276–283

  40. Meier A (1985) Validierung des Depressions-Ratings im Fragebogen SPIKE an Patienten der Psychiatrischen Poliklinik. Dissertation, Medizinische Fakultät, Zürich

  41. Palmer RL, Stonehill E, Crisp AH, Waller L, Misiewicz JJ (1974) Psychological characteristics of patients with the irritable bowel syndrome. Postgr Med J 50:416–419

  42. Regier DA, Myers JK, Kramer M et al. (1984) The NIMH epidemiologic catchment area program. Arch Gen Psychiatry 41: 934–941

  43. Robins LN, Helzer JE, Croughan J et al. (1981) National Institute of Health Diagnostic Interview Schedule. Arch Gen Psychiatry 38:381–389

  44. Scheidegger PU (1992) Reproduzierbarkeit von Strukturen in empirischen Daten. Dissertation, Philosophische Fakultät Zürich

  45. Schüffel W, Schonecke O, Wolfert W (1971) Patienten mit funktionellen Beschwerden im Abdominalbereich—Psychologische Charakteristik und Konsequenzen für Behandlung und Umgang mit diesen Patienten. Verhandlungen Dtsch Gesell Innere Med 77:118–119

  46. Seward GH, Morrison, Fest (1965) Personality structure in a common form of colitis. Psychol Monogr 65:1–26

  47. Sklar M (1970) Functional gastrointestinal disease in the aged. Am J Gastroenterol 53:570

  48. Talley NJ, Fett SL, Zinsmeister AR (1995) Self-reported abuse and gastrointestinal disease in outpatients: association with irritable bowel-type symptoms. Am Gastroenterol 90 (3):366–371

  49. Talley NJ (1994) Why do functional gastrointestinal disorders come and go? Digest Dis Sci 39 (4):673–677

  50. Talley NJ, Weaver AL, Zinsmeister AR, Melton J III (1992) Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 136 (2):165–177

  51. Talley NJ, Philips SF, Wiltgen CM, Zinsmeister AR, Melton LJ III (1990) Assessment of functional gastrointestinal disease: the bowel disease questionnaire. Mayo Clinic Proc 65:1456–1479

  52. Tennant C, Andrews G (1976) A scale to measure the stress of life events. Aust N Z J Psychiatry 10:27–32

  53. Tennant C, Andrews G (1977) A scale to measure the stress of life events. Aust N Z J Psychiatry 11:163–167

  54. Thompson WG (1983) Clinical features and diagnosis of the irritable bowel. In: Chey WY (ed) Functional disorders of the digestive tract. Raven Press, New York, pp 299–310

  55. Thompson WG, Dotevall G, Drossman DA et al. (1989) Irritable bowel syndrome: guidelines for diagnosis. Gastroenterol Int 2: 92–95

  56. Thompson WG, Heaton KW (1980) Functional bowel disorders in apparently healthy people. Gastroenterology 79:283–288

  57. Uexküll T von et al. (ed) (1990) Psychosomatische Medizin. (4. Aufl) Urban und Schwarzenberg, München

  58. Uexküll T von, Köhle K (1990) Funktionelle Syndrome in der Inneren Medizin. In: Uexküll T von et al. (eds) Psychosomatische Medizin. (4. Aufl) Urban und Schwarzenberg, München, pp 475–491

  59. Walker EA, Roy-Byrne PP, Katon WJ et al. (1990) Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. Am J Psychiatry 147:1656–1661

  60. Walker EA, Katon WJ, Jemelka RP, Roy-Bryne PP (1992) Comorbidity of gastrointestinal complaints, depression and anxiety on the epidemiological catchment area (ECA) study. Am J Med 92:26S-30S

  61. Whitehead WE, Bosmajian LS (1982) Behavioral medicine approaches to gastrointestinal disorders. J Consult Clin Psychol 50 (6):972–983

  62. Wicki W (1991) Über den Einfluss psychischer und psychosozialer Faktoren auf Entstehung und Verlauf functioneller Magen- und Darmbeschwerden und Schwindelanfälle. Dissertation Zentralstelle der Studentenschaft Zürich

  63. Wicki W, Angst J (1992) Functional stomach and intestinal complaints in young adults: incidence, follow-up, personality and psychosocial factors. Psychother Psychosom Med Psychol 42: 371–380

  64. Young SJ, Alpers DH, Norland CC et al. (1976) Psychiatric illness and the irritable bowel syndrome. Gastroenterology 70: 162–166

  65. Zighelboim J, Talley NJ (1993) What are functional bowel disorders? Gastroenterology 104:1196–1201

Download references

Author information

Correspondence to B. Hochstrasser.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hochstrasser, B., Angst, J. The Zurich Study: XXII. Eur Arch Psychiatry Clin Nuerosci 246, 261–272 (1996). https://doi.org/10.1007/BF02190278

Download citation

Key words

  • Epidemiology
  • Prevalence
  • Functional gastrointestinal complaints
  • Depressive disorders
  • Anxiety disorders