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Anxiety and depression in Indian patients with irritable bowel syndrome: A meta-analysis

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Functional gastrointestinal disorders (FGIDs), including irritable bowel syndrome (IBS), are associated with psychological abnormalities, such as anxiety and depression. Though the data on this are plenty in global literature, Indian data are sparse. We performed a systematic review and meta-analysis of Indian data on anxiety and depression among patients with IBS to estimate their pooled prevalence and to identify the shortcomings so that future areas of research can be identified.


A comprehensive literature search was performed for studies applying tests for psychological issues in patients with IBS. After applying prospectively decided exclusion criteria, the eligible papers were examined using a meta-analysis approach for the prevalence of anxiety and depression in IBS patients using different tests. The odds ratios (OR) of anxiety and depression among subjects with IBS were calculated compared to controls.


Of seven studies (590 IBS patients and 1520 controls) included in the meta-analysis, the pooled OR of anxiety was 8.060 (95% confidence interval [CI] 4.007–16.213) as compared to controls (random-effect model). The pooled OR of depression was 7.049 (95% CI 3.281–15.147) compared to controls (random-effect model). There was significant heterogeneity in the included studies.


The current meta-analysis shows that the patients with IBS from India have eightfold greater risks of anxiety and sevenfold greater risks of depression than the controls. However, most of these data were from tertiary urban centers, and hence, there might be recruitment bias over-estimating the frequency.

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  1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation global study. Gastroenterology. 2021;160:99–114.e3.

  2. Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569–80.

    Article  CAS  PubMed  Google Scholar 

  3. Ghoshal UC. Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment. J Gastroenterol Hepatol. 2020;35:712–21.

    Article  CAS  PubMed  Google Scholar 

  4. Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain–gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut. 2012;61:1284–90.

    Article  CAS  PubMed  Google Scholar 

  5. Parida PK, Mishra D, Pati GK, et al. A prospective study on incidence, risk factors, and validation of a risk score for post-infection irritable bowel syndrome in coastal eastern India. Indian J Gastroenterol. 2019;38:134–42.

    Article  PubMed  Google Scholar 

  6. Sibelli A, Chalder T, Everitt H, Workman P, Windgassen S, Moss-Morris R. A systematic review with meta-analysis of the role of anxiety and depression in irritable bowel syndrome onset. Psychol Med. 2016;46:3065–80.

    Article  CAS  PubMed  Google Scholar 

  7. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Goldstein RS, Cash BD. Making a confident diagnosis of irritable bowel syndrome. Gastroenterol Clin North Am. 2021;50:547–63.

    Article  PubMed  Google Scholar 

  9. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses, 2012. Available from http://www.ohrica/programs/clinical_epidemiology/oxfordasp. Accessed 25 May 2021

  10. Gerson CD, Gerson MJ, Chang L, et al. A cross-cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome. Neurogastroenterol Motil. 2015;27:490–500.

    Article  CAS  PubMed  Google Scholar 

  11. Ghoshal UC, Singh R. Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population. J Gastroenterol Hepatol. 2017;32:378–87.

    Article  PubMed  Google Scholar 

  12. Sharma S, Pinto C, Masand PS, et al. Relationship of irritable bowel syndrome (IBS) and major depression in Mumbai. India Int J Psych Clin Pract. 2003;7:127–30.

    Article  Google Scholar 

  13. Pinto C, Lele MV, Joglekar AS, Panwar VS, Dhavale HS. Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome. J Assoc Physicians India. 2000;48:589–93.

    CAS  PubMed  Google Scholar 

  14. Singh P, Agnihotri A, Pathak MK, et al. Psychiatric, somatic and other functional gastrointestinal disorders in patients with irritable bowel syndrome at a tertiary care center. J Neurogastroenterol Motil. 2012;18:324–31.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kabra N, Nadkarni A. Prevalence of depression and anxiety in irritable bowel syndrome: A clinic based study from India. Indian J Psychiatry. 2013;55:77–80.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Padhy SK, Mishra S, Sarkar S, Bang LG, Panigrahi M. Comparison of psychiatric morbidity in patients with irritable bowel syndrome and non-ulcer dyspepsia. Ind Psychiatry J. 2016;25:29–34.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kawoos Y, Wani ZA, Kadla SA, et al. Psychiatric co-morbidity in patients with irritable bowel syndrome at a tertiary care center in northern India. J Neurogastroenterol Motil. 2017;23:555–60.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Banerjee A, Sarkhel S, Sarkar R, Dhali GK. Anxiety and depression in irritable bowel syndrome. Indian J Psychol Med. 2017;39:741–5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Goyal O, Nohria S, Dhaliwal AS, et al. Author’s reply to comment on the article: Psychological issues in patients with irritable bowel syndrome: throwing more light is necessary. Indian J Gastroenterol. 2021;40:646–7.

    Article  PubMed  Google Scholar 

  20. Goyal O, Nohria S, Dhaliwal AS, et al. Prevalence, overlap, and risk factors for Rome IV functional gastrointestinal disorders among college students in northern India. Indian J Gastroenterol. 2021;40:144–53.

    Article  PubMed  Google Scholar 

  21. Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2019;50:132–43.

    Article  PubMed  Google Scholar 

  22. Blanchard EB, Scharff L, Schwarz SP, Suls JM, Barlow DH. The role of anxiety and depression in the irritable bowel syndrome. Behav Res Ther. 1990;28:401–5.

    Article  CAS  PubMed  Google Scholar 

  23. Mykletun A, Jacka F, Williams L, et al. Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterol. 2010;10:88.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cho HS, Park JM, Lim CH, et al. Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut Liver. 2011;5:29–36.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ladep NG, Obindo TJ, Audu MD, Okeke EN, Malu AO. Depression in patients with irritable bowel syndrome in Jos. Nigeria. World J Gastroenterol. 2006;12:7844–7.

  26. Guleria A, Karyampudi A, Singh R, et al. Mapping of brain activations to rectal balloon distension stimuli in male patients with irritable bowel syndrome using functional magnetic resonance imaging. J Neurogastroenterol Motil. 2017;23:415–27.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Berna C, Leknes S, Holmes EA, Edwards RR, Goodwin GM, Tracey I. Induction of depressed mood disrupts emotion regulation neurocircuitry and enhances pain unpleasantness. Biol Psychiatry. 2010;67:1083–90.

    Article  PubMed  Google Scholar 

  28. Goodoory VC, Mikocka-Walus A, Yiannakou Y, Houghton LA, Black CJ, Ford AC. Impact of psychological comorbidity on the prognosis of irritable bowel syndrome. Am J Gastroenterol. 2021;116:1485–94.

    Article  PubMed  Google Scholar 

  29. Torun F, Koc G, Ocak SS. Psychiatric symptoms and relationship of disease with stress and traumatic experiences in patients with irritable bowel syndrome. Riv Psichiatr. 2020;55:292–6.

    PubMed  Google Scholar 

  30. Wu JC. Community-based study on psychological comorbidity in functional gastrointestinal disorder. J Gastroenterol Hepatol. 2011;26 Suppl 3:23–6.

  31. Dekel R, Drossman DA, Sperber AD. The use of psychotropic drugs in irritable bowel syndrome. Expert Opin Investig Drugs. 2013;22:329–39.

    Article  CAS  PubMed  Google Scholar 

  32. Halpert A, Dalton CB, Diamant NE, et al. Clinical response to tricyclic antidepressants in functional bowel disorders is not related to dosage. Am J Gastroenterol. 2005;100:664–71.

    Article  CAS  PubMed  Google Scholar 

  33. Tornblom H, Drossman DA. Psychotropics, antidepressants, and visceral analgesics in functional gastrointestinal disorders. Curr Gastroenterol Rep. 2018;20:58.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;S0016–5085(16):00223–7.

    Google Scholar 

  35. Drossman DA, Hasler WL. Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150:1257–61.

    Article  PubMed  Google Scholar 

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Authors and Affiliations



UG, conceptualization of the study, literature search, analysis of the collected data, and preparing the first draft of the paper. SNB, literature search, editing the first draft of the paper. VKD and JSY, overall supervision of the work. All the authors approved the final version of the paper.

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Correspondence to Jai Singh Yadav.

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UG, SNB, VKD, and JSY declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on 

Since it is a meta-analysis, ethics clearance was not required.


The authors are solely responsible for the data and the contents of the paper. In no way is the honorary editor-in-chief, editorial board members, the Indian Society of Gastroenterology or the printer/publishers responsible for the results/findings and content of this article.

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Ghoshal, U., Biswas, S.N., Dixit, V.K. et al. Anxiety and depression in Indian patients with irritable bowel syndrome: A meta-analysis. Indian J Gastroenterol 42, 32–39 (2023).

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