Original article
Alimentary tract
Chronic Diarrhea and Constipation Are More Common in Depressed Individuals

https://doi.org/10.1016/j.cgh.2019.03.046Get rights and content

Background and Aims

Depression is a major health issue in the United States and is highly comorbid with gastrointestinal conditions. We collected data from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the US population, to study the relationship between depression and bowel habits.

Methods

Using data from the NHANES (2009–2010), we identified 495 depressed and 4709 non-depressed adults who filled out the Bowel Health Questionnaire. Depression was defined according to a validated questionnaire. We used multivariable analysis, controlling for clinical and demographic variables, to evaluate the relationship between mood and bowel habits.

Results

In our weighed sample, 24.6% of depressed individuals and 12.6% of non-depressed individuals reported disordered bowel habits. Chronic diarrhea was significantly more prevalent in depressed individuals (15.53%; 95% CI, 11.34%–20.90%) than non-depressed individuals (6.05%; 95% CI, 5.24%–6.98%; P = .0001). Chronic constipation was also more common in depressed individuals (9.10%; 95% CI, 7.02%–11.69%) than non-depressed individuals (6.55%; 95% CI, 5.55%–7.70% CI; P = .003). Mean depression scores in patients with chronic diarrhea (4.9 ± 5.8) and with chronic constipation (4.4 ± 4.93) were significantly higher than mean depression scores for individuals with normal bowel habits (3.2 ± 4.6) (P < .001). Moderate and severe depression were significantly associated with chronic diarrhea but not chronic constipation. Only mild depression was significantly associated with chronic constipation.

Conclusions

In an analysis of the NHANES database, we found a higher proportion of depressed individuals to have chronic diarrhea and constipation than non-depressed individuals; chronic diarrhea was more strongly associated with depression. Our findings provide support for the relationship between mood and specific bowel habits, accounting for multiple co-variables in a large sample of the general US population.

Section snippets

Study Cohort

Data were extracted from the 2009–2010 NHANES dataset. The NHANES offers a publicly available, nationally representative sample of noninstitutionalized individuals in the United States. The NHANES survey program is conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention (Atlanta, GA). Participants are selected using stratified multistage probability design with oversampling of certain ethnic and age groups to allow for sample-weighted inference

Results

A total of 5160 subjects completed the Bowel Health Questionnaire and met our eligibility criteria (20 years of age and did not report a history of inflammatory bowel disease or celiac disease). Of these, there were 491 depressed and 4669 nondepressed.

In our weighted sample, 24.33% (95% CI, 19.57%–29.81%) of depressed subjects and 12.54% (95% CI, 11.17%–14.07%) of nondepressed subjects reported disordered bowel habits (P < .0001). We found that chronic diarrhea was significantly more prevalent

Discussion

This is the first study to evaluate the relationship between depression and bowel habits (constipation, diarrhea, and normal) in a nationally representative adult sample in the United States. In this sample, 24.3% of patients with depression reported disordered bowel habits, compared with 12.5% of those without depression. Chronic diarrhea was present in nearly 16% of individuals with depression and chronic constipation was present in 9% of depressed patients.

In this study, depression severity

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  • Cited by (0)

    Conflicts of interest The authors disclose no conflicts.

    Funding This project was funded in part by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant # T32DK007760 (to Sarah Ballou) and Prashant Singh.

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