The prevalence of neuropsychiatric disorders (Anxiety & depression) among IBS patients

The prevalence of neuropsychiatric disorders (Anxiety & depression) among IBS patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The prevalence of neuropsychiatric disorders (Anxiety & depression) among IBS patients Mu’taz Massad, Farah Alrabadi, Hamza Saleh, Mohammad Khalifa, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8462230/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Irritable bowel syndrome (IBS) is a the most common functional gastrointestinal disorder. Growing evidence suggests a significant association between IBS and psychological problems, such as anxiety and depression. This study was conducted to assess the prevalence of anxiety and depression in Jordanian patients diagnosed with IBS according to Rome IV criteria. Methods: The study was conducted at the Gastroenterology Department of Prince Hamza Hospital and New Zarqa Governmental Hospital in Jordan recruiting 681 patients. IBS diagnosis was established using the validated Rome IV criteria. Anxiety and depression were assessed using an Arabic version of the Hospital Anxiety and Depression Scale (HADS). Results: based on the ROME IV criteria used in this study, 529 (77.68%) people were found to be positive for IBS. Results revealed that 568 (83.41%) participants were not diagnosed with any psychological problems. However, 225 (33.0%) were positive for depression and 356 (52.3%) positive for anxiety among all participants. Conclusion: The findings revealed a high prevalence of depression and anxiety disorders among Jordanian patients with IBS. Suggesting the importance of screening for depression and Anxiety in newly diagnosed IBS patients. HADS IBS anxiety depression Figures Figure 1 Figure 2 Introduction Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, irregular feces, and bloating or discomfort. It is not associated with any anatomical or biochemical abnormalities detectable by conventional diagnostic methods. While some patients may experience severe symptoms, others may only experience mild to moderate symptoms. Furthermore, gut sensitivity, psychiatric disorders such as anxiety and depression, among other somatic comorbidities including pain syndromes, overactive bladder, and migraines are frequently linked to IBS¹. In this study, the Rome IV criteria was used for the screening of IBS, as it was the most recent criteria available during data collection. The Rome IV criteria defines IBS as a functional bowel disorder characterized by recurrent abdominal pain associated with defecation or altered bowel habits. Symptoms of abdominal bloating or distension are typically present, along with disturbed bowel habits, including constipation, diarrhea, or a combination of both. Symptoms onset must occur at least six months before the diagnosis is made, and symptoms must be present during the preceding three months⁴. After excluding other diseases (including other functional gastrointestinal disorders) that may cause symptoms similar to IBS, the diagnosis is made clinically, and the following subtypes must be distinguished: IBS with predominant constipation (IBS-C), IBS with predominant diarrhea (IBS-D), mixed IBS (IBS-M), and unclassified IBS (IBS-U)¹. Significant mental distress, particularly depression and anxiety, are very common among IBS patients⁵. Current psychological research on IBS has demonstrated a clear relationship with psychological factors, especially somatization, anxiety, and depression². Given this strong association, assessing psychological comorbidity is an important component of understanding the overall burden of IBS. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool for anxiety and depression in patients with chronic diseases. Its advantages include its brevity, its clarity of questions, and its ability to simultaneously assess both anxiety and depression disorders⁶. Therefore, this study aims to utilize the HADS to investigate anxiety and depression among patients with IBS. Methodology and tools Data Collection 1- Instrument : The study was conducted at the Gastroenterology Department of Prince Hamza Hospital and New Zarqa Governmental Hospital in Jordan. Data was collected, analyzed and compared using appropriate statistical methods. The questionnaires have been translated using reverse translation to the Arabic language in a simplified manner and the questionnaire use to main validated questionnaires to measure anxiety, depression and irritable bowel syndrome, and the questionnaire includes : Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS): which includes five questions about abdominal pain or discomfort in the last 3 months, change in the appearance or consistency of stool according to Bristol Stool Form Scale and change in the frequency of defecation. Hospitalization Anxiety & Depression Scale (HADS): To evaluate the anxiety and depression levels. Score for each subscale (anxiety and depression) can range from 0 (Minimal) to 21 (Severe). with the following interpretation: 0–7: Normal range, 8–10: Possible anxiety or depression, 11–21: Probable anxiety or depression, ≥ 8: Significant anxiety or depression The questionnaire used in this study was developed specifically for this research . An English version of the questionnaire is provided as Supplementary File 1 2- Study procedure : Informed consent is obtained by the following words at the beginning of the questionnaire “If you started to answer the following questions this means that you agree to participate in this medical research”. The confidentiality of each participant is ensured by not asking any personal questions that might reveal the identity of the participants such as: full name, detailed address, email address, ID number and phone number which ensures that each participant is anonymous. Before data entry into the SPSS database, responses with missing data will be excluded. Initially, we interviewed 872 patients who presented to the Gastroenterology Departments of Prince Hamza Hospital and New Zarqa Governmental Hospital. Based on screening for gastrointestinal symptoms consistent with irritable bowel syndrome (IBS), 190 patients were excluded for not meeting the Rome IV diagnostic criteria. A total of 682 patients who fulfilled the Rome IV criteria were included in the final analysis. Only patients who fulfilled the Rome IV criteria were included in the study. Statistical Analysis Data were tabulated in Microsoft Excel and analyzed using IBM SPSS Statistics v27.0. Descriptive statistics, including frequencies and percentages, were used to summarize sociodemographic data and clinical characteristics. To examine the relationship between variables, the following methods were applied: Bivariate Analysis: Chi-square tests were used to find associations between categorical variables. In cases where cell counts were low, Fisher’s Exact or Fisher-Freeman-Halton tests were utilized. Correlation: Spearman’s correlation was performed to assess the strength and direction of the relationship between IBS symptoms and HADS scores (anxiety and depression). Multivariable Analysis: A binary logistic regression model was conducted to evaluate the association between anxiety/depression and the presence of IBS. This model adjusted for potential confounders, including age, gender, and socioeconomic status. A p-value of < 0.05 was considered statistically significant, and results were reported with 95% confidence intervals (CI). Results 3.1. Inflammatory Bowel Syndrome vs. Psychiatric Disorders In this study, aiming to see if there is any association between the status of having inflammatory bowel syndrome (IBS) and any psychiatric condition, mainly anxiety and depression, a total of 681 participants were included. A large segment of them were already diagnosed with IBS by a physician (n = 448, 65.79%); however, based on the ROME IV criteria used in this study, 529 (77.68%) people were found to be positive for IBS. Table 1 shows the distribution of participants based on their test results and the recalled IBS status diagnosed by a physician. Table 1 Recalled IBS diagnosis vs. ROME IV diagnosis Screening (ROME IV criteria) Diagnosis by a physician Total Yes No Positive 356 (52.3%) 173 (25.4%) 529 (77.7%) Negative 92 (13.5%) 60 (8.8%) 152 (22.3%) Total 448 (65.8%) 233 (34.2%) 681 (100%) As for psychiatric disorders, participants were asked if they were diagnosed with any problem, and they answered the Hospital Anxiety and Depression Scale (HADS). Results revealed that 568 (83.41%) participants were not diagnosed with any psychological problems, though HADS shows that anxiety and depression are prevalent in this study group. Figure 1 shows the recalled psychological status of participants. Table 2 shows the HADS results. Table 2 Hospital Anxiety and Depression Scale (HADS) results Anxiety Results Depression Results Total Normal Borderline Positive Normal 93 (13.7%) 31 (4.6%) 15 (2.2%) 139 (20.4%) Borderline 54 (7.9%) 58 (8.5%) 74 (10.9%) 186 (27.3%) Positive 73 (10.7%) 147 (21.6%) 136 (20.0%) 356 (52.3%) Total 220 (32.3%) 236 (34.7%) 225 (33.0%) 681 (100%) As per the data presented in Table 3 , positive IBS status on the ROME IV criteria was significantly associated with positive anxiety status (X2 (2, n = 681) = 19.953, p < 0.001) and borderline depression status (X2 (2, n = 681) = 12.513, p = 0.002), which indicate that people with IBS suffer from psychiatric problems. Table 3 IBS status (ROME IV) vs. psychiatric disorders Psychiatric disorders Total IBS status (ROME IV) p-value Positive Negative Total 681 (100%) 529 (77.7%) 152 (22.3%) Anxiety < 0.001 Normal 139 (20.4%) 89 (13.1%) 50 (7.3%) Borderline 186 (27.3%) 156 (22.9%) 30 (4.4%) Positive 356 (52.3%) 284 (41.7%) 72 (10.6%) Depression 0.002 Normal 220 (32.3%) 153 (22.5%) 67 (9.8%) Borderline 236 (34.7%) 191 (28.0%) 45 (6.6%) Positive 225 (33.0%) 185 (27.2%) 40 (5.9%) 3.2. Patient Characteristics vs. IBS Diagnosis Patient characteristics, socioeconomic, environmental factors, and clinical outcomes based on IBS diagnosis are presented in Table 4 . With the study population consisting of middle-aged individuals, the majority of participants were in the 20–29 year age group (n = 295, 43.3%). Females constitute a great proportion of IBS-positive people (n = 412, 60.5%). As for work circumstances, people with moderate-effort jobs were found to be more likely to test positive for IBS (n = 291, 42.7%). Almost all participants are educated and have finished high school (n = 174, 25.6%) and a bachelor’s degree (n = 401, 58.9%). Table 4 Patient characteristics vs. IBS diagnosis Patient characteristics Total IBS status (ROME IV) p-value Positive Negative Total 681 (100%) 529 (77.7%) 152 (22.3%) Age 0.275 10–19 years 22 (3.2%) 16 (2.3%) 6 (0.9%) 20–29 years 295 (43.3%) 235 (34.5%) 60 (8.8%) 30–39 years 138 (20.3%) 108 (15.9%) 30 (4.4%) 40–49 years 122 (17.9%) 95 (14.0%) 27 (4.0%) 50–59 years 64 (9.4%) 50 (7.3%) 14 (2.1%) 60 and more 40 (5.9%) 25 (3.7%) 15 (2.2%) Sex 0.005 Female 412 (60.5%) 305 (44.8%) 107 (15.7%) Male 269 (39.5%) 224 (32.9%) 45 (6.6%) Educational level 0.280* Illitrate 9 (1.3%) 8 (1.2%) 1 (0.1%) Less than high school 75 (11.0%) 63 (9.3%) 12 (1.8%) High school 174 (25.6%) 127 (18.6%) 47 (6.9%) Bachelor’s degree 401 (58.9%) 315 (46.3%) 86 (12.6%) Postgraduate studies 22 (3.2%) 16 (2.3%) 6 (0.9%) Work circumstances 0.003 No effort 189 (27.8%) 160 (23.5%) 29 (4.3%) Moderate effort 377 (55.4%) 291 (42.7%) 86 (12.6%) Great effort 115 (16.9%) 78 (11.5%) 37 (5.4%) Physical activity 0.657 No activity 328 (48.2%) 248 (36.4%) 80 (11.7%) 1 time a week 129 (18.9%) 102 (15.0%) 27 (4.0%) 3–5 times a week 161 (23.6%) 129 (18.9%) 32 (4.7%) Everyday 63 (9.3%) 50 (7.3%) 13 (1.9%) Smoking status 0.233 Smoker 284 (41.7%) 227 (33.3%) 57 (8.4%) Non-smoker 397 (58.3%) 302 (44.3%) 95 (14.0%) Diet 0.142 Balanced 71 (10.4%) 51 (7.5%) 20 (2.9%) Moderate calories 461 (67.7%) 368 (54.0%) 93 (13.7%) High calories 149 (21.9%) 110 (16.2%) 39 (5.7%) Lactose intolerance < 0.001 Yes 254 (37.3%) 221 (32.5%) 33 (4.8%) No 427 (62.7%) 308 (45.2%) 119 (17.5%) Family history of IBS 0.200 Yes 455 (66.8%) 360 (52.9%) 95 (14.0%) No 226 (33.2%) 169 (24.8%) 57 (8.4%) Past surgeries in the abdomen 0.097* Appendectomy 36 (5.3%) 25 (3.7%) 11 (1.6%) Cholecystectomy 40 (5.9%) 35 (5.1%) 5 (0.7%) Colectomy 5 (0.7%) 4 (0.6%) 1 (0.1%) Hystrectomy 6 (0.9%) 4 (0.6%) 2 (0.3%) Gastrectomy 12 (1.8%) 7 (1.0%) 5 (0.7%) Others 55 (8.1%) 37 (5.4%) 18 (2.6%) No history 527 (77.4%) 417 (61.2%) 110 (16.2%) * Fisher or Fisher-Freeman-Halton exact tests. Using Pearson’s Chi-Square test, results revealed that IBS diagnosis is significantly associated with sex, with females testing positive more than males ( X 2 (1, n = 681) = 8.018, p = 0.005). Also, work circumstances groups were significantly different in terms of IBS status ( X 2 (2, n = 681) = 11.798, p = 0.003), with moderate effort jobs resulting in a more positive IBS diagnosis when compared to other circumstances. On the other hand, age, educational level, physical activity, diet, and smoking status didn’t show a statistically significant association with IBS diagnosis (p > 0.050). Lactose intolerance was significant when compared between positive and negative IBS diagnoses ( X 2 (1, n = 681) = 20.329, p < 0.001), with 308 (45.2%) participants being positive for IBS but didn’t have lactose intolerance. Family history and having a past abdominal surgery were not significantly associated with IBS diagnosis. People participating in the study were asked if the psychiatric symptoms were present with the gastrointestinal symptoms. Most patients reported IBS symptoms to be in sync with psychiatric ones (n = 211, 31.0%) or preceding gastrointestinal problems (n = 191, 28.0%). For those who are diagnosed with IBS and taking drugs for it, a lot of them reported mood changes for the better when taking IBS medications and treatments (n = 232, 34.1%). Figure 2 shows the detailed answers by participants. Discussion This study analyzed the prevalence of neuropsychiatric disorders -specifically anxiety and depression- among adults with irritable bowel syndrome (IBS), using a wide sample of 681 participants. Our findings imply a high burden of psychological symptoms among individuals with IBS, with statistically significant associations between IBS (based on Rome IV criteria) and both anxiety and depression (based on the Hospital Anxiety and Depression Scale HADS). These results support the bidirectional nature of the gut-brain axis and highlight the importance of integrating psychological assessment into IBS management. In the study, 77.7% of participants fulfilled the Rome IV criteria for IBS, a greater proportion than the 65.8% with a clinical diagnosis of IBS. This difference proposes a potentially large number of individuals with undiagnosed yet symptomatic IBS, consistent with previous evidence that IBS remains underdiagnosed due to symptom overlap and sociocultural barriers to pursuing gastrointestinal care. The prevalence of IBS in our study was higher than that reported by Derar Abdel-Qader [ 7 ], who found a lower percentage. This difference may be credited to our study population, which primarily included patients presenting with abdominal pain, whereas Abdel-Qader’s study was based on a randomly distributed questionnaire among the general population. Fundamentally, anxiety and depression symptoms were markedly common: 52.3% of participants screened positive for anxiety and 33.0% screened positive for depression. IBS-positive individuals had significantly higher rates of both anxiety (p < 0.001) and borderline depression (p = 0.002). These results align with a Vietnamese study on IBS [ 8 ] A systematic review on the prevalence of anxiety and depression in patients with irritable bowel syndrome found that the prevalence rates of anxiety symptoms and disorders among IBS patients were 39.1% (95% CI: 32.4–45.8) and 23% (95% CI: 17.2–28.8) respectively [ 9 ]. In contrast to our results, a Jordanian study conducted among medical students found no significant difference in the prevalence of IBS between males and females (P = 0.477) [ 10 ] However, in our study IBS diagnosis was significantly associated with sex, with females showing higher rates than males (χ²(1, n = 681) = 8.018, p = .005) consistent with global epidemiological trends showing a higher prevalence of IBS in women[ 11 ], possibly due to hormonal influences, differences in stress reactivity, or health-seeking behaviors. This variation may be explained by differences in the study populations and sampling contexts. Medical students represent a relatively homogenous group with extraordinary stressors and health-seeking behaviors that may lessen gender discrepancies. In comparison, our study included a wide-ranging outpatient and online population, which may better reflect community-level gender differences in symptom reporting, healthcare utilization, and IBS susceptibility. Several biological and psychological mechanisms may explain these findings. The gut-brain axis, involving bidirectional communication through neuroendocrine, immune, and autonomic pathways, plays a central role in the pathophysiology of IBS. Dysbiosis, visceral hypersensitivity, and chronic low-grade inflammation can exacerbate anxiety and mood symptoms, while psychological stress can worsen gastrointestinal motility and sensitivity. This cyclical pattern may contribute to the finding that over 59% of participants reported psychiatric symptoms occurring either simultaneously with IBS symptoms (31.0%) or preceding them (28.0%). Such temporal relationships support the hypothesis that psychiatric distress may precipitate or augment gastrointestinal symptoms in susceptible individuals. The association between IBS and psychiatric conditions is thought to stem from disruptions in brain–gut communication . Evidence from psychophysiological and neuroimaging research indicates that impairment of the brain–gut axis— the two-way neural pathway linking the gastrointestinal tract and the central nervous system—plays a key role in the development of IBS. In this model, gastrointestinal discomfort can contribute to anxiety and depressive symptoms, while psychological distress can heighten physiological responses in the gut, thereby worsening IBS manifestations. [ 12 ] [ 13 ] Sociodemographic and clinical variables also revealed interesting patterns. Work circumstances were also associated with IBS status (p = 0.003), with moderate-effort jobs showing the highest proportion of IBS-positive cases. This may indicate a relationship between occupational stress and functional gastrointestinal disorders. The findings of our study indicate an association between IBS diagnosis and self-reported lactose intolerance. This differs from studies that used hydrogen breath tests to evaluate lactose malabsorption, which show no higher prevalence of lactose malabsorption in IBS patients compared to healthy controls [ 14 ] [ 15 ]. Still, our results adjust with their observation that IBS patients frequently report gastrointestinal symptoms triggered by lactose containing food. This suggests that even though lactose malabsorption and IBS may be unrelated pathophysiologically, symptoms overlap and visceral hypersensitivity in IBS may lead patients to misattribute symptoms to lactose ingestion. Accordingly, self-reported lactose intolerance in IBS patients probably reflects symptoms perception not due to enzymatic deficiency. Other variables did not show significant associations including: Age, diet, smoking status, educational level, physical activity, family history and prior abdominal surgery. An interesting clinical observation from this study is that 34.1% of IBS-diagnosed individuals taking IBS medications reported mood improvement with treatment. This suggests that effective management of gastrointestinal symptoms may alleviate psychological distress, possibly through improved quality of life, reduction of pain, or modulation of the gut–brain axis by certain medications or dietary modifications. Although not causal, this finding highlights the potential benefit of integrated care approaches combining gastroenterological and psychological interventions. Unlike a large prospective cohort study that demonstrated a modest but significant inverse association between never smoking and IBS incidence, our study did not find smoking status to be significantly associated with IBS similar to a national study among Jordanian students [ 10 ]. This discrepancy may be explained by methodological differences. Our study used a cross-sectional design and assessed smoking and IBS simultaneously, which limits the ability to determine causal direction. In contrast, the prospective study followed participants for more than a decade, allowing for evaluation of long-term smoking exposure as a risk factor for new-onset IBS. Differences in sample size, age distribution, cultural factors, and the precision of smoking exposure measurement may also account for the variation in findings.[ 16 ] In our study, the analysis of correlation between family history and IBS was statically insignificant [p:200]. This in contrast with several other studies that found a Significant association, shows that individuals with a positive family history of IBS are more likely to exhibit IBS symptoms than whom with no family history [ 10 ] First Variation in sample size and demographic could be a reason and also the method that we used (self-reported data) can introduce a recall bias or inaccuracy comparing with other studies that might use a medical records or more objective measures. This study also showed that psychiatric conditions are underdiagnosed in Jordanian population, because even though Results revealed that 568 (83.41%) participants were not diagnosed with any psychological problems, 225 (33.0%) were positive for depression and 356 (52.3%) positive for anxiety among all participants using HADS questionnaire. This sets an alarming rate at the prevalence of both conditions in Jordan. Key advantages of this research are the employment of an established psychological assessment tool (HADS) a substantial sample size (n = 681) and a confirmed diagnostic criterion (Rome IV criteria). The investigation also examined an array of clinical, lifestyle and demographic attributes providing a comprehensive overview of the factors associated with IBS diagnosis. By incorporating participants from a survey as well, as outpatients attending gastrointestinal clinics our sampling approach enhances the applicability of the results. Despite these benefits some limitations must be acknowledged. It cannot establish sequence or causal links between IBS and mental health issues because of the cross-sectional design. Given that all data were self-reported there is potential for recall and reporting bias, regarding lifestyle habits and mental health diagnoses. Additionally, no comprehensive psychiatric assessment was performed to confirm the findings, from the HADS. The study depended on cross-sectional data. Another drawback is that we didn't look at our patients' IBS subtypes. This finding hold important clinical implications. Given the strong association between IBS and psychological disorders, healthcare providers should routinely screen IBS patients for anxiety and depression symptoms, particularly in primary health centers and gastroenterology clinics. Early detection and management of psychiatric comorbidities may improve the treatment response, symptom severity, and overall quality of life. The high percentage of undiagnosed IBS patients according to Rome IV criteria also draw the attention for our need to increase awareness of IBS symptoms in our public and medical community. Future research should include prospective studies to better understanding of the relationship between IBS and psychological symptoms. Investigations into therapeutic effect, including whether treatment of anxiety or depression alleviate IBS severity. Additionally, searching for biological markers (such as microbiome profiles, inflammatory mediators, or stress-related hormones) may help differentiate subtypes of IBS with specific psychiatric disorders. Conclusion The findings revealed a high prevalence of depression and anxiety disorders among Jordanian patients with IBS. Suggesting the importance of screening for depression and Anxiety in newly diagnosed IBS patients. Declarations Funding The study received no specific grants from any funding agency in the public, commercial or not-for-profit sector Competing interests The authors declare that they have no competing interests. Ethics Approval declaration Ethical approval for this study was obtained from [New Zarqa Hospital IRB committee] (Reference number: [5145]) and [Prince Hamza Hospital IRB committee] (Reference number [4604]). The study was conducted in accordance with the Declaration of Helsinki. Consent to Participate declaration Consent was obtained electronically, and participants were informed that their data would be anonymized, used solely for scientific research purposes, and that no personal identifying information would be collected. Participation in the study was voluntary, and completion of the questionnaire implied consent Consent for publication Not applicable Author Contribution M.M. conceived and designed the study. L.S. and H.G. developed the study methodology and data collection tools. All authors collected the data. B.A. performed the statistical analysis and interpreted the results. F.A. drafted the Discussion . R.H. ,A.A. and S.A.critically revised the manuscript for important intellectual content. M.K. wrote the introduction. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8462230","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602206286,"identity":"a5cecf56-a39e-4fb1-a134-4c248e2f1fcd","order_by":0,"name":"Mu’taz Massad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYBACgwMgsgJMGjAw8BChxfIAM5A8Q4oWe5AWxjaYFmKA2Y38gx9/zruT2MDevE2CQcaGGC3JzBKS254lNvAcK5Ng4EkjSguDhOG2w4kNEjlmQC2HCWsxANryI3EOUIv8G+K1sEkcbADZwkOsljOPzSwbjh02buNJK7ZIIMYvBscTH9/8UXNYtp/98MYbH3uICDE4YAMRiT0k6ICCH6RrGQWjYBSMguEPAH0rO0nTR4bEAAAAAElFTkSuQmCC","orcid":"","institution":"Hashemite University","correspondingAuthor":true,"prefix":"","firstName":"Mu’taz","middleName":"","lastName":"Massad","suffix":""},{"id":602206287,"identity":"39629182-2cd6-4134-89b3-37900ed3ecdf","order_by":1,"name":"Farah Alrabadi","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Farah","middleName":"","lastName":"Alrabadi","suffix":""},{"id":602206288,"identity":"0d1324ff-6707-4a23-8e97-ea4bb0b2b651","order_by":2,"name":"Hamza Saleh","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Hamza","middleName":"","lastName":"Saleh","suffix":""},{"id":602206289,"identity":"11e3dfd4-e15a-4192-9788-61fdcc7fbef1","order_by":3,"name":"Mohammad Khalifa","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Khalifa","suffix":""},{"id":602206290,"identity":"aa097957-8d9b-4af4-813f-c0a27e24d0e6","order_by":4,"name":"Raghad Hwitat","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Raghad","middleName":"","lastName":"Hwitat","suffix":""},{"id":602206292,"identity":"69070ccb-1ba5-4a1e-9591-fdae13372f2f","order_by":5,"name":"Majd Alnimri","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Majd","middleName":"","lastName":"Alnimri","suffix":""},{"id":602206293,"identity":"b1289801-fd88-49a1-94f3-0188b8a72594","order_by":6,"name":"Aya Abuarja","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Aya","middleName":"","lastName":"Abuarja","suffix":""},{"id":602206295,"identity":"0dcf4013-1e70-4326-9117-4f6cd5615b1b","order_by":7,"name":"Nahla Abuhilaleh","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Nahla","middleName":"","lastName":"Abuhilaleh","suffix":""},{"id":602206296,"identity":"70054c39-c62d-4ef6-9ae8-7ac530e654b5","order_by":8,"name":"Leen Shaheen","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Leen","middleName":"","lastName":"Shaheen","suffix":""},{"id":602206297,"identity":"f3a83222-bcfa-46cb-85c9-9fcc83b7f307","order_by":9,"name":"Bashar I. Almaraziq","email":"","orcid":"","institution":"Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Bashar","middleName":"I.","lastName":"Almaraziq","suffix":""},{"id":602206298,"identity":"61d2635e-587f-402a-982b-ed79b3e5df87","order_by":10,"name":"Saleh Abualhaj","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Saleh","middleName":"","lastName":"Abualhaj","suffix":""}],"badges":[],"createdAt":"2025-12-27 16:23:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8462230/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8462230/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104780947,"identity":"3db46237-e75a-4820-8d59-4e32c6d84975","added_by":"auto","created_at":"2026-03-17 07:54:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":247333,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eRecalled psychological status of participants\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8462230/v1/0afd7512ec225c9e72f2a32c.png"},{"id":104472097,"identity":"584ea72f-9f7b-4de4-a8af-136a58a0b62c","added_by":"auto","created_at":"2026-03-12 07:29:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":328345,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eA represents the distribution of participants in terms of the chronological order of symptoms. B represents the distribution of participants in terms of IBS drug taking and mood changes.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8462230/v1/61d35e0f23fb83ab21341c63.png"},{"id":104784487,"identity":"3d5fedb9-f4b2-4def-a9f2-cc54028595ec","added_by":"auto","created_at":"2026-03-17 08:07:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1174425,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8462230/v1/3b685756-a6c5-4514-ba62-2dcd4902286f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The prevalence of neuropsychiatric disorders (Anxiety \u0026 depression) among IBS patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIrritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, irregular feces, and bloating or discomfort. It is not associated with any anatomical or biochemical abnormalities detectable by conventional diagnostic methods. While some patients may experience severe symptoms, others may only experience mild to moderate symptoms. Furthermore, gut sensitivity, psychiatric disorders such as anxiety and depression, among other somatic comorbidities including pain syndromes, overactive bladder, and migraines are frequently linked to IBS\u0026sup1;.\u003c/p\u003e \u003cp\u003eIn this study, the Rome IV criteria was used for the screening of IBS, as it was the most recent criteria available during data collection. The Rome IV criteria defines IBS as a functional bowel disorder characterized by recurrent abdominal pain associated with defecation or altered bowel habits. Symptoms of abdominal bloating or distension are typically present, along with disturbed bowel habits, including constipation, diarrhea, or a combination of both. Symptoms onset must occur at least six months before the diagnosis is made, and symptoms must be present during the preceding three months⁴. After excluding other diseases (including other functional gastrointestinal disorders) that may cause symptoms similar to IBS, the diagnosis is made clinically, and the following subtypes must be distinguished: IBS with predominant constipation (IBS-C), IBS with predominant diarrhea (IBS-D), mixed IBS (IBS-M), and unclassified IBS (IBS-U)\u0026sup1;.\u003c/p\u003e \u003cp\u003eSignificant mental distress, particularly depression and anxiety, are very common among IBS patients⁵. Current psychological research on IBS has demonstrated a clear relationship with psychological factors, especially somatization, anxiety, and depression\u0026sup2;. Given this strong association, assessing psychological comorbidity is an important component of understanding the overall burden of IBS.\u003c/p\u003e \u003cp\u003eThe Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool for anxiety and depression in patients with chronic diseases. Its advantages include its brevity, its clarity of questions, and its ability to simultaneously assess both anxiety and depression disorders⁶.\u003c/p\u003e \u003cp\u003eTherefore, this study aims to utilize the HADS to investigate anxiety and depression among patients with IBS.\u003c/p\u003e"},{"header":"Methodology and tools","content":"\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e1- Instrument\u003c/span\u003e:\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe study was conducted at the Gastroenterology Department of Prince Hamza Hospital and New\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eZarqa Governmental Hospital in Jordan.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData was collected, analyzed and compared using appropriate statistical methods.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThe questionnaires have been translated using reverse translation to the Arabic language in a simplified manner and the questionnaire use to main validated questionnaires to measure anxiety, depression and irritable bowel syndrome, and the questionnaire includes\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS): which includes five questions about abdominal pain or discomfort in the last 3 months, change in the appearance or consistency of stool according to Bristol Stool Form Scale and change in the frequency of defecation.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHospitalization Anxiety \u0026amp; Depression Scale (HADS): To evaluate the anxiety and depression levels. Score for each subscale (anxiety and depression) can range from 0 (Minimal) to 21 (Severe). with the following interpretation: 0\u0026ndash;7: Normal range, 8\u0026ndash;10: Possible anxiety or depression, 11\u0026ndash;21: Probable anxiety or depression, \u0026ge; 8: Significant anxiety or depression\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThe questionnaire used in this study was\u003c/span\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003edeveloped specifically for this research\u003c/span\u003e. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAn English version of the questionnaire is provided as\u003c/span\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupplementary File 1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e2- Study procedure\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eis obtained by the following words at the beginning of the questionnaire \u0026ldquo;If you started to answer the following questions this means that you agree to participate in this medical research\u0026rdquo;. The confidentiality of each participant is ensured by not asking any personal questions that might reveal the identity of the participants such as: full name, detailed address, email address, ID number and phone number which ensures that each participant is anonymous.\u003c/span\u003e \u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBefore data entry into the SPSS database, responses with missing data will be excluded.\u003c/span\u003e \u003c/p\u003e \u003cp\u003eInitially, we interviewed 872 patients who presented to the Gastroenterology Departments of Prince Hamza Hospital and New Zarqa Governmental Hospital. Based on screening for gastrointestinal symptoms consistent with irritable bowel syndrome (IBS), 190 patients were excluded for not meeting the Rome IV diagnostic criteria. A total of 682 patients who fulfilled the Rome IV criteria were included in the final analysis. Only patients who fulfilled the Rome IV criteria were included in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were tabulated in Microsoft Excel and analyzed using IBM SPSS Statistics v27.0. Descriptive statistics, including frequencies and percentages, were used to summarize sociodemographic data and clinical characteristics.\u003c/p\u003e \u003cp\u003eTo examine the relationship between variables, the following methods were applied:\u003c/p\u003e \u003cp\u003eBivariate Analysis: Chi-square tests were used to find associations between categorical variables. In cases where cell counts were low, Fisher\u0026rsquo;s Exact or Fisher-Freeman-Halton tests were utilized.\u003c/p\u003e \u003cp\u003eCorrelation: Spearman\u0026rsquo;s correlation was performed to assess the strength and direction of the relationship between IBS symptoms and HADS scores (anxiety and depression).\u003c/p\u003e \u003cp\u003eMultivariable Analysis: A binary logistic regression model was conducted to evaluate the association between anxiety/depression and the presence of IBS. This model adjusted for potential confounders, including age, gender, and socioeconomic status.\u003c/p\u003e \u003cp\u003eA p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant, and results were reported with 95% confidence intervals (CI).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003e3.1. Inflammatory Bowel Syndrome vs. Psychiatric Disorders\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn this study, aiming to see if there is any association between the status of having inflammatory bowel syndrome (IBS) and any psychiatric condition, mainly anxiety and depression, a total of 681 participants were included. A large segment of them were already diagnosed with IBS by a physician (n\u0026thinsp;=\u0026thinsp;448, 65.79%); however, based on the ROME IV criteria used in this study, 529 (77.68%) people were found to be positive for IBS. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the distribution of participants based on their test results and the recalled IBS status diagnosed by a physician.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eRecalled IBS diagnosis vs. ROME IV diagnosis\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eScreening\u003c/p\u003e \u003cp\u003e(ROME IV criteria)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDiagnosis by a physician\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e356 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173 (25.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e529 (77.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152 (22.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e448 (65.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e233 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e681 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs for psychiatric disorders, participants were asked if they were diagnosed with any problem, and they answered the Hospital Anxiety and Depression Scale (HADS). Results revealed that 568 (83.41%) participants were not diagnosed with any psychological problems, though HADS shows that anxiety and depression are prevalent in this study group. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the recalled psychological status of participants. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the HADS results.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eHospital Anxiety and Depression Scale (HADS) results\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnxiety Results\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eDepression Results\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBorderline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e139 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorderline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e136 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e356 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e236 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e225 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e681 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs per the data presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, positive IBS status on the ROME IV criteria was significantly associated with positive anxiety status (X2 (2, n\u0026thinsp;=\u0026thinsp;681)\u0026thinsp;=\u0026thinsp;19.953, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and borderline depression status (X2 (2, n\u0026thinsp;=\u0026thinsp;681)\u0026thinsp;=\u0026thinsp;12.513, p\u0026thinsp;=\u0026thinsp;0.002), which indicate that people with IBS suffer from psychiatric problems.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eIBS status (ROME IV) vs. psychiatric disorders\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePsychiatric disorders\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eIBS status (ROME IV)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e681 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e529 (77.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e152 (22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorderline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e356 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e284 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220 (32.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67 (9.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorderline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e236 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2. Patient Characteristics vs. IBS Diagnosis\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePatient characteristics, socioeconomic, environmental factors, and clinical outcomes based on IBS diagnosis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. With the study population consisting of middle-aged individuals, the majority of participants were in the 20\u0026ndash;29 year age group (n\u0026thinsp;=\u0026thinsp;295, 43.3%). Females constitute a great proportion of IBS-positive people (n\u0026thinsp;=\u0026thinsp;412, 60.5%). As for work circumstances, people with moderate-effort jobs were found to be more likely to test positive for IBS (n\u0026thinsp;=\u0026thinsp;291, 42.7%). Almost all participants are educated and have finished high school (n\u0026thinsp;=\u0026thinsp;174, 25.6%) and a bachelor\u0026rsquo;s degree (n\u0026thinsp;=\u0026thinsp;401, 58.9%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePatient characteristics vs. IBS diagnosis\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eIBS status (ROME IV)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e681 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e529 (77.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e152 (22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;19 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e295 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e235 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60 and more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e412 (60.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e305 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e107 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e269 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e224 (32.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.280*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIllitrate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174 (25.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e401 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e315 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork circumstances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo effort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate effort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e377 (55.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e291 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreat effort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e328 (48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e248 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80 (11.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 time a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5 times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEveryday\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e397 (58.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e302 (44.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalanced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate calories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e461 (67.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e368 (54.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh calories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactose intolerance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e254 (37.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e221 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e427 (62.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e308 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e119 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history of IBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e455 (66.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e360 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e226 (33.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169 (24.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast surgeries in the abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.097*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppendectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHystrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e527 (77.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e417 (61.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Fisher or Fisher-Freeman-Halton exact tests.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUsing Pearson\u0026rsquo;s Chi-Square test, results revealed that IBS diagnosis is significantly associated with sex, with females testing positive more than males (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e (1, n\u0026thinsp;=\u0026thinsp;681)\u0026thinsp;=\u0026thinsp;8.018, p\u0026thinsp;=\u0026thinsp;0.005). Also, work circumstances groups were significantly different in terms of IBS status (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e (2, n\u0026thinsp;=\u0026thinsp;681)\u0026thinsp;=\u0026thinsp;11.798, p\u0026thinsp;=\u0026thinsp;0.003), with moderate effort jobs resulting in a more positive IBS diagnosis when compared to other circumstances. On the other hand, age, educational level, physical activity, diet, and smoking status didn\u0026rsquo;t show a statistically significant association with IBS diagnosis (p\u0026thinsp;\u0026gt;\u0026thinsp;0.050).\u003c/p\u003e \u003cp\u003eLactose intolerance was significant when compared between positive and negative IBS diagnoses (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e (1, n\u0026thinsp;=\u0026thinsp;681)\u0026thinsp;=\u0026thinsp;20.329, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 308 (45.2%) participants being positive for IBS but didn\u0026rsquo;t have lactose intolerance. Family history and having a past abdominal surgery were not significantly associated with IBS diagnosis.\u003c/p\u003e \u003cp\u003e People participating in the study were asked if the psychiatric symptoms were present with the gastrointestinal symptoms. Most patients reported IBS symptoms to be in sync with psychiatric ones (n\u0026thinsp;=\u0026thinsp;211, 31.0%) or preceding gastrointestinal problems (n\u0026thinsp;=\u0026thinsp;191, 28.0%). For those who are diagnosed with IBS and taking drugs for it, a lot of them reported mood changes for the better when taking IBS medications and treatments (n\u0026thinsp;=\u0026thinsp;232, 34.1%). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the detailed answers by participants.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study analyzed the prevalence of neuropsychiatric disorders -specifically anxiety and depression- among adults with irritable bowel syndrome (IBS), using a wide sample of 681 participants. Our findings imply a high burden of psychological symptoms among individuals with IBS, with statistically significant associations between IBS (based on Rome IV criteria) and both anxiety and depression (based on the Hospital Anxiety and Depression Scale HADS). These results support the bidirectional nature of the gut-brain axis and highlight the importance of integrating psychological assessment into IBS management. In the study, 77.7% of participants fulfilled the Rome IV criteria for IBS, a greater proportion than the 65.8% with a clinical diagnosis of IBS. This difference proposes a potentially large number of individuals with undiagnosed yet symptomatic IBS, consistent with previous evidence that IBS remains underdiagnosed due to symptom overlap and sociocultural barriers to pursuing gastrointestinal care.\u003c/p\u003e \u003cp\u003eThe prevalence of IBS in our study was higher than that reported by Derar Abdel-Qader [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], who found a lower percentage.\u003c/p\u003e \u003cp\u003eThis difference may be credited to our study population, which primarily included patients presenting with abdominal pain, whereas Abdel-Qader\u0026rsquo;s study was based on a randomly distributed questionnaire among the general population. Fundamentally, anxiety and depression symptoms were markedly common: 52.3% of participants screened positive for anxiety and 33.0% screened positive for depression. IBS-positive individuals had significantly higher rates of both anxiety (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and borderline depression (p\u0026thinsp;=\u0026thinsp;0.002). These results align with a Vietnamese study on IBS [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] A systematic review on the prevalence of anxiety and depression in patients with irritable bowel syndrome found that the prevalence rates of anxiety symptoms and disorders among IBS patients were 39.1% (95% CI: 32.4\u0026ndash;45.8) and 23% (95% CI: 17.2\u0026ndash;28.8) respectively [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast to our results, a Jordanian study conducted among medical students found no significant difference in the prevalence of IBS between males and females (P\u0026thinsp;=\u0026thinsp;0.477) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHowever, in our study IBS diagnosis was significantly associated with sex, with females showing higher rates than males (χ\u0026sup2;(1, n\u0026thinsp;=\u0026thinsp;681)\u0026thinsp;=\u0026thinsp;8.018, p\u0026thinsp;=\u0026thinsp;.005) consistent with global epidemiological trends showing a higher prevalence of IBS in women[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], possibly due to hormonal influences, differences in stress reactivity, or health-seeking behaviors. This variation may be explained by differences in the study populations and sampling contexts. Medical students represent a relatively homogenous group with extraordinary stressors and health-seeking behaviors that may lessen gender discrepancies. In comparison, our study included a wide-ranging outpatient and online population, which may better reflect community-level gender differences in symptom reporting, healthcare utilization, and IBS susceptibility.\u003c/p\u003e \u003cp\u003eSeveral biological and psychological mechanisms may explain these findings. The gut-brain axis, involving bidirectional communication through neuroendocrine, immune, and autonomic pathways, plays a central role in the pathophysiology of IBS. Dysbiosis, visceral hypersensitivity, and chronic low-grade inflammation can exacerbate anxiety and mood symptoms, while psychological stress can worsen gastrointestinal motility and sensitivity. This cyclical pattern may contribute to the finding that over 59% of participants reported psychiatric symptoms occurring either simultaneously with IBS symptoms (31.0%) or preceding them (28.0%). Such temporal relationships support the hypothesis that psychiatric distress may precipitate or augment gastrointestinal symptoms in susceptible individuals. The association between IBS and psychiatric conditions is thought to stem from disruptions in \u003cb\u003ebrain\u0026ndash;gut communication\u003c/b\u003e. Evidence from psychophysiological and neuroimaging research indicates that impairment of the brain\u0026ndash;gut axis\u0026mdash; the two-way neural pathway linking the gastrointestinal tract and the central nervous system\u0026mdash;plays a key role in the development of IBS. In this model, gastrointestinal discomfort can contribute to anxiety and depressive symptoms, while psychological distress can heighten physiological responses in the gut, thereby worsening IBS manifestations. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSociodemographic and clinical variables also revealed interesting patterns. Work circumstances were also associated with IBS status (p\u0026thinsp;=\u0026thinsp;0.003), with moderate-effort jobs showing the highest proportion of IBS-positive cases. This may indicate a relationship between occupational stress and functional gastrointestinal disorders.\u003c/p\u003e \u003cp\u003eThe findings of our study indicate an association between IBS diagnosis and self-reported lactose intolerance.\u003c/p\u003e \u003cp\u003eThis differs from studies that used hydrogen breath tests to evaluate lactose malabsorption, which show no higher prevalence of lactose malabsorption in IBS patients compared to healthy controls [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStill, our results adjust with their observation that IBS patients frequently report gastrointestinal symptoms triggered by lactose containing food.\u003c/p\u003e \u003cp\u003eThis suggests that even though lactose malabsorption and IBS may be unrelated pathophysiologically, symptoms overlap and visceral hypersensitivity in IBS may lead patients to misattribute symptoms to lactose ingestion.\u003c/p\u003e \u003cp\u003eAccordingly, self-reported lactose intolerance in IBS patients probably reflects symptoms perception not due to enzymatic deficiency.\u003c/p\u003e \u003cp\u003eOther variables did not show significant associations including: Age, diet, smoking status, educational level, physical activity, family history and prior abdominal surgery.\u003c/p\u003e \u003cp\u003eAn interesting clinical observation from this study is that \u003cb\u003e34.1%\u003c/b\u003e of IBS-diagnosed individuals taking IBS medications reported mood improvement with treatment. This suggests that effective management of gastrointestinal symptoms may alleviate psychological distress, possibly through improved quality of life, reduction of pain, or modulation of the gut\u0026ndash;brain axis by certain medications or dietary modifications. Although not causal, this finding highlights the potential benefit of integrated care approaches combining gastroenterological and psychological interventions.\u003c/p\u003e \u003cp\u003eUnlike a large prospective cohort study that demonstrated a modest but significant inverse association between never smoking and IBS incidence, our study did not find smoking status to be significantly associated with IBS similar to a national study among Jordanian students [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This discrepancy may be explained by methodological differences. Our study used a cross-sectional design and assessed smoking and IBS simultaneously, which limits the ability to determine causal direction. In contrast, the prospective study followed participants for more than a decade, allowing for evaluation of long-term smoking exposure as a risk factor for new-onset IBS. Differences in sample size, age distribution, cultural factors, and the precision of smoking exposure measurement may also account for the variation in findings.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn our study, the analysis of correlation between family history and IBS was statically insignificant [p:200].\u003c/p\u003e \u003cp\u003eThis in contrast with several other studies that found a Significant association, shows that individuals with a positive family history of IBS are more likely to exhibit IBS symptoms than whom with no family history [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFirst Variation in sample size and demographic could be a reason and also the method that we used (self-reported data) can introduce a recall bias or inaccuracy comparing with other studies that might use a medical records or more objective measures.\u003c/p\u003e \u003cp\u003eThis study also showed that psychiatric conditions are underdiagnosed in Jordanian population, because even though Results revealed that 568 (83.41%) participants were not diagnosed with any psychological problems, 225 (33.0%) were positive for depression and 356 (52.3%) positive for anxiety among all participants using HADS questionnaire. This sets an alarming rate at the prevalence of both conditions in Jordan.\u003c/p\u003e \u003cp\u003eKey advantages of this research are the employment of an established psychological assessment tool (HADS) a substantial sample size (n\u0026thinsp;=\u0026thinsp;681) and a confirmed diagnostic criterion (Rome IV criteria). The investigation also examined an array of clinical, lifestyle and demographic attributes providing a comprehensive overview of the factors associated with IBS diagnosis. By incorporating participants from a survey as well, as outpatients attending gastrointestinal clinics our sampling approach enhances the applicability of the results.\u003c/p\u003e \u003cp\u003eDespite these benefits some limitations must be acknowledged. It cannot establish sequence or causal links between IBS and mental health issues because of the cross-sectional design. Given that all data were self-reported there is potential for recall and reporting bias, regarding lifestyle habits and mental health diagnoses. Additionally, no comprehensive psychiatric assessment was performed to confirm the findings, from the HADS. The study depended on cross-sectional data. Another drawback is that we didn't look at our patients' IBS subtypes.\u003c/p\u003e \u003cp\u003eThis finding hold important clinical implications. Given the strong association between IBS and psychological disorders, healthcare providers should routinely screen IBS patients for anxiety and depression symptoms, particularly in primary health centers and gastroenterology clinics. Early detection and management of psychiatric comorbidities may improve the treatment response, symptom severity, and overall quality of life. The high percentage of undiagnosed IBS patients according to Rome IV criteria also draw the attention for our need to increase awareness of IBS symptoms in our public and medical community.\u003c/p\u003e \u003cp\u003eFuture research should include prospective studies to better understanding of the relationship between IBS and psychological symptoms. Investigations into therapeutic effect, including whether treatment of anxiety or depression alleviate IBS severity. Additionally, searching for biological markers (such as microbiome profiles, inflammatory mediators, or stress-related hormones) may help differentiate subtypes of IBS with specific psychiatric disorders.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings revealed a high prevalence of depression and anxiety disorders among Jordanian patients with IBS. Suggesting the importance of screening for depression and Anxiety in newly diagnosed IBS patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study received no specific grants from any funding agency in the public, commercial or not-for-profit sector\u003c/p\u003e \u003cp\u003eCompeting interests\u003c/p\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003cp\u003eEthics Approval declaration\u003c/p\u003e \u003cp\u003e Ethical approval for this study was obtained from [New Zarqa Hospital IRB committee] (Reference number: [5145]) and [Prince Hamza Hospital IRB committee] (Reference number [4604]).\u003c/p\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eConsent to Participate declaration\u003c/p\u003e \u003cp\u003e Consent was obtained electronically, and participants were informed that their data would be anonymized, used solely for scientific research purposes, and that no personal identifying information would be collected. Participation in the study was voluntary, and completion of the questionnaire implied consent\u003c/p\u003e \u003cp\u003e Consent for publication\u003c/p\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.M. conceived and designed the study. L.S. and H.G. developed the study methodology and data collection tools. All authors collected the data. B.A. performed the statistical analysis and interpreted the results. F.A. drafted the Discussion . R.H. ,A.A. and S.A.critically revised the manuscript for important intellectual content. M.K. wrote the introduction. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during the current study are available from the corresponding author upon reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEnck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFond G, Loundou A, Hamdani N, et al. Anxiety and depression comorbidities in irritable bowel syndrome: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2014;264(8):651\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. N Engl J Med. 2015;372:242\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017;6(11):99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. J Neurogastroenterol Motil. 2019;25(4):507\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdel-Qader D. Irritable Bowel Syndrome (IBS) Among Jordanian Adults: Uncovering the Underdiagnosed and The Triggering Factors. 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PMID: 38378250. gutjnl-2023-331254.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HADS, IBS, anxiety, depression","lastPublishedDoi":"10.21203/rs.3.rs-8462230/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8462230/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIrritable bowel syndrome (IBS) is a the most common functional gastrointestinal disorder. Growing evidence suggests a significant association between IBS and psychological problems, such as anxiety and depression. This study was conducted to assess the prevalence of anxiety and depression in Jordanian patients diagnosed with IBS according to Rome IV criteria.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study was conducted at the Gastroenterology Department of Prince Hamza Hospital and New Zarqa Governmental Hospital in Jordan recruiting 681 patients. IBS diagnosis was established using the validated Rome IV criteria. Anxiety and depression were assessed using an Arabic version of the Hospital Anxiety and Depression Scale (HADS).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003ebased on the ROME IV criteria used in this study, 529 (77.68%) people were found to be positive for IBS. Results revealed that 568 (83.41%) participants were not diagnosed with any psychological problems. However, 225 (33.0%) were positive for depression and 356 (52.3%) positive for anxiety among all participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe findings revealed a high prevalence of depression and anxiety disorders among Jordanian patients with IBS. Suggesting the importance of screening for depression and Anxiety in newly diagnosed IBS patients.\u003c/p\u003e","manuscriptTitle":"The prevalence of neuropsychiatric disorders (Anxiety \u0026amp; depression) among IBS patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-12 07:29:06","doi":"10.21203/rs.3.rs-8462230/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-07T11:10:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65438138385068767248604455885705492220","date":"2026-03-18T09:04:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194780628292332104584460232299068940502","date":"2026-03-15T19:12:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T10:17:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300777995027687001147958753156044550974","date":"2026-03-13T09:11:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T12:04:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-11T13:36:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-14T11:28:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-13T17:25:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-01-13T17:21:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb43c7c3-d1e0-4b2f-9c5c-caecf84eaa4d","owner":[],"postedDate":"March 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T07:29:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-12 07:29:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8462230","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8462230","identity":"rs-8462230","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}