Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
권호 표지
DOI QR코드

DOI QR Code

A Study on the Psychosocial Characteristics and Quality of Life in Functional Gastrointestinal Disorders

기능성위장질환 환자들의 정신사회적 특성 및 삶의 질의 관계에 관한 연구

  • Kim, So-Won (Department of Psychiatry, School of Medicine, Wonkwang University) ;
  • Jang, Seung-Ho (Department of Psychiatry, School of Medicine, Wonkwang University) ;
  • Ryu, Han-Seung (Department of Internal Medicine, Wonkwang University) ;
  • Choi, Suck-Chei (Department of Internal Medicine, Wonkwang University) ;
  • Rho, Seung-Ho (Department of Psychiatry, School of Medicine, Wonkwang University) ;
  • Lee, Sang-Yeol (Department of Psychiatry, School of Medicine, Wonkwang University)
  • 김소원 (원광대학교 의과대학 정신건강의학교실) ;
  • 장승호 (원광대학교 의과대학 정신건강의학교실) ;
  • 류한승 (원광대학교 의과대학 내과학교실) ;
  • 최석채 (원광대학교 의과대학 내과학교실) ;
  • 노승호 (원광대학교 의과대학 정신건강의학교실) ;
  • 이상열 (원광대학교 의과대학 정신건강의학교실)
  • Received : 2018.12.07
  • Accepted : 2019.01.21
  • Published : 2019.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : This study aimed to compare the psychosocial characteristics among patients with functional gastrointestinal disorder (FGID), adults with functional gastrointestinal symptoms, and normal control group and investigate factors related to quality of life (QoL) of FGID patients. Methods : 65 patients diagnosed with FGID were selected. 79 adults were selected as normal control group based on the Rome III diagnostic criteria, and 88 adults who showed functional gastrointestinal symptoms were selected as "FGID positive group". Demographic factors were investigated. Psychosocial factors were evaluated using the Korean-Beck Depression Inventory-II, Korean-Beck Anxiety Inventory, Korean-Childhood Trauma Questionnaire, Multi-dimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale and WHO Quality of Life Assessment Instrument Brief Form. A one-way ANOVA was used to compare differences among groups. Pearson correlation test was used to analyze correlations between QoL and psychosocial factors in patients with FGID. Results : There were group differences in the education level. Depression (F=29.012, p<0.001), anxiety (F=27.954, p<0.001) and Childhood trauma (F=7.748, p<0.001) were significantly higher in FGID patient group than in both FGID-positive and normal control group. Social support (F=5,123, p<0.001), Resilience (F=9.623, p<0.001) and QoL (F=35.991, p<0.001) were significantly lower in the FGID patient group than in others. QoL of FGID patients showed a positive correlation with resilience (r=0.475, p<0.01), and showed a negative correlation with depression (r=-0.641, p<0.01), anxiety (r=-0.641, p<0.01), and childhood trauma (r=-0.278, p<0.05). Conclusions : FGID patients have distinctive psychosocial factors compared to the both FGID-positive and normal control group. Therefore, the active interventions for psychosocial factors are required in the treatment of patients with FGID.

연구목적 본 연구에서는 기능성위장질환 환자집단, 기능성 위장증상 양성 집단 및 정상대조집단에서 정신사회적 특성을 비교하고, 기능성위장질환 환자의 삶의 질과 연관된 요인들을 알아보고자 하였다. 방 법 일 대학병원 소화기 내과 전문의에 의해 기능성위장질환으로 진단받은 환자 65명을 기능성위장질환 환자집단으로 선정하였다. 167명의 일 도 지역 공무원을 대상으로 로마III 진단 기준에 따라 기능성 위장증상을 보이지 않는 79명을 정상대조집단, 기능성위장증상을 나타내는 88명은 기능성위장증상 양성 집단으로 선별하였다. 인구통계학적 요인을 조사하였으며 정신사회적 요인을 평가하기 위해 Korean-Beck Depression Inventory-II (K-BDI-II), Korean-Beck Anxiety Inventory (K-BAI), Korean version of Childhood Trauma Questionnaire (K-CTQ), Multi-dimensional Scale of Perceived Social Support (MSPSS), Korean Version of Connor-Davidson Resilience Scale (K-CD-RISC), World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF)를 사용하였다. 일원배치 분산분석을 사용하여 집단들 간의 차이를 비교하고 기능성위장질환 환자군의 삶의 질과 정신사회적 요인들의 상관관계를 분석하기 위해 Pearson correlation test를 시행하였다. 모든 통계는 SPSS 21.0을 사용하였다. 결 과 인구통계학적 특성에서는 학력에서 집단간 차이가 유의했다(p<0.001). FGID 환자집단이 정상대조집단과 FGID-positive집단에 비해 우울(F=29.012, p<0.001) 및 불안(F=27.954, p<0.001)이 유의하게 높았다. 아동기 외상에서 정서학대(F=6.994, p<0.001)와 신체방임(F=5.573, p<0.001)은 FGID환자집단이 정상대조집단과 FGID-positive집단에 비해 유의하게 높았으나, 신체학대, 성 학대 및 정서방임은 세 집단간의 차이가 없었다. 사회적 지지 또한 FGID환자집단이 정상대조집단과 FGID-positive집단에 비해 유의하게 낮은 것으로 나타났다(F=27.664, p<0.001). 회복 탄력성(F=9.623, p<0.001)과 하위영역인 강인성(F=5.123, p<0.001), 인내력(F=8.402, p<0.001), 낙관성(F=15.039, p<0.001) 및 영성(F=5.129, p<0.001)에서도 FGID환자집단이 정상 대조집단과 FGID-positive 집단보다 유의하게 낮은 것으로 나타났다. 삶의 질 척도(F=35.991, p<0.001)와 그 하위영역인 전반적 안녕(F=30.463, p<0.001), 신체적 건강(F=45.247, p<0.001), 심리(F=22.852, p<0.001), 사회(F=20.070, p<0.001), 환경(F=17.851, p<0.001) 모두에서 FGID환자집단이 정상대조집단과 FGID-positive집단에 비해 유의하게 낮은 점수를 나타냈다. FGID 환자집단에서 삶의 질은 회복탄력성과 양의 상관관계를 보였으며(r=0.475, p<0.01), 우울(r=-0.641, p<0.01), 불안(r=-0.441, p<0.01) 및 아동기 외상(r=-0.278, p<0.05)과는 음의 상관관계를 나타냈다. 결 론 연구결과 기능성위장질환 환자집단은 기능성 위장증상 양성 집단 및 정상대조집단에 비해 우울, 불안과 아동기 트라우마가 유의하게 높았으며 사회적 지지 및 회복 탄력성이 낮았다. 따라서 추후 기능성 위장질환 환자의 치료에 있어 정신사회적 요인에 대한 적극적인 개입이 요구된다고 하겠다.

Keywords

Table 1. Demographic and clinical characteristics of participants

JSSCBG_2019_v27n1_25_t0001.png 이미지

Table 2. Comparison of depressive symptom and anxiety among FGID patient, FGID-positive group and FGID-negative group

JSSCBG_2019_v27n1_25_t0002.png 이미지

Table 3. Comparison of childhood trauma among the FGID patient, FGID-positive group and FGID-negative group

JSSCBG_2019_v27n1_25_t0003.png 이미지

Table 4. Comparison of social support and resilience among the FGID patient, FGID-positive group and FGID-negative group

JSSCBG_2019_v27n1_25_t0004.png 이미지

Table 5. Comparison of Quality of life among the FGID Patient, FGID-positive group and FGID-negative group

JSSCBG_2019_v27n1_25_t0005.png 이미지

Table 6. Pearson’s correlation for relationship between quality of life and psychological variables in FGID patients

JSSCBG_2019_v27n1_25_t0006.png 이미지

References

  1. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006;130:1377-1390. https://doi.org/10.1053/j.gastro.2006.03.008
  2. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of subgroups of functional bowel disorders. Gastroenterol Int 1990;3:151-172.
  3. Longstreth GF. Thompson WG. Chey WD. Houghton LA. Mearin F. Spiller RC. Functional bowel disorders. Gastroenterology 2006;130:1480-1491. https://doi.org/10.1053/j.gastro.2005.11.061
  4. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology 2016;150:1262-1279. https://doi.org/10.1053/j.gastro.2016.02.032
  5. Mayer EA, Tillisch K, Bradesi S. Review article: modulation of the brain-gut axis as a therapeutic approach in gastrointestinal disease. Aliment Pharmacol Ther 2006;24:919-933. https://doi.org/10.1111/j.1365-2036.2006.03078.x
  6. Gomborone JE, Gorard DA, Dewsnap PA, Libby GW, Farthing MJ. The prevalence of symptoms of irritable bowel syndrome among acute psychiatric inpatients with an affective diagnosis. Psychosomatics 1996;37:385-389. https://doi.org/10.1016/S0033-3182(96)71553-0
  7. Jones MP. Evaluation and treatment of dyspepsia. Postgrad Med J 2003;79:25-29. https://doi.org/10.1136/pmj.79.927.25
  8. Bennett EJ, Kellow JE, Cowan H, Scott AM, Shuter B, Langeluddecke PM, Hoschl R, Jones MP, Tennant CC. Suppression of anger and gastric emptying in patients with functional dyspepsia. Scand J Gastroenterol 1992;27:869-874. https://doi.org/10.3109/00365529209000156
  9. Kroenke K, Jackson JL, Chamberlin J. Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am J Med 1997;103:339-347. https://doi.org/10.1016/S0002-9343(97)00241-6
  10. Talley NJ, Fett SL, Zinsmeister AR, Melton LJ. Gastrointestinal tract symptoms and self-reported abuse: a populationbased study. Gastroenterology 1994;107:1040-1049. https://doi.org/10.1016/0016-5085(94)90228-3
  11. Fischer S, Lemmer G, Gollwitzer M, Nater UM. Stress and resilience in functional somatic syndromes: a structural equation modeling approach. PLoS ONE 2014;9:e111214. Available from URL:https://journals.plos.org/. https://doi.org/10.1371/journal.pone.0111214
  12. Gonzalez RM, Garcia CJ, Landero HR. The role of stress transactional theory on the development of fibromyalgia: a structural equation model. Actas Esp Psiquiatr 2011;39:81-87.
  13. Sung HM, Kim JB, Park YN, Bai DS, Lee SH, Ahn HN. A study on the reliability and the validity of Korean version of the beck depression inventory-II (BDI-II). J Korean Soc Bio Ther Psychiatry 2008; l4:201-212.
  14. Yook SP, Kim ZS. A clinical study on the korean version of Beck Anxiety Inventory: comparative study of patient and non-patient. Korean J Clin Psychol 1997;16:185-197.
  15. Kim DH, Park SC, Yang HJ, Oh DH. Reliability and validity of the korean version of the childhood trauma questionnaire-short form for psychiatric outpatients. Psychiatry Investig 2011;8:305-311. https://doi.org/10.4306/pi.2011.8.4.305
  16. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. J Pers Assess 1988;52:30-41. https://doi.org/10.1207/s15327752jpa5201_2
  17. Shin JS, Lee YB. The effects of social support on psychosocial well-being of the unemployed. Korean Journal of Social Welfare 1999;4:241-269.
  18. Connor KM, Davison JR. Development of a new resilience scale: The connor-davidson resilience scale (CD-RISC). Depress Anxiety 2003;18:76-82. https://doi.org/10.1002/da.10113
  19. Baek HS, Lee KU, Joo EJ, Lee MY, Choi KS. Reliability and validity of the Korean version of the connor-davidson resilience scale. Psychiatry Investig 2010;7:109-115. https://doi.org/10.4306/pi.2010.7.2.109
  20. Min SK, Lee CI, Kim KI, Suh SY, Kim DK. Development of Korean version of WHO quality of life scale abbreviated version (WHOQOL-BREF). J Korean Neuropsychiatr Assoc 2000;39:571-579.
  21. Koloski NA, Talley NJ, Boyce PM. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol 2002;97:2290-2299. https://doi.org/10.1111/j.1572-0241.2002.05783.x
  22. Kim PH, Kim HS. Relationships between perceived stress, mental health, and social support in community residents. J Korean Public Health Nurs 2010;24:197-210. https://doi.org/10.5932/JKPHN.2010.24.2.197
  23. Mazaheri M, Afshar H, Weinland S, Mohammadi N, Adibi P. Alexithymia and Functional Gastrointestinal Disorders (FGID). MED ARH 2012;66:28-32. https://doi.org/10.5455/medarh.2012.66.28-32
  24. Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS. The effect of emotional stress and depression on the prevalence of digestive diseases. J Neurogastroenterol Motil 2015;21:273-282. https://doi.org/10.5056/jnm14116
  25. Pinto-Sanchez MI, Ford AC, Avila CA, Verdu EF, Collins SM, Morgan D. Anxiety and depression increase in a stepwise manner in parallel with multiple FGID and symptom severity and frequency. Am J Gastroenterol 2015;110:1038-1048. https://doi.org/10.1038/ajg.2015.128
  26. Fowlie S, Eastwood MA, Ford MJ. Irritabile bowel syndrome: The influence of psychological factors on the symptom complex. J Psychosom Res 1992;36:166-173.
  27. Lydiard RB. Greenwald S. Weissman MM. Johnson J. Drossman DA. Ballenger JC. Panic disorder and gastrointestinal symptoms: Findings from the NIMH epidemiologic catchment area project. Am J Psychiatry 1994;151:64-70. https://doi.org/10.1176/ajp.151.1.64
  28. Foster JA. Neufeld KAM. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci 2013;36:305-312. https://doi.org/10.1016/j.tins.2013.01.005
  29. Budavari AI. Olden KW. Psychological aspects of functional gastrointestinal disorder. Gastroenterol Clin North Am 2003;32:477-506. https://doi.org/10.1016/S0889-8553(03)00030-X
  30. Drossman DA, Talley NJ, Leserman J, Olden KW, Barreiro MA. Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med 1995;123:782-794. https://doi.org/10.7326/0003-4819-123-10-199511150-00007
  31. Drossman DA, Leserman J, Nachman G. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990;113:828-833. https://doi.org/10.7326/0003-4819-113-11-828
  32. Carlos FF, Ami DS, Xiucai F, Shin F, Mary JG, Jin YK, Max S. Multicultural aspects in functional gastrointestinal disorders. Gastroenterology 2016;150:1344-1354. https://doi.org/10.1053/j.gastro.2016.02.013
  33. Levy RL, Olden KW, Naliboff BD, Bradley LA, Francisconi C, Drossman DA, Creed F. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006;130:1447-1458. https://doi.org/10.1053/j.gastro.2005.11.057
  34. El-Serag HB, Olden KW, Bjorkman D. Health-related quality of life among persons with irritable bowel syndrome: a systematic review. Aliment Pharmacol Ther 2002;16:1171-1185. https://doi.org/10.1046/j.1365-2036.2002.01290.x
  35. Creed FH, Ratcliffe J, Fernandes L, Palmer S, Rigby C, Tomenson B, Guthrie E, Read N. Thompson DG. Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders. Br J Psychiatry 2005;186:507-515. https://doi.org/10.1192/bjp.186.6.507