Psychological determinants of irritable bowel syndrome and its impact on quality of life: a machine learning approaches
Gastroenterology and Hepatology from Bed to Bench,
Vol. 18 No. 1 (2025),
4 January 2025
https://doi.org/10.22037/ghfbb.v18i1.3082
Abstract
Aim: This study examined the associations between psychosocial factors, Irritable bowel syndrome (IBS) diagnosis, and quality of life (QOL) in both control and IBS groups. Additionally, we explored the potential influence of psychosocial factors on the onset of IBS and developed a machine-learning model for IBS prediction.
Background: IBS is a prevalent gastrointestinal disorder, with various factors predicting its severity and associated symptoms.
Methods: Through convenience sampling, a cross-sectional study recruited participants diagnosed with IBS (n=134) and healthy controls (n=150) from Arak Gastroenterology Clinics. Linear regression assessed the impact of psychosocial factors on IBS symptom severity and QOL. Logistic regression analyzed the association of these factors with IBS onset. Machine learning algorithms were used to predict IBS based on psychosocial features. Instruments include IBS-SSS, IBS-QOL, Toronto Alexithymia Scale (TAS-20), Visceral Sensitivity Index (VSI), and Pain Catastrophe Scale (PCS).
Results: A total of 284 participants (61.27% females) were recruited in the study, with a mean age of 36.48±10.75 years. Compared to controls, IBS patients exhibited significantly higher scores on measures of pain catastrophizing scale (PCS, 40.95 vs. 27.73), somatization (13.91 vs. 6.49), and alexithymia (60.23 vs. 54.71) as well as lower VSI (40.54 vs. 72.10). For those with IBS, only difficulty identifying feelings and somatization remained associated with worse symptoms, while VSI presented an inverse correlation. Psychological factors were inversely related to QOL. Elevated levels of alexithymia (OR 1.06; 95% CI 0.48, 1.63), somatization (OR 1.80; 95%CI 1.12, 2.48), and PCS (OR 1.70; 95% CI 1.30, 2.10) were associated with a higher chance of developing IBS, while higher VSI (OR -1.65; 95% CI -1.89, -1.42) was protective. Among machine learning models, logistic regression based on these factors (excluding alexithymia) and age achieved good performance (AUC: 0.86, 95% CI: 0.78-0.94; Accuracy: 0.83, 95% CI: 0.73-0.90) in predicting IBS onset.
Conclusion: Psychological factors were linked to worse IBS symptoms and quality of life. A machine learning model for IBS prediction presented promising results.
- irritable bowel syndrome (IBS)
- Machine Learning
- Psychosocial Factors
- Quality of Life
How to Cite
References
Hellström PM, Benno P. The Rome IV: Irritable bowel syndrome - A functional disorder. Best Pract Res Clin Gastroenterol 2019;40-41:101634.
Elhosseiny D, Mahmoud NE, Manzour AF. Factors associated with irritable bowel syndrome among medical students at Ain Shams University. J Egypt Public Health Assoc 2019;94:1-9.
Tack J, Stanghellini V, Mearin F, Yiannakou Y, Layer P, Coffin B, et al. Economic burden of moderate to severe irritable bowel syndrome with constipation in six European countries. BMC Gastroenterol 2019;19:1-13.
Wang K, Liu H, Liu J, Han L, Kang Z, Liang L, et al. Factors related to irritable bowel syndrome and differences among subtypes: A cross-sectional study in the UK Biobank. Front Pharmacol 2022;13:905564.
Zhang T, Ma X, Tian W, Zhang J, Wei Y, Zhang B, et al. Global research trends in irritable bowel syndrome: a bibliometric and visualized study. Front Med 2022;9:922063.
Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012;10:712-21.
Cassar GE, Youssef GJ, Knowles S, Moulding R, Austin DW. Health-related quality of life in irritable bowel syndrome: a systematic review and meta-analysis. Gastroenterol Nurs 2020;43:102-22.
Sperber AD, Dumitrascu D, Fukudo S, Gerson C, Ghoshal UC, Gwee KA, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut 2017;66:1075-82.
Black CJ, Ford AC. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol 2020;17:473-86.
Creed F. the incidence and risk factors for irritable bowel syndrome in population‐based studies. Aliment Pharmacol Ther 2019;50:507-16.
Sirri L, Grandi S, Tossani E. Smoking in irritable bowel syndrome: a systematic review. J Dual Diagn 2017;13:184-200.
Pellissier S, Bonaz B. The place of stress and emotions in the irritable bowel syndrome. Vitam Horm 2017;103:327-54.
Bisgaard TH, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol 2022;19:717-26.
Hollier JM, van Tilburg MA, Liu Y, Czyzewski DI, Self MM, Weidler EM, et al. Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome. Neurogastroenterol Motil 2019;31:13509.
Zhu L, Huang D, Shi L, Liang L, Xu T, Chang M, et al. Intestinal symptoms and psychological factors jointly affect quality of life of patients with irritable bowel syndrome with diarrhea. Health Qual Life Outcomes 2015;13:1-8.
Martino G, Caputo A, Schwarz P, Bellone F, Fries W, Quattropani M, et al. Alexithymia and inflammatory bowel disease: a systematic review. Front Psychol 2020;11:1763.
Knowles SR, Austin DW, Sivanesan S, Tye-Din J, Leung C, Wilson J, et al. Relations between symptom severity, illness perceptions, visceral sensitivity, coping strategies and well-being in irritable bowel syndrome guided by the common sense model of illness. Psychol Health Med 2017;22:524–34.
Van Oudenhove L, Törnblom H, Störsrud S, Tack J, Simrén M. Depression and somatization are associated with increased postprandial symptoms in patients with irritable bowel syndrome. Gastroenterology 2016;150:866-74.
Sherwin LB, Leary E, Henderson WA. The association of catastrophizing with quality-of-life outcomes in patients with irritable bowel syndrome. Qual Life Res 2017;26:2161–70.
Oligschlaeger Y, Yadati T, Houben T, Condello Oliván CM, Shiri-Sverdlov R. Inflammatory bowel disease: a stressed “gut/feeling”. Cells 2019;8:659.
Aswani-Omprakash T, Shah ND. Sociocultural Considerations for Food-Related Quality of Life in Inflammatory Bowel Disease. Gastroenterol Clin 2022;51:885-95.
Berens S, Schaefert R, Baumeister D, Gauss A, Eich W, Tesarz J. Does symptom activity explain psychological differences in patients with irritable bowel syndrome and inflammatory bowel disease? Results from a multi-center cross-sectional study. J Psychosom Res 2019;126:109836.
Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144:742–52.
Mitrasinovic S, Camacho E, Trivedi N, Logan J, Campbell C, Zilinyi R, et al. Clinical and surgical applications of smart glasses. Technol Health Care 2015;23:381–401.
Abbasi M, Kashiyarndi S. Clinical decision support systems: a discussion on different methodologies used in health care [master’s thesis]. Västerås (Sweden): Mälardalen University; 2006.
Davenport T, Kalakota R. The potential for artificial intelligence in healthcare. Future Healthc J 2019;6:94.
Sarker IH. Machine learning: algorithms, real-world applications and research directions. SN Comput Sci 2021;2:160.
Ibrahim I, Abdulazeez A. The role of machine learning algorithms for diagnosing diseases. J Appl Sci Technol Trends 2021;2:10–9.
Kaur M, Jat A, Ajith R. Pediatric irritable bowel syndrome prediction using 2-tier ensemble classifier. Int J Comput Inf Syst Ind Manag Appl 2019;11:7–14.
Jat A, Kaur M. Prediction of pediatric IBS using machine learning models. Int J Res Comput Sci 2017;4:1–6.
Surdea-Blaga T, Dumitraşcu D-L. An expert system for the diagnosis of irritable bowel syndrome. Clujul Med 2013;86:208–13.
Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther 1997;11:395–402.
Haviland MG. Structure of the twenty-item Toronto Alexithymia Scale. J Pers Assess 1996;66:116–25.
Labus J, Bolus R, Chang L, Wiklund I, Naesdal J, Mayer E, et al. The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom‐specific anxiety scale. Aliment Pharmacol Ther 2004;20:89–97.
Derogatis LR, Unger R. Symptom Checklist‐90‐Revised. In: Weiner IB, Craighead WE, editors. The Corsini Encyclopedia of Psychology. 4th ed. Hoboken (NJ): Wiley; 2010. p. 1–2.
Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:524–32.
Patrick DL, Drossman DA, Frederick IO, Dicesare J, Puder KL. Quality of life in persons with irritable bowel syndrome (development and validation of a new measure). Dig Dis Sci 1998;43:400–11.
Hamburg M. Basic Statistics: A Modern Approach. New York: Harcourt Brace Jovanovich; 1974.
Oka P, Parr H, Barberio B, Black CJ, Savarino EV, Ford AC. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5:908–17.
Fasbender U, Burmeister A, Wang M. Managing the risks and side effects of workplace friendships: The moderating role of workplace friendship self-efficacy. J Vocat Behav 2023;143:103875.
Boey RA, Van de Heyning PH, Wuyts FL, Heylen L, Stoop R, De Bodt MS. Awareness and reactions of young stuttering children aged 2–7 years old towards their speech disfluency. J Commun Disord 2009;42:334–46.
Rocha M, Yaruss JS, Rato JR. Stuttering impact: A shared perception for parents and children? Folia Phoniatr Logop 2020;72:478–86.
Fournier A, Mondillon L, Luminet O, Canini F, Mathieu N, Gauchez AS, et al. Interoceptive abilities in inflammatory bowel diseases and irritable bowel syndrome. Front Psychiatry 2020;11:229.
Cutler DR, Edwards TC Jr, Beard KH, Cutler A, Hess KT, Gibson J, et al. Random forests for classification in ecology. Ecology 2007;88:2783–92.
Strobl C. Statistical Issues in Machine Learning: Towards Reliable Split Selection and Variable Importance Measures. Göttingen: Cuvillier Verlag; 2008.
Calle ML, Urrea V. Stability of random forest importance measures. Brief Bioinform 2011;12:86–9.
Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 2008;26:1364–70.
Quinto RM, De Vincenzo F, Graceffa D, Bonifati C, Innamorati M, Iani L. The relationship between alexithymia and mental health is fully mediated by anxiety and depression in patients with psoriasis. Int J Environ Res Public Health 2022;19:3649.
Wang X, Li X, Guo C, Hu Y, Xia L, Geng F, et al. Prevalence and correlates of alexithymia and its relationship with life events in Chinese adolescents with depression during the COVID-19 pandemic. Front Psychiatry 2021;12:774952.
Saigo T, Tayama J, Hamaguchi T, Nakaya N, Tomiie T, Bernick PJ, et al. Gastrointestinal-specific anxiety in irritable bowel syndrome: validation of the Japanese version of the visceral sensitivity index for university students. BioPsychoSoc Med 2014;8:1–9.
Domschke K, Stevens S, Pfleiderer B, Gerlach AL. Interoceptive sensitivity in anxiety and anxiety disorders: an overview and integration of neurobiological findings. Clin Psychol Rev 2010;30:1–11.
Busch FN. Clinical approaches to somatization. J Clin Psychol. 2014;70:419–27.
Kinsinger SW. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights. Psychol Res Behav Manag 2017;10:231–7.
Fukudo S, Saito K, Sagami Y, Kanazawa M. Can modulating corticotropin releasing hormone receptors alter visceral sensitivity? Gut 2006;55:146–8.
Trieschmann K, Chang L, Park S, Naliboff B, Joshi S, Labus JS, et al. The visceral sensitivity index: a novel tool for measuring GI‐symptom‐specific anxiety in inflammatory bowel disease. Neurogastroenterol Motil 2022;34:14384.
Davoodi E, Wen A, Dobson KS, Noorbala AA, Mohammadi A, Farahmand Z. Emotion regulation strategies in depression and somatization disorder. Psychol Rep 2019;122:2119–36.
Lipscombe K, Tindall-Ford S, Kidson P. Developing a personalized educational leadership theory: a promising approach to school leadership development? J Res Leadersh Educ 2024;0:19427751241245971.
Boudabbous M, Issa AB, Feki I, Gdoura H, Chtourou L, Moalla M, et al. Alexithymia impairs quality of life in irritable bowel syndrome. Future Sci OA 2023;9:FSO881.
Cassar GE, Knowles SR, Moulding R, Austin D. The impact of diagnostic status on quality of life in irritable bowel syndrome. Turk J Gastroenterol 2021;32:808–19.
Sherwin LB, Leary E, Henderson WA. Effect of illness representations and catastrophizing on quality of life in adults with irritable bowel syndrome. J Psychosoc Nurs Ment Health Serv 2016;54:44–53.
Melchior C, Colomier E, Trindade IA, Khadija M, Hreinsson JP, Törnblom H, et al. Irritable bowel syndrome: factors of importance for disease‐specific quality of life. United Eur Gastroenterol J 2022;10:754–64.
Simrén M, Törnblom H, Palsson OS, Van Oudenhove L, Whitehead WE, Tack J. Cumulative effects of psychologic distress, visceral hypersensitivity, and abnormal transit on patient-reported outcomes in irritable bowel syndrome. Gastroenterology 2019;157:391–402.
Arsiè E, Coletta M, Cesana B, Basilisco G. Symptom‐association probability between meal ingestion and abdominal pain in patients with irritable bowel syndrome: does somatization play a role? Neurogastroenterol Motil 2015;27:416–22.
van Tilburg MA, Palsson OS, Whitehead WE. Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res 2013;74:486–92.
Cassar G, Knowles S, Youssef G, Moulding R, Uiterwijk D, Waters L, et al. Examining the mediational role of psychological flexibility, pain catastrophizing, and visceral sensitivity in the relationship between psychological distress, irritable bowel symptom frequency, and quality of life. Psychol Health Med 2018;23:1168–81.
Garland EL, Gaylord SA, Palsson O, Faurot K, Douglas Mann J, Whitehead WE. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med 2012;35:591–602.
Porcelli P, De Carne M, Leandro G. The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome. Compr Psychiatry 2017;73:127–35.
Schauer B, Grabe HJ, Ittermann T, Lerch MM, Weiss FU, Mönnikes H, et al. Irritable bowel syndrome, mental health, and quality of life: Data from a population-based survey in Germany (SHIP-Trend-0). Neurogastroenterol Motil 2019;31:13511.
Portincasa P, Moschetta A, Baldassarre G, Altomare DF, Palasciano G. Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome. World J Gastroenterol 2003;9:2293–9.
Porcelli P, Guidi J, Sirri L, Grandi S, Grassi L, Ottolini F, et al. Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology. Gen Hosp Psychiatry 2013;35:521–7.
Schubach A, Quigley BM, Lackner JM, Gudleski GD. Somatization mediates the relationship between childhood trauma and pain ratings in patients with irritable bowel syndrome. J Clin Gastroenterol 2024. doi:10.1097/MCG.0000000000001889
Semen MO, Lychkovska OL. Trait anxiety and somatization levels in children with irritable bowel syndrome. Childs Health 2023;18:53–9.
Torun F, Koç G, Ocak Serın S, Dılek Torun S. Psychiatric symptoms and relationship of disease with stress and traumatic experiences in patients with irritable bowel syndrome. Riv Psichiatr 2020;55:292–6.
Sierżantowicz R, Lewko J, Jurkowska G. The impact of an individual educational program on the quality of life and severity of symptoms of patients with irritable bowel syndrome. Int J Environ Res Public Health 2020;17:4430.
Kuo B, Bhasin M, Jacquart J, Scult MA, Slipp L, Riklin EI, et al. Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease. PLoS One 2015;10:0123861.
Trieschmann K, Chang L, Park S, Naliboff B, Joshi S, Labus JS, et al. The visceral sensitivity index: A novel tool for measuring GI‐symptom‐specific anxiety in inflammatory bowel disease. Neurogastroenterol Motil 2022;34:14384.
Addante R, Naliboff B, Shih W, Presson AP, Tillisch K, Mayer EA, et al. Predictors of health-related quality of life in irritable bowel syndrome patients compared with healthy individuals. J Clin Gastroenterol 2019;53:142–9.
Kordi M, Dehghan MJ, Shayesteh AA, Azizi A. The impact of artificial intelligence algorithms on management of patients with irritable bowel syndrome: a systematic review. Inform Med Unlocked 2022;29:100891.
Haleem N, Lundervold AJ, Lied GA, Hillestad EMR, Bjorkevoll M, Bjørsvik BR, et al. A psychological symptom based machine learning model for clinical evaluation of irritable bowel syndrome. Open Res Eur 2023;3:19.
- Abstract Viewed: 400 times
- PDF Downloaded: 243 times