Psychological aspects of gastrointestinal illness among Israeli medical outpatients

Psychological factors in the etiology and course of gastrointestinal (GI) illness have been extensively studied, yet despite the ubiquitous clinical impression of their importance, results have been inconclusive and difficult to apply in clinical practice. These problems may be due to methodological issues (poor research design, sampling bias, inadequate assessment instruments); and a narrow focus on specific functional GI illnesses in connection with specific emotional difficulties. Recent research in health psychology suggests a multi-dimensional model that includes emotional, social, demographic and illness related variables in the course and development of medical illness. The present study sought to apply this model to a general survey of gastrointestinal patients in comparison with a medically ill control group as well as a comparison of GI patients with functional and organic diagnoses. Patients were recruited on a consecutive basis from first time attenders at two outpatient clinics in Israel. The experimental group were 101 gastrointestinal patients at the Sha\u27are Zedek Medical Center in Jerusalem, and control subjects were 33 cardiac patients at Tel Ha-Shomer Medical Center in Tel Aviv. All subjects completed the Symptom Checklist-90, Beck Depression Inventory, State-Trait Anxiety Inventory, Social Readjustment Rating Scale and a questionnaire regarding demographic and medical illness related issues. GI and cardiac samples were found to be comparable for most demographic and illness related variables. GI patients reported higher levels of anxiety than cardiac patients, while differences on levels of psychological distress, depression and life event stress were not found. GI patients with functional diagnoses (irritable bowel, ulcer) in comparison with patients with organic diagnoses, exhibited higher levels of general psychological distress and life stress, but evidence of different depression and anxiety levels was not found. Illness related factors (time ill, number of clinic visits, number of medical symptoms reported) and demographic variables (age, education) were significantly associated with subjects\u27 distress, however this association was inconsistent across test instruments. A clear cut pattern of psychological characteristics distinguishing GI patients from other chronically ill medical subjects was not found. The importance of demographic and illness related variables supports a multi-dimensional research model and argues for the inclusion and more precise measurement of illness related variables in future research