Psychological comorbidity in irritable bowel syndrome: insights from the primary-secondary care interface

Objective This service evaluation aimed to determine the prevalence of anxiety and depression and the severity of anxiety and depression symptoms experienced in irritable bowel syndrome (IBS) patients crossing the primary-secondary care interface. It also aimed to assess how routinely collected symptom scores for anxiety and depression influence clinician recognition and response in the IBS clinic. Method A retrospective review of online medical records was conducted for new patients referred to a specialist IBS clinic at a large National Health Service Teaching Hospital over 12 months. Baseline clinicodemographic data, IBS subtype and pre-existing diagnoses of anxiety and/or depression were extracted. All patients completed Generalised Anxiety Disorder-7 (GAD-7), which measures anxiety symptoms, and Patient Health Questionnaire-9 (PHQ-9), which measures depression symptoms, forms prior to clinic review. Severity scores were compared using non-parametric statistical tests (p<0.05) Results A total of 103 patients were included. Overall, 63.1% had a diagnosis of anxiety and/or depression, and most reported moderate-to-severe anxiety and depression symptoms when crossing the primary-secondary care interface. Patients with pre-existing mental health diagnoses had significantly higher GAD-7 and PHQ-9 scores (p<0.01 and p<0.001, respectively) than those without; however, there were no significant differences in symptom burden between groups (anxiety, depression or mixed disorder) on GAD-7 or PHQ-9. Elevated preclinic GAD-7 and PHQ-9 scores were acknowledged in over 80% of consultations and frequently resulted in mental-health-specific management recommendations. Conclusion Introducing preclinic screening enhances the visibility of anxiety and depression symptoms as patients cross the primary-secondary care interface, providing early insight into symptom severity.