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A population based case control study of work and psychosocial problems in patients with irritable bowel syndrome: women are more seriously affected than men
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-0723-139X
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
Cardiovascular Institute, University of Gothenburg, Gothenburg, Sweden; and Department of Epidemiology, AstraZeneca R and D, Mölndal, Sweden.
Department of Epidemiology, AstraZeneca R and D, Mölndal, Sweden; and Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
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2007 (English)In: American Journal of Gastroenterology, ISSN 0002-9270, Vol. 102, no 2, 371-379 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Everyday psychosocial functioning and quality of life are known to be reduced for patients with irritable bowel syndrome (IBS), but few previous studies have analyzed associations with functioning in working life. Accordingly, we examined perceptions of working conditions, functioning in the workplace, quality of life, and psychological complaints among IBS patients compared with age- and sex-matched controls.

Methods: A case–control study design was used based on 347 IBS patients from Swedish general practice who were compared with age- and sex-matched controls (N = 1,041) randomly selected from the general population. A survey was performed including validated questions concerning job strain, quality of life (SF-36 [Short Form 36]), absence because of illness, depression, anxiety, and sleeping habits.

Results: The IBS patients reported considerably more often that their daily performance in working life was affected by their gastrointestinal problems (OR [odds ratio] 7.14, 95% CI 5.45–9.36). Male IBS cases only reported less authority regarding decisions on their working pace (OR 5.44, 95% CI 1.28–23.18), while female IBS patients reported less decision authority regarding planning their work (OR 2.29, 95% CI 1.13–4.64), fewer learning opportunities at work (OR 2.12, 95% CI 1.26–3.57), and more long-term sick leave than their controls (OR 3.70, 95% CI 1.94–7.07). The female IBS cases also reported lower quality of life in all dimensions than their controls.

Conclusion: In particular, female IBS patients reported lower authority over decisions at work and problems in their daily functioning in the workplace. These associations persisted after adjustments for possible confounders such as mood, sleeping problems, and perceived health.

Place, publisher, year, edition, pages
2007. Vol. 102, no 2, 371-379 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13967DOI: 10.1111/j.1572-0241.2006.01012.xOAI: diva2:22349
Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2013-09-05
In thesis
1. Irritable bowel syndrome diagnosed in primary care: Occurrence, treatment and impact on everyday life
Open this publication in new window or tab >>Irritable bowel syndrome diagnosed in primary care: Occurrence, treatment and impact on everyday life
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: IBS is the most common functional gastrointestinal disorders and affects approximately 10-20 % of the general population and is widespread in all societies and socio-economic groups. Although the disorder does not have a life-threatening course, it still seriously affects the patients in their everyday life.

Aim: The general aims of this thesis were to estimate the occurrence of irritable bowel syndrome in the general population and to achieve a better understanding of present treatment of this disorder and impact on every-day life in those suffering from IBS.

Material and methods: The LIPS study comprises two parts. Part I was a retrospective register study where the data collection was based on computerised medical records at three selected Primary Health Care centres in a defined region. Part II was a population based case-control study. The identified IBS cases from part I constitute the cases, while their control groups were randomly selected from the population census register in the same area as the cases. Data in part II were collected by means of a postal questionnaire to cases and controls. The study was conducted in Linköping, a city located in the south-east of Sweden with 135 000 inhabitants.

Results: The female IBS patients reported lower influence on planning their work and working hours as well as fewer opportunities to learn new things at their work compared to their controls, even after adjustments in multiple logistic regressions for potential confounders like; mood, sleeping problems and perceived health. The female IBS patients had considerably lower HRQOL in all dimensions compared to their controls, even when compared to male patients. Younger female IBS cases (18-44 years) reported lower mental health on the SF-36 scale than the older IBS female cases (p=0.015). In the multivariate analysis these variables, lack of influence on planning the work, family history of IBS, anxiety and sleeping disturbance displayed an association with being diagnosed with IBS in women. In men, lack of influence on working pace, family history of IBS was associated with an IBS diagnosis.The consultation incidence of IBS in part I was 3.4 (95% CI 3.20-3.70) per 1000 person-years for all IBS cases, among females; the incidence rate was 4.6 per 1000 person-years (95% CI 4.16-4.97) and males; 2.3 per 1000 person-years (95% CI 2.01-2.59). The dominating pharmacological treatment prescribed for abdominal complaints were fibre and bulking laxatives agents as well as acid suppressive drugs. These variables had an independent impact on the probability of a follow-up consultation; diagnosed co-morbidity besides the IBS diagnosis, rectoscopy ordered and laboratory tests ordered.

Conclusions: IBS patients identified in primary care are significantly affected in their working-life compared to individuals in the general population. Especially female IBS-patients report lower decision latitude at work and they also appear to have a particularly impaired psychosocial functioning in their every day life and impaired HRQOL. Factors associated with IBS diagnosis among females are anxiety as well as family history of IBS and lack of co-determination at work.

The incidence rate of IBS was 3.4 per 1000 person-years which increased with age and with an overrepresentation of females. IBS patients did not appear to be heavy utilisers of primary care and those who attended were treated by their GP without further consultation. The strongest predictors for having a follow-up consultation were diagnosed co-morbidity, rectoscopy and laboratory tests ordered

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle, 2006
Linköping University Medical Dissertations, ISSN 0345-0082 ; 958
Irritable bowel syndrome (IBS), occurence, treatment, psychosocial factors, psychological factors, working conditions, gender, health-related qualtity of life (HRQOL)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
urn:nbn:se:liu:diva-7336 (URN)91-85523-09-7 (ISBN)
Public defence
2006-10-06, Hälsans Hus, Ingång 16, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Figure on page 8 reprinted from Lancet 360(9332), Nicholas, J Talley and Robin Spiller, "Irritable bowel syndrome: a little understood organic bowel disease?", pp. 555-564, Copyright 2006 with permission from Elsevier. On the day of the public defence of the doctoral thesis, the status of articles III and IV was Submitted.Available from: 2006-09-19 Created: 2006-09-19 Last updated: 2013-09-05

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Olsen Faresjö, ÅshildGrodzinsky, EwaTimpka, ToomasÅkerlind, Ingemar
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Division of Preventive and Social Medicine and Public Health ScienceFaculty of Health SciencesGeneral PracticeUnit of Research and Development in Local Health Care, County of ÖstergötlandWork and Rehabilitation
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