The Relationship Between Depressive Symptoms and Functional Gastrointestinal Disorders (FGIDs): The Chain Mediating Effect of... 2025 Sun et al

[Andy]

Full title: The Relationship Between Depressive Symptoms and Functional Gastrointestinal Disorders (FGIDs): The Chain Mediating Effect of Sleep Disorders and Somatic Symptom

Abstract

Background: More than two-thirds of patients with functional gastrointestinal disorders (FGIDs) experience various degrees of mental health issues. Although studies indicate that FGIDs are related to depressive symptoms, sleep disorders, and somatic symptoms, the underlying mechanism between these variables remains unknown. Our objective was to establish a model that outlines the interactions between these psychological dimensions in FGIDs and, thus, provide valuable insights into how to enhance the well-being of affected individuals.

Methods: This study used the convenient sampling method to enroll patients who visited the digestive internal medicine department. A total of 238 patients were investigated using the Rome IV criteria (irritable bowel syndrome used Rome Ⅲ criteria). A questionnaire including the Hospital Anxiety and Depressive Symptoms Scale, the Pittsburgh Sleep Quality Index, and the Patient Health Questionnaire-12 was used. The chain mediating roles of sleep disorders and somatic symptoms in the relationship between depressive symptoms and FGIDs were examined by the bootstrap method.

Results: Correlation analysis revealed that depressive symptoms were positively related to sleep disorders, somatic symptoms, and FGIDs. Sleep disorders were positively related to somatic symptoms and FGIDs. Somatic symptoms were positively related to FGIDs. Chain mediating effect analysis showed that depressive symptoms can not only affect FGIDs but also through three indirect paths, as follows: the mediating role of sleep disorders and somatic symptoms, the chain mediating roles of sleep disorders and somatic symptoms, and the mediating effect size accounted for 7.2%, 7.7%, and 2.5% of the total effect, respectively.

Conclusions: This study is conducive to understanding the internal mechanism underlying the relationship between depressive symptoms and FGIDs. It reminds us that when treating FGIDs patients, we should not only provide adequate psychological support to improve but also pay attention to improvements in their sleep quality and somatic symptoms.

Open access

 

[Utsikt]

Correlation analysis revealed

This study is conducive to understanding the internal mechanism underlying the relationship between depressive symptoms and FGIDs.

Correlation doesn’t really do much for our understanding of anything.

It reminds us that when treating FGIDs patients, we should not only provide adequate psychological support to improve but also pay attention to improvements in their sleep quality and somatic symptoms.

Or maybe we shouldn’t focus on the psychological aspects at all?

 

[Emily Marcel]

This is such an important area of research. It makes total sense that there’s a deeper link between depressive symptoms and FGIDs, especially when you factor in things like sleep and somatic symptoms. It really highlights how interconnected mental and physical health are — you can’t just treat the GI symptoms in isolation and expect long-term results.

The chain mediation findings are interesting too — especially how sleep disorders and somatic symptoms each play their own role, but also work together to worsen FGID outcomes. That layered effect shows why a more holistic treatment plan is so necessary.

It’d be great to see more studies like this with larger sample sizes or even tracking changes over time. Definitely a step in the right direction for improving how these conditions are managed.

 

[Yann04]

It really highlights how interconnected mental and physical health are — you can’t just treat the GI symptoms in isolation and expect long-term results.

There’s no showing any sort of causation though.

For all we know the mental health symptoms could be caused by the burden associated with having gastro symptoms, and thus just focusing on the gastro symptoms could work.

This study just finds a correlation, no causation, so we need to find causation before your statement can be said to be true or false.
(This statement)

you can’t just treat the GI symptoms in isolation and expect long-term results.

 

[Yann04]

Just realised you’re new here. Welcome @Emily Marcel glad to have you here.

Feel free to make a thread introducing yourself if you’d like

 

[Utsikt]

First of all, welcome!

The chain mediation findings are interesting too — especially how sleep disorders and somatic symptoms each play their own role, but also work together to worsen FGID outcomes.

It shows nothing of this sort. Correlation does not equal causation.

That layered effect shows why a more holistic treatment plan is so necessary.

Again, there is no causation so we have no idea about what’s necessary or not.

It’d be great to see more studies like this with larger sample sizes or even tracking changes over time. Definitely a step in the right direction for improving how these conditions are managed.

Tracking changes over time would be an improvement, but if they only show correlation it won’t really tell us much about how to deal with them.

 

[Amw66]

HADS scale again. It has huge issues when used for chronic illness. I'm not familiar with the others.
The gut is a huge chemical factory - key for synthesis and break down of neurotransmitters and hormones amongst many other things. Its little wonder that if there are gut issues, correlations can be found with sleep, pain, mood etc.... or is that just my my naivety?

Or am I just being an annoyed simpleton enjoying other classics such as
Cheese Consumption vs. Deaths by Bed Sheet Tangling
Nicolas Cage Movies and Swimming Pool Drownings.........

 

[Yann04]

Discussion on HADS and potential issues with it here:
https://www.s4me.info/threads/the-hospital-anxiety-and-depression-scale-hads-a-discussion.10160/

 

[Utsikt]

Discussion on HADS and potential issues with it here:
https://www.s4me.info/threads/the-hospital-anxiety-and-depression-scale-hads-a-discussion.10160/

Potential is generous!

 

[rvallee]

Always early pilot studies dreaming up fake models and fishing for exploring vague generalities. Always.

Also, allow me to laugh mercilessly at having significant digits. Good grief. Might as well be adding actual apples and relating their ratio to the Moon's shadow.

you can’t just treat the GI symptoms in isolation and expect long-term results.

Sure we can. If my GI symptoms were fully treated, all the resulting problems they cause would be 100% gone, forever. In fact, treating the symptoms is the only thing that matters here, the rest can be ignored in 99% of cases.

But that requires doing the work. The work to solve this has not been done, hence no solutions. No such thing as a free lunch in life. Waiting for answers to come up while doing the same 'studies' in loops won't achieve that.

 

[Emily Marcel]

There’s no showing any sort of causation though.

For all we know the mental health symptoms could be caused by the burden associated with having gastro symptoms, and thus just focusing on the gastro symptoms could work.

This study just finds a correlation, no causation, so we need to find causation before your statement can be said to be true or false.
(This statement)

Absolutely agree — that's an important clarification. This study does show correlation, not causation, and you're right that the relationship could be bidirectional or even driven primarily by the burden of FGIDs themselves. It's possible that the stress of dealing with chronic GI symptoms leads to poorer mental health and sleep, not necessarily the other way around.

That said, even without established causation, the correlations are still clinically meaningful. If addressing sleep and mental health can ease the overall symptom burden — even indirectly — it might still be worth exploring in treatment. But yes, more longitudinal and interventional studies are definitely needed to clarify the direction of these relationships and establish causality.

Thanks for pointing that out.

 

[Utsikt]

Absolutely agree — that's an important clarification. This study does show correlation, not causation, and you're right that the relationship could be bidirectional or even driven primarily by the burden of FGIDs themselves.

I understand what you’re saying here and I know this is a pedantic comment, but I don’t think there is any reason to even accept the label of FGID because it implies and unproven causal relationship.

Your next sentence is how I would prefer to approach things, i.e. saying GI symptoms.

It's possible that the stress of dealing with chronic GI symptoms leads to poorer mental health and sleep, not necessarily the other way around.

This also opens the possibility of there being no direct connection between GI and mental health symptoms. The FGID proponents claim that it happens through e.g. the nervous system, but the mechanisms might be entirely external to the patient.

That said, even without established causation, the correlations are still clinically meaningful. If addressing sleep and mental health can ease the overall symptom burden — even indirectly — it might still be worth exploring in treatment.

That depends on how you approach it. If the GI symptoms cause sleep and mental health burdens, and you try to help them through CBT or similar interventions, you have to be very clear with the patient that you’re trying to help them deal with their symptoms and not to treat them. If the symptoms ease, that’s a bonus.

The proponents of FGID or any gut-brain-axis-mumbo-jumbo often go down the path of victim blaming because they try to treat the symptoms through mechanisms that didn’t cause the symptoms. When the patient fails to improve, it’s because they didn’t do it right.

But yes, more longitudinal and interventional studies are definitely needed to clarify the direction of these relationships and establish causality.

I think we need to start by reconsidering the underlying assumptions first, especially with regards to FGID. It is unethical to keep doing studies that don’t have a testable hypothesis, unless you’re trying to determine the prevalence, etc.