Co-morbidity of and treatment for irritable bowel syndrome, depression and anxiety in residents of retirement villages
Introduction: Irritable bowel syndrome (IBS), depression and anxiety are very common and often co-occur. Data for depression prevalence in the elderly in South Africa is available, but there is no data on the prevalence of anxiety and IBS in this population. Further, the existing literature does not report on the influence of medication use on these conditions. Aim and objectives: The aim of this study was to determine the prevalence and co-morbidity of IBS, depression and anxiety in retirement village residents against the background of the pattern of medication use. Specific objectives of the study were the assessment of current symptoms of IBS, depression and anxiety and the assessment of the use of antidepressants, anxiolytics and gastrointestinal (GI) medications that might influence the symptoms of IBS. Methods: Two hundred ambulant residents older than 50 years were recruited from 2 retirement villages in an urban setting in South Africa by means of convenience sampling. A cross-sectional observational study was performed with a questionnaire. The questionnaire consisted of the Manning criteria and the Hospital Anxiety and Depression Scale (HADS), supplemented by custom designed questions to evaluate medication use. Results: The prevalence of IBS, depression and anxiety were found to be 4.5%, 3.0% and 4.5%, respectively. Sixty-nine participants (34.5%) reported antidepressant use. Selective serotonin re-uptake inhibitors (SSRis) were used by 63.8% and tricyclic antidepressants (TCAs) by 33.3% of participants reporting antidepressant medication use, fluoxetine and amitriptyline being used in the majority of such cases. Forty-one participants (20.5%) reported the current use of benzodiazepines (BZDs). Proton pump inhibitors (PPis) were used by 17.5%. The majority of participants using antidepressants, anxiolytics and PPis were taking these for one year or longer. Participants taking PPis or antidepressants were more likely to experience symptoms of IBS than those who were not taking PPis or antidepressants and these differences were statistically significant. BZDs did not have an influence on the presence of IBS symptoms. There was no association between constipation and use of the target medication groups. Conclusion: The lower than expected prevalence of IBS, depression and anxiety occurred against the background of a high level of prolonged antidepressant, anxiolytic and proton pump inhibitor use.