Impact of Depression and Anxiety on the Quality of Life of Constipated Patients

  • Jenna J. Albiani
  • Stacey L. Hart
  • Laura Katz
  • Julia Berian
  • Amanda Del Rosario
  • Janet Lee
  • Madhulika Varma


Constipation negatively affects quality of life (QOL), however, the specific mechanisms through which this relationship occurs are unclear. The present study examined anxiety and depression as potential mediators of the relationship between constipation severity and QOL in a sample of 142 constipated patients. Results indicated that depression symptom severity mediated the relationship between constipation severity and mental health-related QOL. For patients meeting diagnostic criteria for Major Depressive Disorder, indirect effects were observed in the relationship between constipation severity and both physical and mental health-related QOL. Anxiety did not contribute to this model. Treating depression may be useful in improving QOL in severely constipated patients, which highlights the importance of psychological screening and treatment referrals in primary care settings.


Anxiety Constipation Depression Quality of life (QOL) 



Supported by the University of California, San Francisco Hellman Family Award for Early Career Faculty.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edition, text revision (DSM-IV-TR)). Washington, DC.Google Scholar
  2. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  3. Chami, T. N., Andersen, A. E., Crowell, M. D., Schuster, M. M., & Whitehead, W. E. (1995). Gastrointestinal symptoms in bulimia nervosa: Effects of treatment. American Journal of Gastroenterology, 90, 88–92.PubMedGoogle Scholar
  4. Charach, G., Greenstein, A., Rabinovich, P., Groskopf, I., & Weintraub, M. (2001). Alleviating constipation in the elderly improves lower urinary tract symptoms. Gerontology, 47, 72–76.PubMedCrossRefGoogle Scholar
  5. Chattat, R., Bazzocchi, G., Balloni, M., Conti, E., Ercolani, M., Zaccaroni, S., et al. (1997). Illness behavior, affective disturbance and intestinal transit time in idiopathic constipation. Journal of Psychosomatic Research, 42, 95–100.PubMedCrossRefGoogle Scholar
  6. Cheng, C., Chan, A. O., Hui, W. M., & Lam, S. K. (2003). Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: A population-based study. Alimentary Pharmacology and Therapeutics, 18, 319–326.PubMedCrossRefGoogle Scholar
  7. Damon, H., Dumas, P., & Mion, F. (2004). Impact of anal incontinence and chronic constipation on quality of life. Gastroenterologie Clinique et Biologique, 28, 16–20.PubMedCrossRefGoogle Scholar
  8. Dennison, C., Prasad, M., Lloyd, A., Bhattacharyya, S. K., Dhawan, R., & Coyne, K. (2005). The health-related quality of life and economic burden of constipation. Pharmacoeconomics, 23, 461–476.PubMedCrossRefGoogle Scholar
  9. Diaz Sibaja, M. A., Comeche Moreno, M. I., & Mas Hesse, B. (2007). Protocolized cognitive-behavioural group therapy for inflammatory bowel disease. Revista Espanola de Enfermedades Digestivas, 99, 593–598.PubMedGoogle Scholar
  10. Donald, I. P., Smith, R. G., Cruikshank, J. G., Elton, R. A., & Stoddart, M. E. (1985). A study of constipation in the elderly living at home. Gerontology, 31, 112–118.PubMedCrossRefGoogle Scholar
  11. Drossman, D. A. (1999). Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome? American Journal of Medicine, 107, 41S–50S.PubMedCrossRefGoogle Scholar
  12. Drossman, D. A., Talley, N. J., Leserman, J., Olden, K. W., & Barreiro, M. A. (1995). Sexual and physical abuse and gastrointestinal illness: Review and recommendations. Annals of Internal Medicine, 123, 782–794.PubMedGoogle Scholar
  13. Glia, A., & Lindberg, G. (1997). Quality of life in patients with different types of functional constipation. Scandinavian Journal of Gastroenterology, 32, 1083–1089.PubMedCrossRefGoogle Scholar
  14. Goldenberg, D. L. (2008). Multidisciplinary modalities in the treatment of fibromyalgia. Journal of Clinical Psychiatry, 69(S2), 30–34.Google Scholar
  15. Hart, S. L., Fonareva, I., Merluzzi, N. M., & Mohr, D. C. (2005). Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients. Quality of Life Research, 14, 695–703.PubMedCrossRefGoogle Scholar
  16. Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408–420.CrossRefGoogle Scholar
  17. Irvine, E. J., Ferrazzi, S., Pare, P., Thompson, W. G., & Rance, L. (2002). Health-related quality of life in functional GI disorders: Focus on constipation and resource utilization. American Journal of Gastroenterology, 97, 1986–1993.PubMedCrossRefGoogle Scholar
  18. Irwin, C., Falsetti, S. A., Lydiard, R. B., Ballenger, J. C., Brock, C. D., & Brener, W. (1996). Comorbidity of posttraumatic stress disorder in irritable bowel syndrome. Journal of Clinical Psychiatry, 57, 576–578.PubMedCrossRefGoogle Scholar
  19. Kennedy, T., Jones, R., Darnley, S., Seed, P., Wessely, S., & Chalder, T. (2005). Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: Randomized controlled trial. British Medical Journal, 331, 435–440.PubMedCrossRefGoogle Scholar
  20. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.PubMedCrossRefGoogle Scholar
  21. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41, 1284–1292.PubMedCrossRefGoogle Scholar
  22. Lee, V., Guthrie, E., Robinson, A., Kennedy, A., Tomenson, B., Rogers, A., et al. (2008). Functional bowel disorders in primary care: Factors associated with health-related quality of life and doctor consultation. Journal of Psychosomatic Research, 64, 129–138.PubMedCrossRefGoogle Scholar
  23. Leopold, K. A., Ahles, T. A., Walch, S., Amdur, R. J., Mott, L. A., Wiegand-Packard, L., et al. (1998). Prevalence of mood disorders and utility of the PRIME-MD in patients undergoing radiation therapy. International Journal of Radiation Oncology Biology Physics, 42, 1105–1112.CrossRefGoogle Scholar
  24. Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006). Functional bowel disorders. Gastroenterology, 130, 1480–1491.PubMedCrossRefGoogle Scholar
  25. Lowe, B., Kroenke, K., & Grafe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58, 163–171.PubMedCrossRefGoogle Scholar
  26. Mallinckrodt, B., Abraham, T. W., Wei, M., & Russel, D. W. (2006). Advances in testing the statistical significance of mediation effects. Journal of Counseling Psychology, 53, 372–378.CrossRefGoogle Scholar
  27. Mason, H. J., Serrano-Ikkos, E., & Kamm, M. A. (2000). Psychological morbidity in women with idiopathic constipation. American Journal of Gastroenterology, 95, 2852–2857.PubMedCrossRefGoogle Scholar
  28. Mason, H. J., Serrano-Ikkos, E., & Kamm, M. A. (2002). Psychological state and quality of life in patients having behavioral treatment (biofeedback) for intractable constipation. American Journal of Gastroenterology, 97, 3154–3159.PubMedCrossRefGoogle Scholar
  29. Mathieu, J. E., & Taylor, S. R. (2006). Clarifying conditions and decision points for mediational type inferences in organizational behavior. Journal of Organizational Behavior, 27, 1031–1056.CrossRefGoogle Scholar
  30. McHorney, C. A., Ware, J. J. E., & Raczek, A. E. (1996). The MOS 36-item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247–263.CrossRefGoogle Scholar
  31. Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33, 187–205.PubMedCrossRefGoogle Scholar
  32. Mussell, M., Kroenke, K., Spitzer, R. L., Williams, J. B., Herzog, W., & Lowe, B. (2008). Gastrointestinal symptoms in primary care: Prevalence and association with depression and anxiety. Journal of Psychosomatic Research, 64, 605–612.PubMedCrossRefGoogle Scholar
  33. Nehra, V., Bruce, B. K., Rath-Harvey, D. M., Pemberton, J. H., & Camilleri, M. (2000). Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. American Journal of Gastroenterology, 95, 1755–1758.PubMedCrossRefGoogle Scholar
  34. Osborn, R. L., Demoncada, A. C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. International Journal of Psychiatry in Medicine, 36, 13–34.PubMedCrossRefGoogle Scholar
  35. Ostaszkiewicz, J., Hornby, L., Millar, L., & Ockerby, C. (2010). The effects of conservative treatment for constipation on symnptom severity and quality of life in community-dwelling adults. Journal of Wound, Ostomy and Continence Nursing, 37, 193–198.CrossRefGoogle Scholar
  36. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36, 717–731.PubMedCrossRefGoogle Scholar
  37. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.PubMedCrossRefGoogle Scholar
  38. Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42, 185–227.CrossRefGoogle Scholar
  39. Simon, G. E., Revicki, D. A., Grothaus, L., & Vonkorff, M. (1998). SF-36 summary scores: Are physical and mental health truly distinct? Medical Care, 36, 567–572.PubMedCrossRefGoogle Scholar
  40. Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of the PRIME-MD: The PHQ primary care study. JAMA, 282, 1737–1744.PubMedCrossRefGoogle Scholar
  41. Varma, M. G., Wang, J. Y., Berian, J. R., Patterson, T. R., McCrea, G. L., & Hart, S. L. (2008). The Constipation Severity Instrument: A validated measure. Diseases of the Colon and Rectum, 51, 162–172.PubMedCrossRefGoogle Scholar
  42. Wald, A., Scarpignato, C., Kamm, M. A., Mueller-Lissner, S., Helfrich, I., Schuijt, C., et al. (2007). The burden of constipation on quality of life: Results of a multinational survey. Alimentary Pharmacology and Therapeutics, 26, 227–236.PubMedCrossRefGoogle Scholar
  43. Waldholtz, B. D., & Andersen, A. E. (1990). Gastrointestinal symptoms in anorexia nervosa. Gastroenterology, 98, 1415–1419.PubMedGoogle Scholar
  44. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.PubMedCrossRefGoogle Scholar
  45. Whitehead, W. E., Drinkwater, D., Cheskin, L. J., Heller, B. R., & Schuster, M. M. (1989). Constipation in the elderly living at home. Definition, prevalence, and relationship to lifestyle and health status. Journal of the American Geriatrics Society, 37, 423–429.PubMedGoogle Scholar
  46. Whooley, M. A., Avins, A. L., Miranda, J., & Browner, W. S. (1997). Case-finding instruments for depression. Two questions are as good as many. Journal of General Internal Medicine, 12, 439–445.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jenna J. Albiani
    • 1
  • Stacey L. Hart
    • 1
  • Laura Katz
    • 2
  • Julia Berian
    • 3
  • Amanda Del Rosario
    • 4
  • Janet Lee
    • 5
  • Madhulika Varma
    • 6
  1. 1.Department of PsychologyRyerson UniversityTorontoCanada
  2. 2.Department of PsychologyQueen’s UniversityKingstonCanada
  3. 3.School of MedicineUniversity of ChicagoChicagoUSA
  4. 4.School of MedicineUniversity of WashingtonSeattleUSA
  5. 5.School of MedicineUniversity of California, San DiegoLa JollaUSA
  6. 6.Section of Colorectal SurgeryUniversity of California, San FranciscoSan FranciscoUSA

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