State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting G. Addolorato, 1 A. Mirijello, 1 C. D’Angelo, 1 L. Leggio, 1 A. Ferrulli, 1 L. Abenavoli, 1 L. Vonghia, 1 S. Cardone, 1 V. Leso, 1 A. Cossari, 2 E. Capristo, 1 G. Gasbarrini 1 Introduction Anxiety and depression represent a common feature in patients affected by gastrointestinal diseases (1,2). In some cases as in patients with functional gastro- intestinal disorders, anxiety and depression are pres- ent particularly as a personality trait (3) and they seem to play a main role in the genesis and / or the perception of symptoms (1). Recent studies showed that in these subjects, medical consultation is neces- sary because of the ‘healthcare seeking behaviour’ strictly related to the anxious trait, more than to the organic symptoms (4,5). In this case, the socio- economic impact resulting from consultations with several gastroenterologists and from undergoing clinical examinations and consumption of drugs, is very high (6). On the other hand, few information are at present available about anxiety and depression in patients in whom an organic cause for their symptoms has been found (2). In these cases, anxiety and / or depression could be present mainly in the ‘state’ and / or ‘cur- rent’ form, reactive to the symptoms (7), to the long-term diseases (8), to long-term therapies and dietary restrictions (9), to the necessity of frequent medical control and to the reduction of the quality of life and of general well-being (10,11). However, at present, few data about the prevalence of state and trait form of anxiety and of current depression are available in large sample of patients SUMMARY Objectives: To evaluate state and trait form of anxiety and current depression in patients affected by gastrointestinal diseases. Methods: We studied 1641 outpa- tients with gastrointestinal disorders, consecutively referred to our Internal Medi- cine outpatients from 1997 to 2005. State and trait anxiety were assessed by the State and Trait Anxiety Inventory. Current depression was assessed by the Zung self-rating depression scale. Results: Among patients, 1379 (84.1%) showed state anxiety, 1098 (67%) showed trait anxiety and 442 (27%) showed current depres- sion. The number of gastrointestinal diseases was directly correlated to state anxi- ety (p < 0.001) and trait anxiety (p = 0.04). Females showed higher levels of anxiety and depression than males (p < 0.001). State anxiety was related to food allergies (p < 0.001), small intestinal bacterial overgrowth (SIBO) (p = 0.001), Hp infection (p = 0.01) and ulcerative colitis in active phase (p = 0.03). Trait anxiety was related to irritable bowel syndrome (IBS) (p < 0.001), Helicobacter pylori (Hp) infection (p = 0.001), food allergies (p = 0.001) and SIBO (p = 0.001). Current depression was related to IBS (p < 0.001) and coeliac disease (p = 0.01), SIBO (p = 0.02). A predicted probability of 0.77 ± 0.16 to have state anxiety, of 0.66 ± 0.12 to have trait anxiety and of 0.39 ± 0.14 to have depression was found in these patients. Conclusions: Most of the patients who seek medical con- sultation for gastrointestinal problems show an associated affective disorder. These patients should be managed by a team including gastroenterologists, psychologists and / or psychiatrists, or by a gastroenterologist having expertise in the treatment of psychological disorders. What’s known Anxiety and depression represent a common feature in patients affected by gastrointestinal diseases. These affective disorders can be present as a personality trait or in a reactive form. What’s new The study supports that the approach to patients affected by gastrointestinal diseases should be managed by a team including gastroenterologists, psychologists and / or psychiatrists, or alternatively they should be managed by gastroenterologist having expertise in the treatment of psychological disorders. 1 Institute of Internal Medicine, Catholic University of Rome, Rome, Italy 2 Department of Economics and Statistics, University of Calabria, Rende, Italy Correspondence to: Giovanni Addolorato, MD, Institute of Internal Medicine, Catholic University of Rome, Largo A. Gemelli 8, I-00168 Rome, Italy Tel.: + 39 06 30154334 Fax: + 39 06 35502775 Email: g.addolorato@rm.unicatt.it Disclosure The authors have declared that they have no interest which might be perceived as posing conflict or bias. doi: 10.1111/j.1742-1241.2008.01763.x ORIGINAL PAPER ª 2008 The Authors Journal compilation ª 2008 Blackwell Publishing Ltd Int J Clin Pract, July 2008, 62, 7, 1063–1069 1063