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. 2024 Nov 14:20:2145-2158.
doi: 10.2147/NDT.S486784. eCollection 2024.

The Value of PHQ-9 and GAD-7 for Screening Emotional Disorders in IBS-D and the Specificity of the Gut Flora Associated with Emotional Comorbidity: Preliminary Findings

Jun Zhao #  1   2 , Xia Li #  3 , Xin Wang  4 , Xuefei Wang  4 , Xin Hao  2 , Zhigang Li  2 , Lin Zhu  1
Affiliations

The Value of PHQ-9 and GAD-7 for Screening Emotional Disorders in IBS-D and the Specificity of the Gut Flora Associated with Emotional Comorbidity: Preliminary Findings

Jun Zhao et al. Neuropsychiatr Dis Treat. .

Abstract

Background: To identify irritable bowel syndrome with diarrhea (IBS-D) combined with anxiety and/or depression through a psychological screening tool and to further explore the relationships between patients with comorbidities and gut microbiota.

Methods: The GAD-7, SAS, PHQ-9 and SDS were administered to evaluate anxiety and depression. Faeces were subsequently collected from 44 patients with emotional disorders (IBS-EDs), 22 patients without emotional disorders (IBS-nEDs) and 18 healthy controls (HCs) via 16S rRNA sequencing, depending on the participants' wishes. The differences in gut microbiota among different groups were analysed. Spearman analysis was conducted at the genus level and was based on psychological assessment scores. Patients with IBS-D were recruited from December 2020 to November 2022.

Results: This study included 124 outpatients with IBS-D. According to the GAD-7 and SAS scores, 40.3% and 19.3% of the participants, respectively, had anxiety (P < 0.05). Similarly, a significantly greater percentage of participants had depression according to the PHQ-9 than according to the SDS (61.3% vs 33.1%) (P < 0.05). Overall, approximately 66.1% of the participants had emotional disorders (anxiety and/or depression) according to the GAD-7 and PHQ-9. Correlation analysis revealed that the abundances of Eubacterium_hallii_group, Monoglobus and Lachnoclostridium were closely related to the PHQ-9 scores and that the abundances of Subdoligranulum and Holdemanella were closely related to the GAD-7 scores.

Conclusion: In comparison to the SAS and SDS, both the GAD-7 and PHQ-9 identified a greater number of individuals with emotional disorders within the IBS-D population. Furthermore, our findings demonstrated that Lachnoclostridium is not only a biomarker for IBS-ED patients but also that its abundance changes are related to PHQ-9 scores, which may provide insights for further brain gut investigations.

Keywords: 16S rRNA; IBS-D; anxiety; depression.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Abnormality in each item of GAD-7 and PHQ-9. (A): The percentage of abnormality of each item in GAD-7. The items were as follows: 1. Feeling nervous, anxious or on edge? 2. Not being able to stop or control worrying? 3. Worrying too much about different things? 4. Trouble relaxing? 5. Being so restless that it is hard to sit still? 6.Becoming easily annoyed or irritable? 7. Feeling afraid as if something awful might happen? (B): The percentage of abnormality in each item of PHQ-9. The items were as follows: 1. Little interest or pleasure in doing things? 2. Feeling down, depressed, or hopeless? 3. Trouble falling or staying asleep, or sleeping too much? 4. Feeling tired or having little energy? 5. Poor appetite or overeating? 6. Feeling bad about yourself or that you are a failure or have let yourself or your family down? 7. Trouble concentrating on things, such as reading the newspaper or watching television? 8. Moving or speaking so slowly that other people could have noticed? Or the opposite being so fidgety or restless that you have been moving around a lot more than usual? 9. Thoughts that you would be better off dead, or of hurting yourself in some way? (C): Number of patients with item 1 of GAD-7 scores which was greater than 0. (D): Number of patients with item 4 of PHQ-9 scores which was greater than 0. (E): Total scores of GAD-7 in different item 1 scores. (F): Total scores of PHQ-9 in different item 4 scores.
Figure 2
Figure 2
The barplots showed the relative abundance of genera enriched between groups. (A): Taxonomic composition of IBS-nED and HC samples at genus level; (B): Taxonomic composition of IBS-ED patients and HC samples at genus level; (C): Taxonomic composition of IBS-nED and IBS-ED patients at genus level.
Figure 3
Figure 3
Heatmap of correlations between abundances of genera and clinical scales. Positive and negative correlations are shown in red and green blocks, respectively. *P< 0.05.
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Grants and funding

Dr Zhigang Li was supported by the National Key R&D Program of China (grant 2019YFC1709004) and Dr Lin Zhu was supported by the Sichuan Provincial Science and Technology Plan Project (grant No. 2024YFFK0175). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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