Gastrointestinal symptoms are closely associated with depression in iron deficiency anemia: a comparative study

Abstract

BACKGROUND AND OBJECTIVES: Until now, very few studies evaluated the association between gastrointestinal and psychiatric symptoms in iron deficiency anemia (IDA). The study investigated the frequency of functional dyspepsia (FD) in IDA patients and determined its association with depression and somatization. DESIGN AND SETTINGS: The study was conducted at the Hematology Department of Trakya University Medical Faculty, which is a tertiary referral center in northwestern Turkey. It was a case-control study. MATERIALS AND METHODS: A total of 125 consecutive IDA patients and 57 healthy control subjects were included. Patients and controls were questioned about the severity of their gastrointestinal system (GIS)-related symptoms and the presence of constipation and associated symptoms using a visual analog scale. In addition, IDA patients were administered a validated depression scale (Beck Depression Inventory, BDI) and somatization symptoms checklist. RESULTS: IDA patients had more frequent self-reported constipation compared with controls (56% vs 22.8%, P<.001). The mean scores of bloating, dyspepsia, and constipation-related quality of life (QoL) disturbance were significantly higher in the IDA group than in the control group (all P values ≤.01). A total of 71 IDA patients were depressed according to the BDI. Depressed IDA patients had higher mean reflux, bloating, halitosis, and dyspepsia-related QoL disturbance scores compared with nondepressed patients (all P values ≤.01). Their frequency of self-reported constipation and mean constipation-related QoL disturbance score (P values, .002 and <.001) were also higher. Depressed IDA patients had significantly higher somatization scores compared with others (P=.001). CONCLUSION: An increased frequency of dyspepsia symptoms and constipation-related QoL disturbance were observed in IDA patients. The findings of this study suggested that in IDA patients without red flags in favor of malignancy, physicians should try to uncover any psychiatric factors before undertaking extensive GIS investigation.