Association between psychological distress and gastrointestinal symptoms in diabetes mellitus

Table 1 Socio-demographic characteristics of the diabetic subjects with gastrointestinal symptoms and controls n (%)

Variables	Totaln = 906	Diabetic with GIn = 453	Healthysubjectsn = 453	P value
Age (mean ± SD)	46.9 ± 10.3	49.0 ± 9.9	44.8 ± 10.2	< 0.001
Age group (yr)
< 35	121 (13.4)	37 (8.2)	84 (18.5)	< 0.001
35-44	225 (24.8)	101 (22.3)	124 (27.4)
45-54	329 (36.3)	178 (39.3)	151 (33.3)
≥ 55	231 (25.5)	137 (30.2)	94 (20.8)
Gender
Male	544 (60.0)	278 (61.4)	266 (58.7)	0.456
Female	362 (40.0)	175 (38.6)	187 (41.3)
Nationality
Qatari	423 (46.7)	200 (44.2)	223 (49.2)	0.143
Non-Qatari	483 (53.3)	253 (55.8)	230 (50.8)
Marital status
Single	146 (16.1)	62 (13.7)	84 (18.5)	0.058
Married	760 (83.9)	391 (86.3)	369 (81.5)
Educational level
Illiterate	56 (6.2)	32 (7.1)	24 (5.3)	0.329
Primary	114 (12.6)	63 (13.9)	51 (11.3)
Intermediate	182 (20.1)	96 (21.2)	86 (19.0)
Secondary	296 (32.7)	139 (30.7)	157 (34.7)
University	258 (28.5)	123 (27.2)	135 (29.8)
Occupation
Not working/housewife	275 (30.4)	132 (29.1)	143 (31.6)	0.564
Sedentary/professional	275 (30.4)	138 (30.5)	137 (30.2)
Clerk/manual	187 (20.6)	90 (19.9)	97 (21.4)
Businessman	106 (11.7)	56 (12.4)	50 (11.0)
Army/police/security	63 (7.0)	37 (8.2)	26 (5.7)
Household income1
< 5000	71 (7.8)	38 (8.4)	33 (7.3)	0.227
5000 – 9999	303 (33.4)	147 (32.5)	156 (34.4)
10 000 – 15 000	328 (36.2)	176 (38.9)	152 (33.6)
> 15 000	204 (22.6)	92 (20.3)	112 (24.7)
Mental health severity
PHQ-9 depression (0–24) mean ± SD (95% CI)	7.1 ± 3.8	8.2 ± 3.7	6.0 ± 3.7	< 0.001
		(7.9-8.6)	(5.7-6.4)
GAD-7 anxiety (0-21)	6.8 ± 3.6	7.6 ± 3.3	6.0 ± 3.7	< 0.001
mean ± SD (95% CI)		(7.3-7.9)	(5.7-6.4)
Comorbidity
Severe depression (PHQ≥ 15)	59 (6.5)	43 (9.5)	20 (4.4)	< 0.001
Severe anxiety (GAD7≥ 11)	169 (18.6)	107 (23.6)	62 (13.7)	< 0.001
Frequency of GI symptoms	389 (42.9)	264 (58.3)	217 (47.9)	0.002
(at least two or more symptoms)

¹$ 1 US Dollars = 3.65 Qatar Riyals; GI: Gastrointestinal; PHQ: Patient health questionnaire; GAD: General anxiety disorders.

Table 2 Lifestyle habits and family history of diabetic patients with gastrointestinal symptoms and healthy subjects (n = 906) n (%)

Variables	Diabetic with GIn = 453	Healthysubjectsn = 453	P value
BMI (kg/m2)
Normal (< 25)	74 (16.3)	118 (26.0)
Overweight (25-30)	217 (47.9)	194 (42.8)	0.001
Obese (> 30)	162 (35.7)	141 (31.2)
Physical activity
Yes1	159 (35.1)	254 (56.1)	< 0.001
No	294 (64.9)	199 (43.9)
Smoking (Cigarette/sheesha)
Yes	136 (30.0)	63 (13.9)	0.001
No	317 (70.0)	390 (86.1)
Dietary habits2
Type of food
Arabic	408 (90.1)	402 (88.7)	0.590
Indian/Pakistani	59 (13.0)	87 (19.2)	0.014
Western	24 (5.3)	34 (7.5)	0.222
Type of oil
Vegetable oil	302 (66.7)	299 (66.0)	0.833
Olive oil	248 (54.7)	181 (40.0)	< 0.001
Animal fat/butter	104 (23.0)	92 (20.3)	0.334
Pattern of daily food
Vegetable	327 (72.2)	242 (53.4)	< 0.001
Fruit	221 (48.8)	144 (31.8)	< 0.001
Red meat	206 (45.5)	256 (56.5)	0.001
Chicken	240 (53.0)	157 (34.7)	< 0.001
Fish	189 (41.7)	113 (24.9)	< 0.001
Type of drink
Arabic coffee	342 (75.5)	337 (74.4)	0.759
Turkish coffee	55 (12.1)	49 (10.8)	0.602
Nescafe	170 (37.5)	54 (11.9)	< 0.001
Juice	100 (22.1)	78 (17.2)	0.079
Tea	361 (79.7)	367 (81.0)	0.676

¹At least 30 min walking per day.

²Multiple option. BMI: Body mass index; GI: Gastrointestinal.

Table 3 Comparison of gastrointestinal symptoms between diabetic patients and healthy subjects with severe anxiety and depression (n = 906)

Variables	Severe anxiety1		P value	Severe depression2		P value
	DM with GI	Healthy subjects		DM with GI	Healthy subjects
GI symptoms	n = 107	n = 62		n = 43	n = 20
Anal blockage	57 (53.3)	22 (35.5)	0.026	20 (46.5)	4 (20)	0.050
Bloating	54 (50.5)	25 (40.3)	0.203	18 (41.9)	6 (30)	0.416
Urgency	54 (50.5)	24 (38.7)	0.139	17( 39.5)	5 (25)	0.395
Vomiting	37 (34.6)	16 (25.8)	0.236	18 (41.9)	5 (25)	0.264
Dysphasia	44 (41.1)	-	-	26 (60.5)		-
Nausea	38 (35.5)	19 (30.6)	0.519	13 (30.2)	6 (30)	0.980
Heartburn	37 (34.6)	11 (17.7)	0.019	18 (41.9)	3 (15)	0.046
< 3 bowels/wk	36 (33.6)	18 (29.0)	0.805	22 (51.2)	4 (20)	0.028
> 3 Bowels/d	32 (29.9)	18 (29.0)	0.993	21 (48.8)	4 (20)	0.050
Abdominal pain	22 (20.6)	16 (25.8)	0.431	10 (23.3)	5 (25)	0.989
Lumpy/hard stools	30 (28.0)	13 (21.0)	0.309	13 (30.2)	5 (25)	0.770
Blood in stool	24 (22.4)	19 (30.6)	0.237	6 (14.0)	5 (25)	0.304
Early satiety	28 (26.2)	17 (27.4)	0.859	18 (41.9)	1 (5)	0.003
Loose/watery stools	28 (26.2)	7 (11.3)	0.021	10 (23.3)	5 (25)	0.989
Fecal incontinence	25 (23.4)	17 (27.4)	0.557	16 (37.2)	1 (5)	0.007
Weight loss	25 (23.4)	10 (16.1)	0.263	6 (14.0)	6 (30)	0.172
Postprandial fullness	28 (26.2)	8 (12.9)	0.042	7 (16.3)	4 (20)	0.732

¹Severe anxiety (GAD7 ≥ 11).

²Severe depression (PHQ ≥ 15). DM: Diabetes mellitus; GI: Gastrointestinal; PHQ: Patient Health Questionnaire; GAD: General Anxiety Disorders.

Table 4 Odd ratios and 95% CI of gastrointestinal symptoms on anxiety and depression in diabetes mellitus patients vs controls

GI symptoms	OR	95% CI	P value
Anxiety
Loose/watery stools	2.79	(1.14-6.83)	0.029
Heartburn	2.45	(1.14-5.26)	0.022
Postprandial fullness	2.39	(1.01-5.65)	0.042
Anal blockage	2.07	(1.10-3.95)	0.026
Dysphasia	1.98	(1.67-2.36)	< 0.001
Depression
Early satiety	10.8	(1.30-89.34)	0.009
Fecal incontinence	8.89	(1.07-73.8)	0.024
Heartburn	5.04	(1.02-24.98)	0.036
< 3 bowels/wk	4.54	(1.13-18.26)	0.038
> 3 Bowels/d	4.14	(1.03-16.6)	0.043
Anal blockage	3.77	(0.94-15.41)	0.050

GI: Gastrointestinal; OR: Odd ratios.