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      Work productivity and activity impairment in disorders of gut‐brain interaction: Data from the Rome Foundation Global Epidemiology Study

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          Abstract

          Background

          Disorders of Gut‐Brain Interaction (DGBI) are highly prevalent worldwide, but their effect on work productivity has not gained much attention.

          Aims and Methods

          We aimed to compare work productivity and activity impairment (WPAI) in persons with and without DGBI in a large population‐based cohort and identify factors independently associated with WPAI in subjects with DGBI. Data were collected from Germany, Israel, Italy, Japan, the Netherlands, Poland, Spain and Sweden via Internet surveys as part of the Rome Foundation Global Epidemiology Study. Apart from the Rome IV diagnostic questionnaire, questionnaires evaluating WPAI related to general health (WPAI:GH), psychological distress (PHQ‐4), somatic symptom severity (PHQ‐15) and other factors were assessed.

          Results

          Of the 16,820 subjects, 7111 met the criteria for DGBI according to the Rome IV diagnostic questionnaire. Subjects with DGBI were younger (median (interquartile range) age 43 (31–58) vs. 47 (33–62)) and more often female (59.0% vs. 43.7%) compared to subjects without DGBI. Subjects with DGBI had higher absenteeism, presenteeism (poor work productivity due to illness), overall work impairment and activity impairment ( p < 0.001) compared with subjects without. For subjects with DGBI affecting more than one anatomical region, WPAI was incrementally higher for each additional region. There were significant differences in WPAI for subjects with DGBI in different countries. Subjects from Sweden had the highest overall work impairment and from Poland the lowest. Using multiple linear regression, male sex, fatigue, psychological distress, somatic symptom severity and number of anatomical regions were independently associated with overall work impairment ( p < 0.05 for all).

          Conclusion

          In the general population, people with DGBI have substantial WPAI compared with those without DGBI. The reasons for these findings should be explored further, but having multiple DGBI, psychological distress, fatigue and somatic symptom severity seem to contribute to this impairment associated with DGBI.

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          An ultra-brief screening scale for anxiety and depression: the PHQ-4.

          The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.
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            A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population.

            The 4-item Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report questionnaire that consists of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). Given that PHQ-4, PHQ-2, and GAD-2 have not been validated in the general population, this study aimed to investigate their reliability and validity in a large general population sample and to generate normative data. A nationally representative face-to-face household survey was conducted in Germany in 2006. The survey questionnaire consisted of the PHQ-4, other self-report instruments, and demographic characteristics. Of the 5030 participants (response rate=72.9%), 53.6% were female and mean (SD) age was 48.4 (18.0) years. The sociodemographic characteristics of the study sample closely match those of the total populations in Germany as well as those in the United States. Confirmatory factor analyses showed very good fit indices for a two-factor solution (RMSEA .027; 90% CI .023-.032). All models tested were structurally invariant between different age and gender groups. Construct validity of the PHQ-4, PHQ-2, and GAD-2 was supported by intercorrelations with other self-report scales and with demographic risk factors for depression and anxiety. PHQ-2 and GAD-2 scores of 3 corresponded to percentile ranks of 93.4% and 95.2%, respectively, whereas PHQ-2 and GAD-2 scores of 5 corresponded to percentile ranks of 99.0% and 99.2%, respectively. A criterion standard diagnostic interview for depression and anxiety was not included. Results from this study support the reliability and validity of the PHQ-4, PHQ-2, and GAD-2 as ultra-brief measures of depression and anxiety in the general population. The normative data provided in this study can be used to compare a subject's scale score with those determined from a general population reference group. Copyright 2009 Elsevier B.V. All rights reserved.
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              Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study

              Although functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents.
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                Author and article information

                Contributors
                asa.frandemark@gu.se
                Journal
                United European Gastroenterol J
                United European Gastroenterol J
                10.1002/(ISSN)2050-6414
                UEG2
                United European Gastroenterology Journal
                John Wiley and Sons Inc. (Hoboken )
                2050-6406
                2050-6414
                18 June 2023
                July 2023
                : 11
                : 6 ( doiID: 10.1002/ueg2.v11.6 )
                : 503-513
                Affiliations
                [ 1 ] Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
                [ 2 ] Department of Medicine Israelitic Hospital Hamburg Germany
                [ 3 ] Emma Children's Hospital Amsterdam UMC University of Amsterdam Pediatric Gastroenterology Amsterdam The Netherlands
                [ 4 ] Department of Gastroenterology Istituto Clinico Humanitas Rozzano Italy
                [ 5 ] Department of Behavioral Medicine Tohoku University Graduate School of Medicine Sendai Japan
                [ 6 ] Department of Gastroenterology and Hepatology Wroclaw Medical University Wroclaw Poland
                [ 7 ] Department of Gastroenterology University Hospital Vall d’Hebron Autonomous University of Barcelona & Neuro‐Inmuno‐Gastroenterology Lab Vall d’Hebron Research Institute Barcelona Spain
                [ 8 ] Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
                [ 9 ] Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
                [ 10 ] Population Health Research Institute McMaster University Hamilton Ontario Canada
                [ 11 ] Center for Functional GI & Motility Disorders University of North Carolina‐Chapel Hill Chapel Hill North Carolina USA
                Author notes
                [*] [* ] Correspondence

                Åsa Frändemark.

                Email: asa.frandemark@ 123456gu.se

                Author information
                https://orcid.org/0000-0002-6886-7255
                https://orcid.org/0000-0003-2117-9874
                https://orcid.org/0000-0002-0078-3063
                https://orcid.org/0000-0002-3695-3327
                https://orcid.org/0000-0003-4678-8393
                Article
                UEG212425
                10.1002/ueg2.12425
                10337740
                37332146
                7d19ea28-cbf3-409e-b1a2-2316991b1e1f
                © 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 10 January 2023
                : 10 May 2023
                Page count
                Figures: 4, Tables: 4, Pages: 11, Words: 5784
                Funding
                Funded by: Takeda
                Funded by: Ironwood
                Funded by: Shire , doi 10.13039/501100004321;
                Funded by: Allergan , doi 10.13039/100007819;
                Categories
                Original Article
                Neurogastroenterology
                Custom metadata
                2.0
                July 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.1 mode:remove_FC converted:12.07.2023

                activity impairment,fatigue,gut‐brain axis,psychological distress,rome foundation,rome iv criteria,somatic symptom,work productivity

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