Psychological medicineFeb 10, 2026

Two-way links between irritable bowel syndrome and mental distress over time in a general population

Gut-Brain Axis Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 4, 2026

Abstract

IBS is associated with a 55% increased risk of depression and a 68% increased risk of anxiety.

Depression and anxiety are linked to a higher risk of developing IBS, with adjusted hazard ratios of 1.45 and 1.51, respectively.
The relationship between IBS and psychological distress is bidirectional, indicating that each condition may influence the onset of the other.
Stronger associations were observed among females and younger adults aged 18-39 years.
Sleep disorders significantly modify the relationship between IBS and psychological distress, with a sub-distribution hazard ratio of approximately 1.60.
Findings were consistent across various sensitivity analyses.

Simplified

BACKGROUND: Irritable bowel syndrome (IBS) commonly co-occurs with psychological distress, including depression and anxiety, but the temporal and bidirectional nature of this relationship remains unclear. Dysregulation of the gut-brain-microbiota axis has been proposed as a shared mechanism.

METHODS: We conducted two retrospective, population-based cohort studies using Taiwan's National Health Insurance Research Database (2000-2015). Cohort 1 assessed the risk of incident IBS among patients with newly diagnosed depression or anxiety, while Cohort 2 evaluated the risk of subsequent depression or anxiety among patients with newly diagnosed IBS. Propensity score matching, multivariable Cox regression, and Fine-Gray competing risk models were applied.

RESULTS: IBS was associated with increased risks of depression (adjusted hazard ratio [aHR] = 1.55) and anxiety (aHR = 1.68). Conversely, depression and anxiety were associated with higher risks of developing IBS (aHR = 1.45 and 1.51, respectively). Associations were stronger among females and younger adults aged 18-39 years. Sleep disorders (SDs) showed the strongest modifying effect in both directions (sub-distribution HR ≈ 1.60). Results were consistent across sensitivity analyses.

CONCLUSIONS: This nationwide longitudinal study demonstrates a robust bidirectional association between IBS and psychological distress, supporting integrated screening and multidisciplinary care approaches targeting gut-brain interactions.

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Two-way links between irritable bowel syndrome and mental distress over time in a general population

Abstract

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