Summary Background Little is known about associations with reduced quality of life in irritable bowel syndrome (IBS) or impact of IBS on quality of life compared with other chronic conditions. Methods We collected demographic, gastrointestinal and psychological symptoms, healthcare usage, direct healthcare costs, impact on work and activities of daily living data from 752 individuals with Rome IV‐defined IBS. We used the irritable bowel syndrome quality of life (IBS‐QOL) and the EQ‐5D‐5L questionnaires to examine characteristics associated with lower quality of life. Results The mean IBS‐QOL among all 752 individuals with Rome IV IBS was 48.4 (SD 22.3) and the mean EQ‐5D score was 0.570 (SD 0.283), the latter being comparable to people with stroke, leg ulcers or chronic obstructive pulmonary disease. Lower levels of both disease‐specific and generic quality of life were associated with severe IBS symptom scores, abnormal anxiety or depression scores, and higher somatoform symptom‐reporting and gastrointestinal symptom‐specific anxiety scores (p < 0.001 for all analyses). Those with lower quality of life had significantly higher healthcare usage and direct healthcare costs and more impairment in work and activities of daily living (p < 0.01 for all analyses). Avoidance of alcohol, lower educational level, abnormal anxiety, depression or somatoform symptom‐reporting scores, and impairment in social leisure activities, home management or maintaining close relationships were all independently associated with lower quality of life. Conclusion IBS has a substantial impact on the quality of life of those affected, and worse than observed in some severe chronic organic conditions.

This paper will focus primarily on the most recent research studies involving doctors in the UK. We will not discuss the treatment of doctors who are psychiatrically unwell as this is covered in other papers elsewhere in this issue. Before reviewing specific studies, we will consider the measurement of psychiatric disorder, stress and burn-out.

The dramatic development of cognitive–behavioural therapy (CBT) over the past 30 years, with associated high-quality research into the evaluation of its treatment effects, is to be welcomed and applauded. This form of therapy is now a recognised psychological treatment of choice for a wide variety of psychological disorders. The role of cognitive processes in the development and prolongation of psychological symptoms has been studied, and resulted in the development of coherent and effective treatment models.

Psychodynamic interpersonal therapy is a relational therapy which combines elements of dynamic, interpersonal and humanistic approaches. This paper describes three central aspects of its practice: its focus on the therapeutic relationship; the importance of self and personal being; and the role of symbolic transformation.

INTRODUCTION:Symptoms of common mental disorders, such as anxiety or depression, are associated with adverse clinical outcomes in inflammatory bowel disease (IBD). We report trajectories of these symptoms in IBD, patient characteristics associated with different trajectories, and effects on healthcare utilization and prognosis.METHODS:We collected demographic, symptom, psychological, and quality-of-life data, with questionnaires at 3-month intervals, over 12 months of follow-up. We collected healthcare utilization and IBD outcomes through notes review. We compared characteristics of those with persistently normal or improving anxiety or depression scores with those with persistently abnormal or worsening scores and the number of flares, glucocorticosteroid prescriptions, escalations of therapy, hospitalizations, or intestinal resections due to IBD activity.RESULTS:Among 771 and 777 patients, respectively, worsening or persistently abnormal anxiety or depression scores were associated with increased antidepressant (28.6% vs 12.3% anxiety, 35.8% vs 10.1% depression, P < 0.001) and opiate use (19.0% vs 7.8% anxiety, P = 0.001 and 34.0% vs 7.4% depression, P < 0.001), compared with those with persistently normal or improving scores. These individuals were also more likely to have been diagnosed with IBD in the last 12 months (16.3% vs 5.0% anxiety, P = 0.001, and 15.1% vs 5.5% depression, P = 0.006), to have clinically active disease at baseline (57.1% vs 26.6% anxiety and 71.7% vs 29.1% depression, P < 0.001) and lower quality-of-life scores (P < 0.001). Individuals with worsening or persistently abnormal trajectories of anxiety or depression required significantly more outpatient appointments, radiological investigations, and endoscopic procedures for IBD-related symptoms.DISCUSSION:In this 12-month follow-up study, patients with IBD with worsening or persistently high anxiety or depression scores were higher utilizers of health care but were not at an increased risk of future adverse disease outcomes.