Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: A critical review of the literature on symptom and psychosocial factors

OBJECTIVES: Health care use is a costly outcome of the irritable bowel synd rome (IBS) and nonulcer dyspepsia (NUD), but the predictors of this behavio r remain poorly defined. We aimed to systematically review the literature t o determine which symptoms and psychosocial factors drive health care seeki ng in these disorders. METHODS: A broad based MEDLINE and Current Contents search between 1966 and 2000 identified 44 relevant publications. References from these articles w ere also reviewed. RESULTS: The literature suggests that symptom severity is an important fact or, but only explains a small proportion of the health care seeking behavio r associated with these disorders in population-based studies. Psychosocial factors including life event stress, psychological morbidity, personality, abuse and abnormal illness attitudes and beliefs have been found to charac terize those that seek help versus those that do not. The role of other psy chosocial factors such as social support, coping style and knowledge about illness are as yet undetermined. CONCLUSIONS: A model for health care seeking fur IBS and NUD, with an empha sis on psychosocial factors is presented, but remains to be tested. (C) 200 1 by Am. Cell. of Gastroenterology.