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World J Psychiatry. Aug 19, 2026; 16(8): 119686
Published online Aug 19, 2026. doi: 10.5498/wjp.119686
Anxiety and depression in Rome IV disorders of gut–brain interaction: Prevalence, clinical impact, and temporal association
Manjeet Kumar Goyal, Omesh Goyal, Praneet Wander, Jaskirat Kaur, Gargi Prashar, Prerna Goyal, Ajit Sood
Manjeet Kumar Goyal, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH 44308, United States
Omesh Goyal, Jaskirat Kaur, Gargi Prashar, Ajit Sood, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Praneet Wander, Division of Gastroenterology, St Mary’s Hospital, Trinity Health Of New England, Waterbury, CT 06708, United States
Prerna Goyal, Department of Medicine, R.G. Stone Super Speciality Hospital, Ludhiana 141001, Punjab, India
Co-first authors: Manjeet Kumar Goyal and Omesh Goyal
Author contributions: Goyal MK and Goyal O provided equal contributions as detailed below, meriting co-first authorship; Goyal MK, Goyal O and Sood A conceptualized the study; Goyal MK, Goyal O and Goyal P designed the methodology; Wander P, Goyal P, and Prashar G performed literature search; Goyal O, Goyal MK, Kaur J and Prashar G contributed to patient enrollment; Goyal MK, Prashar G, Kaur J, and Goyal P performed the investigation and statistical analysis; Goyal MK, Wander P, Prashar G and Kaur J generated the visualization of data and writing of the original manuscript draft; All authors performed editing of the subsequent versions of the manuscript; Goyal O, Mehta V, and Sood A provided the study supervision and data validation; All authors read and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Dayanand Medical College and Hospital, Ludhiana, No. 2018-394.
Informed consent statement: Informed consent was obtained.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data technical appendix, statistical code, and dataset available from the corresponding author upon reasonable request.
Corresponding author: Omesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana 141001, Punjab, India.
goyalomesh@yahoo.co.in
Received: February 3, 2026
Revised: March 9, 2026
Accepted: April 8, 2026
Published online: August 19, 2026
Processing time: 165 Days and 21.7 Hours
BACKGROUND
Patients with disorders of gut-brain interaction (DGBIs) frequently report co-existing anxiety and depression; yet data on the prevalence, clinical impact and temporal association of psychological comorbidities across the full spectrum of DGBIs, particularly regarding overlap syndromes, remain limited.
AIM
To evaluate the prevalence and temporal relationship of anxiety and depression among DGBIs, and assess the impact of overlapping DGBIs.
METHODS
In this prospective cross-sectional study conducted at a tertiary care centre in northern India, adults fulfilling Rome IV criteria for DGBIs were enrolled and compared with age- and sex-matched controls. Anxiety and depression were assessed using validated Generalized Anxiety Disorder 7-item and Patient Health Questionnaire 9-item depression scales, and health-related quality-of-life using the Patient-Reported Outcomes Measurement Information Systems (PROMIS) global questionnaire.
RESULTS
Among 1044 patients with DGBIs, anxiety and depression were present in 64.2% and 37.8%, respectively; being significantly higher in patients with overlapping DGBIs compared with single DGBI (81.2% vs 52.8%; and 51.3% vs 28.7%, respectively; both P < 0.0001). Health-related quality-of-life was significantly worse among DGBI patients, particularly those with overlap syndromes. In temporal analyses, gastrointestinal symptoms preceded the onset of anxiety in 71.0% and depression in 78.5% patients (P < 0.0001), with DGBI overlap being the strongest predictor of anxiety and depression.
CONCLUSION
DGBIs are associated with a substantial psychological burden, especially in patients with overlapping syndromes. Gastrointestinal symptom onset commonly antedates psychological distress, supporting a clinically relevant ‘gut-first’ trajectory. Early recognition and effective management of DGBIs may therefore play a role in mitigating subsequent psychological morbidity, underscoring the need for integrated management.
Core Tip: Psychological comorbidities are highly prevalent in disorders of gut-brain interaction (DGBIs), particularly among patients with overlapping syndromes. In this large Rome IV-based cohort, anxiety and depression affected nearly two-thirds and one-third of patients, respectively, with substantially worse quality of life in overlap DGBIs. Notably, gastrointestinal symptoms preceded the onset of anxiety and depression in most cases, supporting a predominant gut-to-brain trajectory. These findings emphasize the need for early identification and proactive management of DGBIs, alongside integrated gut-brain care strategies, to potentially mitigate subsequent psychological morbidity.
