Anxiety and depression in Rome IV disorders of gut–brain interaction: Prevalence, clinical impact, and temporal association

Figure 1 Box and whisker plots. A: Comparison of Generalized Anxiety Disorder 7-item scale between overlapping and non-overlapping disorder of gut-brain interactions (DGBI) groups; B: Comparison of the Patient Health Questionnaire 9-item between overlapping and non-overlapping DGBI groups; C: Comparison of Generalized Anxiety Disorder 7-item scale between overlapping and non-overlapping individual DGBIs; D: Comparison of the Patient Health Questionnaire 9-item between overlapping and non-overlapping individual DGBIs. GAD-7: Generalized Anxiety Disorder 7-item; PHQ-9: Patient Health Questionnaire 9-item; DGBI: Disorder of gut-brain interaction; FC: Functional constipation; FD: Functional dyspepsia; FEsD: Functional esophageal disorders; IBS: Irritable bowel syndrome; GD: Gastroduodenal; AD: Anorectal disorder.

Figure 2 Venn diagrams. A: Venn diagrams illustrating the overlap of specific disorders of gut-brain interaction; B: Venn diagrams illustrating the overlap of specific disorders of gut-brain interaction. FC: Functional constipation; FD: Functional dyspepsia; FEsD: Functional esophageal disorders; IBS: Irritable bowel syndrome; FDD: Functional defecation disorder.

Figure 3 Distribution of depression severity and anxiety severity. A: Distribution of depression severity in the study cohort. Pie chart illustrating the distribution of depression severity assessed using the Patient Health Questionnaire-9. Categories represent absent, mild, moderate, and moderately severe depression, based on the standard Patient Health Questionnaire-9 score thresholds. Values indicate the number of patients in each severity category; B: Distribution of anxiety severity in the study cohort. Pie chart illustrating the distribution of anxiety severity assessed using the Generalized Anxiety Disorder-7 scale. Categories represent absent, mild, moderate, and severe anxiety based on standard Generalized Anxiety Disorder-7 score thresholds. Values indicate the number of patients in each severity category.

Figure 4 Temporal sequencing of disorder of gut-brain interaction and psychological comorbidity. A: Difference between duration of disorder of gut-brain interaction and anxiety symptoms; negative values indicate gut-first onset, positive values indicate anxiety-first onset, and zero indicates concurrent onset; B: Difference between duration of disorder of gut-brain interaction and depressive symptoms using the same convention, demonstrating a predominance of gut-first sequencing. DGBI: Disorder of gut-brain interaction.