Department of Psychology, Macquarie University, Sydney, Australia.
Gut. 2013 Nov;62(11):1573-80. doi: 10.1136/gutjnl-2012-302634. Epub 2012 Aug 23.
Gastric sensorimotor function, abuse history, 'trait' and 'state' psychological factors and 'somatisation' all play a role in functional dyspepsia (FD) and its associated impaired quality of life (QoL), but their interplay remains poorly understood. We aimed to test a comprehensive, a priori hypothesised model of interactions between these dimensions in FD.
In 259 FD patients, we studied gastric sensitivity with a barostat. We measured abuse history (sexual/physical, childhood/adulthood), 'trait' (alexithymia, trait anxiety) and 'state' (positive/negative affect, depression, panic disorder) psychological factors, somatic symptom reporting (somatic symptom count, dyspepsia, irritable bowel syndrome and fatigue symptoms) and QoL (physical, mental) using validated questionnaires. Confirmatory factor analysis (CFA) was used to assess whether four a priori hypothesised latent variables ('abuse', 'trait affectivity', 'state affect' and 'somatic symptom reporting') were adequately supported by the data. Structural equation modelling (SEM) was used to test the a priori hypothesised relationships between these latent variables and the observed variables gastric sensitivity and QoL.
Both the CFA and SEM models fitted the data adequately. Abuse exerted its effect directly on 'somatic symptom reporting', rather than indirectly through psychological factors. A reciprocal relationship between 'somatic symptom reporting' and 'state affect' was found. Gastric sensitivity influences 'somatic symptom reporting' but not vice versa. 'Somatic symptom reporting' and 'trait affectivity' are the main determinants of physical and mental QoL, respectively.
We present the first comprehensive model elucidating the complex interactions between multiple dimensions (gastric sensitivity, abuse history, 'state' and 'trait' psychological factors, somatic symptom reporting and QoL) in FD.
胃感觉运动功能、滥用史、“特质”和“状态”心理因素以及“躯体化”在功能性消化不良（FD）及其相关生活质量（QoL）受损中均起作用，但它们之间的相互作用仍知之甚少。我们旨在测试 FD 中这些维度之间相互作用的综合假设模型。
在 259 名 FD 患者中，我们使用测压计研究胃敏感性。我们测量了滥用史（性/身体、儿童/成年）、“特质”（述情障碍、特质焦虑）和“状态”（积极/消极情绪、抑郁、惊恐障碍）心理因素、躯体症状报告（躯体症状计数、消化不良、肠易激综合征和疲劳症状）以及使用经过验证的问卷测量 QoL（身体、心理）。验证性因子分析（CFA）用于评估四个预先假设的潜在变量（“滥用”、“特质情感”、“状态情感”和“躯体症状报告”）是否得到数据的充分支持。结构方程模型（SEM）用于测试这些潜在变量与观察到的变量胃敏感性和 QoL 之间的预先假设关系。
CFA 和 SEM 模型均适当地拟合数据。滥用直接对“躯体症状报告”产生影响，而不是通过心理因素间接产生影响。发现“躯体症状报告”和“状态情感”之间存在相互关系。胃敏感性影响“躯体症状报告”，反之则不然。“躯体症状报告”和“特质情感”分别是身体和心理 QoL 的主要决定因素。
我们提出了第一个综合模型，阐明了多个维度（胃敏感性、滥用史、“状态”和“特质”心理因素、躯体症状报告和 QoL）在 FD 中的复杂相互作用。
