Implications of shame for patient reported outcomes in Bowel Disorders of Gut-Brain Interaction.

Background And Aims: Bowel Disorders of Gut-Brain Interaction (DGBI) are a highly stigmatized group of disorders. Even though the link between stigma and shame is overall acknowledged, few studies focusing on health-related stigma mention shame, and research on shame in Bowel DGBI is non-existent. The aim of this study was to examine the implications of shame in Bowel DGBI.

Methods: We included two Swedish population-based samples: a Bowel DGBI sample (n=537) and a matched comparative sample without bowel symptoms (n=1881). Participants completed an online survey with validated self-report scales. A cross-sectional mediation analysis via structural equation modelling, and a moderation analysis were conducted to analyze the role of shame in the associations between bowel symptom severity and psychosocial outcomes.

Results: The Bowel DGBI sample reported significantly higher levels of shame than the comparative sample. The mediation model, conducted with the Bowel DGBI sample, showed that shame was a mediator of the associations of bowel symptoms with general anxiety, depressive symptoms, QoL, and activity impairment. Gastrointestinal (GI)-specific anxiety was not associated with any outcome of this model. Moderation results showed that shame was an exacerbator of the associations of bowel symptoms with higher severity of GI-specific anxiety and depressive symptoms, and poorer quality of life.

Conclusions: Shame appears to be a particularly important emotion deriving from the experience of GI symptoms in Bowel DGBI, influencing the associations between these symptoms and important patient reported outcomes. An empathetic doctor-patient relationship and psychological therapies may be helpful for individuals with Bowel DGBI experiencing high levels of shame.