Perceived Stress and Bowel-Related Symptoms Among Participants with and Without Self-Reported Physician-Diagnosed Irritable Bowel Syndrome: A Cross-Sectional Study

Abstract

Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction, and psychological stress is widely believed to aggravate its symptoms. Many people live with recurring abdominal pain, bloating, or altered bowel habits without ever receiving a diagnosis, and very little is known about how their psychological state compares with that of diagnosed patients and of people without symptoms. This study was conducted to examine the relationship between perceived stress and bowel-related discomfort, and to compare stress, anxiety, and depressive symptoms between people with a physician-diagnosed IBS, people reporting IBS-type symptoms without a diagnosis, and people without such symptoms. An analytical cross-sectional study was carried out using a bilingual (Arabic and English) online questionnaire distributed between 30 May and 7 July 2026. Perceived stress was measured with the 10-item Perceived Stress Scale (PSS-10), anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and bowel symptoms and their impact with ten items rated 1 to 5. Of 102 submissions, 78 had complete stress and symptom data and were analysed using Spearman correlation, Mann–Whitney U, Kruskal–Wallis, and chi-square tests, with a two-sided p-value below 0.05 taken as significant. The mean age was 23.9 ± 9.3 years and 85.9% of participants were female. Nine participants (11.5%) reported a physician diagnosis of IBS, 41 (52.6%) reported symptoms without a diagnosis, and 25 (32.1%) reported no symptoms. The mean PSS-10 score was 19.17 ± 6.28, with moderate stress in 76.9%. Higher stress was positively correlated with the bowel symptom score (ρ = 0.442), symptom impact (ρ = 0.432), overall bowel distress (ρ = 0.430), anxiety (ρ = 0.632), and depression (ρ = 0.396), all p < 0.001. PSS-10 scores differed across the three groups (p = 0.001): 24.0 ± 4.5 in diagnosed, 19.6 ± 6.5 in self-reported, and 16.4 ± 5.4 in symptom-free participants. Anxiety above the HADS threshold was found in 88.9%, 62.2%, and 17.4% of the three groups, respectively (p < 0.001), whereas depression did not differ significantly (p = 0.252). In a multivariable model, perceived stress remained independently associated with the symptom score (p = 0.032). Higher perceived stress was associated with more severe, more disruptive, and more distressing bowel symptoms. Participants with symptoms but no diagnosis carried a stress and anxiety burden that lay between that of diagnosed and symptom-free participants. Because of the small diagnosed group and the cross-sectional design, these results describe associations only and should be confirmed in larger and longitudinal studies.