BMC public health · 2025
Social inequalities, psychosocial influences, and symptom development in patients with irritable bowel syndrome - a longitudinal qualitative analysis of the SOMA.SOC study.
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Barbek Rieke, Makowski Anna Christin, von dem Knesebeck Olaf
Аннотация
BACKGROUND: Despite the individual and economic relevance of irritable bowel syndrome (IBS), research on social inequalities in the development of IBS symptoms is lacking. Therefore, the aim of the study was to shed light on (1) IBS symptom development across different social identities, and (2) psychosocial influences on and impact of IBS symptom development to understand the processes by and the social contexts in which these experiences are created.
METHODS: Analyses made use of a prospective longitudinal qualitative study with three serial time points (initial interview, three-months, and twelve-month follow-up). Interviews of n = 20 participants were included capturing a variety of social identities (occupational status, gender, history of migration), symptom specifics, and experiences with and in relation to their IBS symptomatology. Following a longitudinal qualitative research (LQR) approach, deductive and optional inductive themes were extracted.
RESULTS: Over the one-year study period, participants' symptoms largely improved, undulated, remained mainly stagnant, or worsened. Social inequalities became apparent in that participants with a high occupational status and males experienced improvements in their symptoms compared to participants with a low occupational status and females, respectively. To understand these differences, the following deductive themes related to psychosocial influences on and impact of IBS symptom development were identified: stressors regarding private environment (e.g., life events, familial responsibilities) and livelihood, coping, and perceived stigma in medical contexts.
CONCLUSIONS: To mitigate social inequalities in IBS symptom development, both, individuals' coping strategies and social power need to be strengthened, especially for those with intersecting social identities associated with oppression, like low socioeconomic status, female gender, or a history of migration. Thereby, work-related, medical, and psychoeducational interventions are needed addressing both the individual and structural level.
METHODS: Analyses made use of a prospective longitudinal qualitative study with three serial time points (initial interview, three-months, and twelve-month follow-up). Interviews of n = 20 participants were included capturing a variety of social identities (occupational status, gender, history of migration), symptom specifics, and experiences with and in relation to their IBS symptomatology. Following a longitudinal qualitative research (LQR) approach, deductive and optional inductive themes were extracted.
RESULTS: Over the one-year study period, participants' symptoms largely improved, undulated, remained mainly stagnant, or worsened. Social inequalities became apparent in that participants with a high occupational status and males experienced improvements in their symptoms compared to participants with a low occupational status and females, respectively. To understand these differences, the following deductive themes related to psychosocial influences on and impact of IBS symptom development were identified: stressors regarding private environment (e.g., life events, familial responsibilities) and livelihood, coping, and perceived stigma in medical contexts.
CONCLUSIONS: To mitigate social inequalities in IBS symptom development, both, individuals' coping strategies and social power need to be strengthened, especially for those with intersecting social identities associated with oppression, like low socioeconomic status, female gender, or a history of migration. Thereby, work-related, medical, and psychoeducational interventions are needed addressing both the individual and structural level.