A Study on the Emotional State of College Students with Functional Constipation

Guang-Qi Lu, Xin-Yu Zhang, Yi-Fei Liu, Yue Chen, Jia-Qi Xu, Rong-Di Yan＊

1Shandong University Of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Jinan, 250014, China.

Abstract Objective: Functional constipation (FC) is a common problem in college students. In this study, we aimed to analyze emotional state and psychological well-being of college students. Methods: 500 college students in Changqing University City of Jinan were selected for questionnaire survey. According to the Roma III diagnosis criteria, 139 students were diagnosed patients with FC. Qiqing Assessment Scale Questionnaire was used to assess the emotional state of students with FC. Results: The prevalence rate of FC in college students was 32.5%. The psychological well-being score of normal students was higher than that of college students with FC. Significant difference was also observed in terms of mean score of emotional state dimensions in college students with FC. The score of worry was the highest, followed by anxiety and fright in college students with FC. Joy, as the only upward emotion in the seven emotions, had the lowest score. The scores of female students with FC were higher than those of men in anger, anxiety, sadness and worry. Conclusion: There is a close relationship between emotional factors and FC in college students. Emotional factors should be paid attention to in the prevention and treatment of FC.

Keywords: Functional constipation, Emotional state, Psychological well-being

Introduction

Functional constipation (FC) is a common gastrointestinal disease in clinic, which is characterized by reduced defecation, dry stool and strenuous defecation. In recent years, with the change of people's diet structure and the influence of mental and psychological factors and social factors, the prevalence rate of FC in China has increased year by year, which has seriously affected people's quality of life. According to traditional Chinese medicine, stagnation, heat knot,cold coagulation, deficiency of qi and blood, yin and yang and emotional factors play an important role in the production of constipation. Melancholy, depression and exasperation, liver depression and qi stagnation, or sitting for a long time and less movement can all lead to stagnation of fu-qi, abnormal health, or the stool dry knot into constipation [1]. In western medicine, the incidence of chronic FC is systemic, involving multiple systems and multiple organs, which are not only closely related to gastrointestinal neuromuscular lesions and rectoanal local anatomical changes； drugs, hormones,spirit, diet, living habits, age and other related factors may lead to the occurrence of constipation. Modern medicine is mostly from the intestinal nervous system,neurotransmitters, intestinal smooth muscle, colon Cajal cells to explain the etiology and pathogenesis,but its pathogenesis is still not completely clear [2].Under the influence of the huge pressure of study and employment, mental immaturity and other factors,college students' emotions often fluctuate greatly and become more and more likely to have a high incidence of functional constipation. Therefore, it is of great significance to study the emotional state of college students with FC. This study conducted an assessment of emotional state of the college students in Changqing University City of Jinan to investigate the possible relationship with FC.

Subjects and methods

Design of the questionnaire

There are two questionnaires in this study. The questionnaire 1 includes three parts. 1-2 items investigates general situation. 3-5 items were used to assess the psychological well-being of college students,which was made according to the MOS item short from health survey (SF-36). 6-9 items were diagnostic questions for FC as defined by the Rome III criteria[3]. Psychological well-being score = (actual scorethe lowest possible score in this aspect) / (the highest possible score in this aspect-the lowest possible score in this aspect) * 100. The higher the score, the healthier the examiner is. Students diagnosed with FC must meet more than two criteria: (1) defecation is laborious； (2)defecation is dry ball or hard defecation； (3) defecation has a sense of defecation is not. (4) Defecation times ＜3 times per week.

Questionnaire 2 is the Qiqing Assessment Scale (QAS)[4] and can be used as a tool for the evaluation of seven emotions (joy, anger, worry, anxiety, sadness, fear and fright). The QAS has a total of 42 items, which is composed of seven dimensions, The corresponding entries of each dimension are as follows: anger: 6, 9,17, 21, 30, 39； joy: 1, 8, 15, 24, 24, 34； anxiety: 7, 10,18, 25, 27, 42； sadness: 2, 13, 20, 29, 35, 40； fear: 5,12, 19, 26, 36, 41； worry: 4, 11, 16, 23, 31, 38； fright:3, 14, 22, 28, 33, 37. The Likert5 rating system was adopted: 1 (never) ～ 5 (always). The main statistical index is the total score of the corresponding items of anger, joy, anxiety, sadness, fear, worry and fright. The higher the score, the more obvious the performance of this dimension [5].

Subjects

Using the method of random sampling, the college students in Changqing University City of Jinan were investigated to fill the questionnaire 1. questionnaire 2 is filled out by the students who matched listed criteria:

(1) Those who meet the diagnostic criteria of FC mentioned above.

(2) College students in Changqing University City,Jinan.

(3) Those who fill in the questionnaire truthfully and objectively.

Statistical methods

SPSS 13.0 software package was applied. Mean ±standard deviation was used to assess measurement data. Continuous variables between the two groups were compared using Student’s t-test. Skew distributional data was assessed using the Wilcoxon Mann-Whitney U rank sum test. P ＜ 0.05 was considered statistically significant.

Results

A total of 500 questionnaire 1 were collected, including 428 valid questionnaires, 315 electronic questionnaires and 113 paper questionnaires. Questionnaire 2 was filled in by 139 studengts diagnosed FC who were tested in questionnaire 1. The original data is inputted into the computer after being checked correctly. Of the 428 respondents, 139 college students suffered from FC, with an incidence of 32.5%； 41 were males and 98 were females, with a prevalence rate of 24.40% for males and 37.69% for females (Table 1 and Table 2). In addition, among the 428 respondents, there were 168 males and 260 females. The prevalence rate of female is much higher than that of male (Table 2).

The psychological well-being score of college students with FC and normal college students were compared and analyzed by Wilcoxon Mann-Whitney U rank sum test. The normal students have higher score than that of students with FC group in psychological well-being (160.42 ± 81.25 vs 143.75 ± 81.25； P =0.001) (Table 3).

Significant difference was also observed in terms of mean score of emotional state dimensions in college students with FC (Table 4) (P ＜ 0.001). Among the 139 patients with FC, the worry score was the highest,followed by anxiety and fright. As the only upward emotion among the seven emotions, joy has the lowest score. The QAS scores of female students with FC were higher than those of male in anger, anxiety, sadness and worry, and the difference was statistically significant(Table 5) (All P ＜ 0.001).

Table 1 Distribution of functional constipation among the respondents

Table 2 Gender distribution of students with functional constipation among the respondents

Table 3 Comparison of Mental health scores in both groups (Median ± Quartile)

Table 4 Comparison of QAS score in 139 college students with functional constipation (score, x±s)

Table 5 Gender comparison of QSA score in 139 college students with functional constipation

Discussion

The seven emotions refer to seven emotional activities including joy, anger, worry, anxiety, sadness, fear and fright. They are external manifestations of the functional activities of viscera. Normally, the seven emotions don’t cause diseases, but under long-term excessive emotional stimulation, if it exceeds the degree of tolerance of the human body, it can lead to the occurrence of disease [6]. Emotional factors are closely related to FC of college students. From the perspective of traditional Chinese medicine, emotional imbalance will lead to disharmony between yin and yang, disorder of qi, and affect the normal defecation function of the large intestine. This coincides with the view that psychological factors can induce or aggravate FC. This survey data also show that college students with peace of mind, less psychological stress and higher mental health are less likely to suffer from FC；conversely, college students with emotional disorders and lower mental health are more likely to develop functional constipation.

Among the 139 patients with FC, the patients with worry and anxiety were the most, followed by fright and fear, and the patients with joy were the least. The score of worry is the highest, followed by anxiety and fright. As the only upward emotion among the seven emotions, Joy has the lowest score. It also shows that there is a close relationship between anxiety and worry and the occurrence of FC. In the theory of traditional Chinese medicine, excessive worry may lead to blockage of qi movement, excessive pensiveness leading to qi knotting, blockage of qi in the large intestine,can not conduct, resulting in constipation.Wang Jingxiu [7] believes that sadness and autumn can affect the lung qi, and the lung plays an important role in the process of qi descending. If the lung qi is not smooth, the qi is in disorder, and the qi cannot descend normally, which leads to constipation symptoms such as abdominal pain. Excessive contemplation impairs the spleen. Fang Xucheng et al. have achieved a good effect in the treatment of chronic FC by soothing the liver and tonifying the spleen [8].

In addition, we found that the prevalence of FC and QAS scores of anger, anxiety, sadness and worry in women were higher than those in men. It can be explained that the emotional reaction of women is stronger than that of men, which may be related to the rich emotions of women. The average level of psychological well-being of women is low than that of men.

At present, there has been some progress in the treatment of FC in the field of emotion. Biofeedback therapy combined with psychosocial intervention can affect the symptoms of patients with constipation.Biofeedback therapy is a method of psychotherapy based on the principle of conditioned reflex. It uses instruments to display some biological information related to psychophysiological processes that patients are not aware of under normal circumstances, such as visual or auditory methods, to train patients to consciously control their psycho-physiological activities, adjust body functions, and achieve therapeutic goals. In essence, it is also a kind of behavioral and psychotherapy [9]. Systematic reviews by Palsson [10] showed that the effective rate of biofeedback in the treatment of FC was 62.4%. The randomized controlled study by RAO et al. on 77 patients with FC showed that the efficacy of biofeedback therapy was significantly better than that of traditional therapy group and pseudo-biofeedback group in terms of subjective symptoms and objective parameters such as defecation frequency, stool characteristics, anorectal manometry, balloon excretion test [11]. This method can increase the number of spontaneous defecation,reduce the effort of defecation, reduce the use of laxatives, and significantly improve the quality of life.

Li Xiuxia [12] treats constipation caused by qi stagnation with adds and subtracts Chaihu Shugan Powder combined with the treatment of tonifying qi,nourishing blood, clearing heat, promoting dampness,nourishing yin. As a result, 9 cases were cured, 8 cases were effective, 3 cases were ineffective, and the total effective rate was 85%. Zhou Desheng et al.[13] treated 68 patients with FC with the method of regulating the liver and invigorating the spleen with Xiaoyao Powder. The total effective rate was 92.7%. It is effective to treat FC by changing patients' emotional factors. Therefore, college students should improve their awareness of "Preventive treatment of disease" and pay attention to psychological counseling and emotional regulation in daily study and life, so as to reduce the incidence of FC. In the treatment, we should emphasize soothing the liver qi, flirting, looking for effective psychotherapy to dispel the patients'psychological depression and anxiety, which will play a very positive role in the treatment of FC. In the followup investigation and study, we will further clarify the specific pathogenic mechanism of emotion on FC and provide more practical and reliable methods for clinical diagnosis and treatment.