Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Relationship between Stressful Life Events and Gastrointestinal Symptoms among Students: The Mediating role of Generalized Anxiety Disorder Symptoms

Document Type : Original Article (s)

Authors
Department of Psychology, Ne.C., Islamic Azad University, Neyshabur, Iran
10.48305/jims.v44.i868.1116
Abstract
Background: A range of psychosocial factors plays an important role in the experience of gastrointestinal symptoms. Although the association between life stressful events and gastrointestinal problems is well established, the mediating role of psychological variables—particularly symptoms of generalized anxiety disorder—has received less attention. The present study aimed to examine the mediating role of generalized anxiety disorder symptoms in the relationship between life stressful events and gastrointestinal symptoms among university students.
Methods: This descriptive cross-sectional study was conducted on undergraduate and graduate students at the Islamic Azad University of Neyshabur during the 2024–2025 academic year. The sample consisted of 338 students selected through convenience sampling from the faculties of Humanities, Medical Sciences, and Engineering. Data were collected using the Spitzer et al. Generalized Anxiety Disorder (GAD) scale, the Green et al. Life Stressful Events Screening Questionnaire (SLESQ), and the Revicki et al. Gastrointestinal Symptom Rating Scale (GSRS). Structural equation modeling (SEM) was performed using LISREL and SPSS software.
Findings: The findings revealed significant positive correlations among life stressful events, generalized anxiety disorder symptoms, and gastrointestinal symptoms. Moreover, generalized anxiety disorder symptoms significantly mediated the relationship between life stressful events and gastrointestinal symptoms, and the structural model demonstrated good fit indices.
Conclusion: The results highlight the influential role of life stressful events and generalized anxiety disorder symptoms in the development and persistence of gastrointestinal symptoms among students. Future studies should explore educational and therapeutic interventions targeting generalized anxiety disorder symptoms to help reduce gastrointestinal complaints in student populations.

Highlights

Mahdi Najafi:  PubMed

Ahmad Mansouri: Google Scholar ,PubMed

Keywords
Subjects

1.     Fikree A, Byrne P. Management of functional gastrointestinal disorders. Clin Med (Lond) 2021; 21(1): 44-52.
2.     Black CJ, Drossman DA, Talley NJ, Ruddy J, Ford AC. Functional gastrointestinal disorders: advances in understanding and management. Lancet 2020; 396(10263): 1664-74.
3.     Lee S-B, Chae H-W, Kwon J-W, Sung S, Moon S-H, Suk K-S, et al. Association of functional gastrointestinal disorders with adolescent idiopathic scoliosis. Children (Basel) 2024; 11(1): 118.
4.     Yan L, Zhang X, Li Y, Liu C, Yang H, Yang C. The role of psychological factors in functional gastrointestinal disorders: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38(1): 65.
5.     Ramezani F, Salehi M. The effect of stress and psychological disorders on functional gastrointestinal disorders [in Persian]. Govaresh 2022; 26(3): 143-8.
6.     Donthu RK, Mohammed AS, Kiran NOAS, Kancharlapalli PK, Pallem A. A cross-sectional study of stressful life events and quality of life among FGID and non-FGID patients. Ind Psychiatry J 2024; 33(Suppl 1): S134-S41.
7.     Prakash S, Singh V, Verma K, Singhal AK, Aswal S, Joshi A. Psychiatric morbidity, personality pattern and stressful life events in functional and organic gastrointestinal disorders. Journal of Mental Health and Human Behaviour 2013; 18(2): 97-103.
8.     Hendrix J, Ranginani D, Montero AM, Lockett C, Xu H, James‐Stevenson T, et al. Early adverse life events and post‐traumatic stress disorder in patients with constipation and suspected disordered defecation. Neurogastroenterol Motil 2022; 34(3): e14195.
9.     Ju T, Naliboff BD, Shih W, Presson AP, Liu C, Gupta A, et al. Risk and protective factors related to early adverse life events in irritable bowel syndrome. J Clin Gastroenterol 2020; 54(1): 63-9.
10.  Surdea-Blaga T, Băban A, Dumitrascu DL. Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol 2012; 18(7): 616-26.
11.  Bradford K, Shih W, Videlock EJ, Presson AP, Naliboff BD, Mayer EA, et al. Association between early adverse life events and irritable bowel syndrome. Clin Gastroenterol Hepatol 2012; 10(4): 385-90. e3.
12.  Li Y, Dai J, Wang M, Yan C, Xiu M, Qu M. Alterations in gut microbiota and plasma metabolites in patients with generalized anxiety disorder: A multi-omics study. Int J Neurosci 2026; 136(3): 268-85.
13.  Javed M, Yadav T, Shakil J, Zaidi STH, Zehra M. Prevalence of irritable bowel syndrome and functional dyspepsia and their relationship with generalized anxiety disorder among medical students in Karachi. J Pak Med Assoc 2022; 72(10): 2132-6.
14.  Association AP. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR: American Psychiatric Association Publishing; 2022.
15.  Guo X, Lin F, Yang F, Chen J, Cai W, Zou T. Gut microbiome characteristics of comorbid generalized anxiety disorder and functional gastrointestinal disease: Correlation with alexithymia and personality traits. Front Psychiatry 2022; 13: 946808.
16.  Dong Z, Shen X, Hao Y, Li J, Li H, Xu H, et al. Gut microbiome: a potential indicator for differential diagnosis of major depressive disorder and general anxiety disorder. Front Psychiatry 2021; 12: 651536.
17.  Jiang H-y, Zhang X, Yu Z-h, Zhang Z, Deng M, Zhao J-h, et al. Altered gut microbiota profile in patients with generalized anxiety disorder. J Psychiatr Res 2018; 104: 130-6.
18.  Wetherell JL, Ayers CR, Nuevo R, Stein MB, Ramsdell J, Patterson TL. Medical conditions and depressive, anxiety, and somatic symptoms in older adults with and without generalized anxiety disorder. Aging Ment Health 2010; 14(6): 764-8.
19.  Waters AM, Schilpzand E, Bell C, Walker LS, Baber K. Functional gastrointestinal symptoms in children with anxiety disorders. J Abnorm Child Psychol 2013; 41(1): 151-63.
20.  Meyers LS, Gamst G, Guarino AJ. Applied multivariate research: Design and interpretation: SAGE Publications; 2016.
21.  Green BL, Chung JY, Daroowalla A, Kaltman S, DeBenedictis C. Evaluating the cultural validity of the stressful life events screening questionnaire. Violence Against Women 2006; 12(12): 1191-213.
22.  Sabouri M, Mansouri A. The relationship between stressful events and psychological distress in women with substance use disorder: The moderating roles of resilience and mindfulness [in Persian]. S Research on Addiction 2022; 16(65): 27-48.
23.  Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166(10): 1092-7.
24.  Rezaeidoust A, Mansouri A. The mediating role of spiritual distress and spiritual coping in the relationship between stressful life events and generalized anxiety disorder. Journal of Clinical Psychology & Personality 2025; 23(2): 99-110.
25.  Revicki DA, Wood M, Wiklund I, Crawley J. Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Qual Life Res 1997; 7(1): 75-83.
26.  Mazaheri M, SadatKhoshouei M. Comparison between psychometric characteristics of Persian version of the gastrointestinal symptoms rating scale in functional gastrointestinal disorders and normal groups [in Persian]. Govaresh 2012; 17(1): 18-24.
27.  Baziari M, Vaziri S, Lotfi Kashani F, Ahi Q, Mansouri A. The mediating role of transdiagnostic factors in relationship between stressful events and generalized anxiety disorder [in Persian]. J Res Behav Sci 2023; 21(2): 340-51.
28.  Shakeri M, Mansouri A. The relationship between stressful life events and non-suicidal self-injury among students: The mediating role of generalized anxiety and depression. Journal of Clinical Psychology & Personality 2025; 24(1): 79-94.
29. Barlow DH, Durand VM, Hofmann S. Psychopathology: An integrative approach to mental disorders: Cengage Learning; 2023.
Volume 44, Issue 868
4th Week, August
July and August 2026
Pages 1116-1123

  • Receive Date 22 September 2025
  • Accept Date 25 July 2026