Psychological Interventions for Irritable Bowel Syndrome: A Meta-Analysis of Iranian Randomized Trials

Background: : Irritable bowel syndrome (IBS) is a common health problem, with considerable effects on the individual's quality of life, mental health, work productivity, and financial aspects. Psychological interventions, which are commonly used as adjunct treatments, have received fairly strong empirical support. In Iran, several randomized clinical trials (RCTs) have evaluated the efficacy of these treatments; however, the results of these RCTs have not been synthesized yet. Therefore, in this meta-analysis, we aimed to summarize the results of these trials on the efficacy of psychological interventions in Iranian adults with IBS. Methods: We searched IranDoc, ElmNet, PubMed, and Scopus for eligible RCTs. The risk of bias was assessed in each trial, according to the Cochrane guidelines, and the random-effect model was used to pool the effect size (EF) across trials. Results: Twenty RCTs met the eligibility criteria and were included in the meta-analysis. Compared to the controls, the standardized mean difference (SMD) for psychological interventions was large regarding the severity of IBS symptoms (-1.21; 95% CI:-1.63 to-0.80), anxiety (-0.97; 95% CI:-1.32 to-0.63), and depression (-0.86; 95% CI:-1.28 to-0.44). There was considerable heterogeneity among the included RCTs regarding all three outcomes, which could not be explained by the available information. On the other hand, the EF of health-related quality of life was 0.64 (95% CI: 0.38 to 0.85), with no significant heterogeneity among RCTs. Conclusion: The existing evidence suggests that psychological interventions can be highly effective in improving the severity of IBS symptoms, mental health, and quality of life for Iranian adults with IBS. However, some weaknesses should be considered in the interpretation of the results and future research. The risk of randomization was high or unclear in almost all of the existing trials; there was no single large trial in this area; and there was substantial inconsistency in the EFs, which might be related to methodological or clinical moderators.