Journal Article

Gender and Sex Differences in Abdominal Pain, Fatigue, And Psychological Symptoms Among Adults with Inflammatory Bowel Disease: A Network Analysis

Altman, Molly R, Yang, Pei-Lin, Kane, Sunanda, Yoo, Linda, Heitkemper, Margaret, Tsai, Chi-Shan, Conley, Samantha, Winders, Samantha, Kamp, Kendra, Zhang, Xiaoyu

2025

Overview

Abstract Background and Aims Individuals with inflammatory bowel disease (IBD) experience a high symptom burden, including abdominal pain, fatigue, anxiety, depression, and sleep disturbances; yet, little is known regarding the relationship between sex and gender on symptoms. We sought to report symptom severity for cisgender men, cisgender women, and transgender and gender-diverse (TGD) individuals. In addition, we used network analysis to identify core symptoms and explore if symptoms and their relationships differ between cisgender men and cisgender women. Methods This was a cross-sectional study. We recruited adults with IBD online through ResearchMatch. Individuals responded to Patient-Reported Outcomes Measurement Information symptom questionnaires, as well as demographic and clinical questionnaires. Network analysis was used to identify the core symptoms driving the symptom structure. Results One-hundred and fifty-seven (63.3%) participants identified as cisgender women, 84 (33.9%) as cisgender men, and 7 (2.8%) as TGD. Cisgender men (M = 61.8) and TGD (M = 61.3) groups reported higher abdominal pain levels compared with cisgender women (M = 57.8; P = .02). Transgender and gender-diverse individuals reported higher depression levels (M = 64.8) compared with cisgender men (M = 56.7) and cisgender women (M = 54.4; P = .01). Using a network analysis approach, anxiety and fatigue emerged as core symptoms for the entire sample (clinically active and inactive disease), and among only those with active clinical disease. Fatigue was a top core symptom for cisgender women; anxiety emerged as a top core symptom for cisgender men. Conclusions This study highlights that fatigue and anxiety are core symptoms among individuals with IBD and demonstrates a potential sex and/or gender difference in core symptoms. Replication of this study is needed with further consideration of inclusion of TGD patients. Lay Summary For those with inflammatory bowel disease, the severity of symptoms and core symptoms may differ between cisgender women, cisgender men, and transgender and gender-diverse individuals.

• Publisher: Oxford University Press
• Subject: Abdomen / Abdominal Pain - etiology / Abdominal Pain - psychology / Adult / Adults / Anxiety / Anxiety - etiology / Anxiety - psychology / Cisgender / Cross-Sectional Studies / Depression - etiology / Depression - psychology / Fatigue / Fatigue - etiology / Fatigue - psychology / Female / Gender differences / Humans / Inflammatory bowel disease / Inflammatory Bowel Diseases - complications / Inflammatory Bowel Diseases - psychology / Male / Mental depression / Middle Aged / Pain / Patient Reported Outcome Measures / Questionnaires / Severity of Illness Index / Sex Factors / Sleep Wake Disorders - etiology / Surveys and Questionnaires / Transgender persons