Psychological disorders and chronic constipation

TO THE EDITOR: I read with interest Hosseinzadeh et al's paper (1). The aim of their study was to screen two categories of psychiatric disorders in chronic functional constipation, using HADS (Hospital Anxiety and Depression Scale) and MINI (Mini International Neuropsychiatric Interview) on fifty four constipated patients. They concluded that the prevalence of mood and anxiety disorders in constipated patients is much higher than general population and in order to reduce health care costs for constipated patients, we need to have an intervention program for co-morbid psychological dysfunctions which affect the course of gastrointestinal disorders. We know that although constipation is less common in the Iranian population than in western countries (2, 3), there is substantial burden of it in Iranian population (4, 5). So determining the social and demographic factors of this disorder would be beneficial. In Hosseinzadeh et al's paper (1) the authors claimed that constipated patients have a higher rate of both mood and anxiety disorders compared to general population by referring to some other studies about mood and anxiety in Iran (6) but this is not a justified conclusion because the authors did not study any controls in order to compare