We read with great interest the study by O'Connor et al. [1] on the impact of anxiety and depression (measured using the Hospital Anxiety and Depression Scale [HADS]) on the efficacy of dietary interventions for irritable bowel syndrome (IBS). The study's exploration of psychological comorbidities in IBS treatment outcomes offers a valuable perspective on the gut–brain axis, a pathway that has been linked to IBS pathophysiology through complex interactions between gastrointestinal symptoms and mental health factors. As Taiwan experiences similarly high prevalence rates of IBS, ranging from 17% to 22% with a notable predominance in females, the implications of this study are especially relevant. We would like to provide additional commentary on the psychological factors associated with IBS and suggest further directions for research and clinical practice.

O'Connor et al. have contributed significantly to the understanding that patients with elevated HADS depression scores (≥ 8) are less likely to achieve therapeutic response to dietary interventions. This aligns with previous findings [2], suggesting that gastrointestinal-specific anxiety, visceral hypersensitivity and autonomic nervous system dysregulation often complicate symptom management in IBS. The results highlight the critical need to consider patients' mental health profiles when implementing dietary interventions, given that those with higher depression scores had significantly lower response rates. This is particularly important as it supports the concept of a biopsychosocial approach to IBS, which integrates psychological screening and management into the therapeutic strategy.

Langvik et al. [3] have shown that HADS, particularly the depression subscale, may capture anhedonic symptoms, which could affect motivation and adherence to dietary regimens. Furthermore, Martin and Patel [4] demonstrated that the duration and structure of dietary education in patients with IBS influence treatment outcomes, with both 4- and 8-week dietitian-led low FODMAP interventions yielding similar efficacy. Future studies could explore whether modifying dietary intervention length or structure might improve outcomes for IBS patients with higher HADS scores by accommodating these patients' unique psychological profiles.

Given the established link between psychological stressors and IBS [5], addressing anxiety and depressive symptoms may provide additional relief for patients with IBS. Including cognitive behavioural interventions alongside dietary modifications could enhance treatment response in patients with high HADS scores, supporting a comprehensive gut–brain therapeutic approach. Riggott et al. [6] have advocated for gut–brain axis-targeted therapies in conditions like inflammatory bowel disease, which shares similar gut–brain dynamics with IBS. Therefore, incorporating stress management and mental health support could also be beneficial in IBS treatment models.

In conclusion, the findings of O'Connor et al. underscore the importance of individualised treatment approaches that consider mental health status as a predictor of dietary intervention outcomes in IBS. Future research focusing on the optimisation of intervention strategies based on psychological comorbidities, including the use of short-term dietary regimens and mental health support, may lead to improved management of IBS. This commentary advocates for the integration of mental health care into IBS treatment, fostering a more holistic approach to managing this complex and often distressing condition.