Severe Gastro-oesophageal Reflux Symptoms in Relation to Anxiety, Depression and Coping in a Population-Based Study

C. Jansson; H. Nordenstedt; M.-A. Wallander; S. Johansson; R. Johnsen; K. Hveem; J. Lagergren

Disclosures

Aliment Pharmacol Ther. 2007;26(5):683-691. 

In This Article

Results

Characteristics of the Study Participants

Some characteristics of the 3153 case participants and the 40 210 control participants are presented in Table 1 . There were 30 188 (2378 cases and 27 810 controls) participants in both HUNT 2 and HUNT 1. The case participants were on average slightly older than the control participants, while the distribution of men and women was similar between the groups. Tobacco smoking (≥10 years), obesity (BMI > 30) and a low educational level (≤10 years) were more common among the cases (51%, 27% and 77%, respectively) than among the controls (39%, 12% and 64%, respectively) ( Table 1 ).

Distribution of Psychiatric and Psychological Factors

The number of missing observations for the psychiatric/psychological variables was fairly large, but there were no major differences between the cases and controls; 983 cases (31%) and 10 528 controls (26%) had missing data on the anxiety variables (HUNT 2 data), 738 cases (23%) and 8576 controls (21%) had missing data on the depression variables (HUNT 2 data), 1269 cases (40%) and 17 723 controls (44%) had missing data on the anxiety and depression variables (HUNT 1 data), and 32-35% cases and 29-32% controls had missing data on the coping items.

Presence of anxiety and depression was higher among the case participants (27% and 18%, respectively, HUNT 2 data) than among the control participants (12% and 8%, respectively, HUNT 2 data). Presence of combined anxiety and depression was also more common among the cases (11%, HUNT 2 data) than among the controls (4%, HUNT 2 data), with a similar tendency seen regarding HUNT 1 data. The distribution of covert coping was similar between the cases and the controls ( Table 2 ).

Associations Between Psychiatric and Psychological Factors and Reflux Symptoms

The results from the crude and adjusted models are presented in Table 2 . Both anxiety and depression were associated with increased risks of reflux symptoms. We found significant associations between anxiety analysed separately (OR 2.9, 95% CI: 2.6-3.2, adjusted model, HUNT 2 data), and depression analysed separately (OR 2.2, 95% CI: 1.9-2.4, adjusted model, HUNT 2 data) and an increased risk of reflux symptoms. In the analyses including high-risk anxiety and depression groups strong dose-response associations were observed. Subjects in the high-risk anxiety group had a more than fourfold increased risk of reflux symptoms (OR 4.3, 95% CI: 3.5-5.4, adjusted model, HUNT 2 data), while subjects in the high-risk depression group had an almost threefold increased risk of reflux symptoms (OR 2.9, 95% CI: 2.2-4.0, adjusted model, HUNT 2 data; Table 2 ). Similarly, subjects reporting anxiety without depression had a more than threefold increased risk of reflux symptoms (OR 3.2, 95% CI: 2.7-3.8, adjusted model, HUNT 2 data), subjects with depression without anxiety had a nearly twofold increased risk of reflux symptoms (OR 1.7, 95% CI: 1.4-2.1, adjusted model, HUNT 2 data) and subjects with both anxiety and depression had a nearly threefold increased risk of reflux symptoms (OR 2.8, 95% CI: 2.4-3.2, adjusted model, HUNT 2 data), compared to subjects without reported anxiety or depression ( Table 2 ). A significant association of similar strength was observed between combined anxiety and depression and an increased risk of reflux symptoms also in the model based on HUNT 1 data (OR 2.6, 95% CI: 2.3-2.9, adjusted model), and a dose-response association was observed in the analysis including the high-risk group with an almost fourfold increased risk for reflux symptoms seen among subjects in the high-risk anxiety and depression group (OR 3.8, 95% CI: 3.1-4.7, adjusted model, HUNT 1 data; Table 2 ).

We observed a weak inverse association between one measure of covert coping and risk of reflux symptoms (OR 0.8, 95% CI: 0.7-0.9, adjusted model), while a weak positive association was observed between the other measure of covert coping and risk of reflux symptoms (OR 1.2, 95% CI: 1.0-1.4, adjusted model; Table 2 ).

The risk estimates for all studied variables were approximately similar in the crude models and in the models adjusted for age, sex, smoking, BMI and socioeconomic status ( Table 2 ).

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