Depression or Anxiety in GI Outpatients: Upper GI Symptoms and Symptom Clusters Showed Stronger Associations Than Lower GI

Abstract

Background and Aim

Gastrointestinal (GI) problems have been always linked to psychiatric disorders. The aim of our study was to explore specific GI symptoms or symptom clusters that may indicate the presence of depression or anxiety in outpatients.

Methods

One thousand one hundred twenty-five outpatients from 20 hospitals completed questionnaires assessing GI symptoms, depression (the Patient Health Questionnaire-9, PHQ-9), and anxiety (General Anxiety Disorder-7, GAD-7). Principal component analysis was employed to identify symptom clusters based on 22 GI symptoms. The patients were categorized into three groups: Control (PHQ-9 < 5 and GAD-7 < 5), DA1 (5 ≤ PHQ-9 < 10 or/and 5 ≤ GAD-7 < 10), and DA2 (PHQ-9 ≥ 10 or GAD-7 ≥ 10).

Results

There were 781, 249, and 95 patients in the group of Control, DA1, and DA2, respectively. Fecal incontinence (4.835, [2.213–10.563]), heartburn (3.338, [2.416–4.611]), belching (2.862, [2.145–3.821]), and globus sensation (2.845, [2.110–3.837]) demonstrated the highest potential risk of psychiatric comorbidity. The 22 GI symptoms were categorized into eight clusters. Dyspepsia-related Cluster F2, reflux-related Cluster F3, and esophageal-related Cluster F4 were noteworthy in the identification of psychiatric comorbidity. Cluster F4, including globus sensation, discomfort with swallowing, and chest pain, exhibited the most significant increase in the prevalence of depression or anxiety (2.645, [1.851–3.778]).

Conclusion

Specific GI symptoms including heartburn, belching, globus sensation, and GI symptom clusters including F2, F3, and F4 were noteworthy in the identification of psychiatric comorbidity. They were mostly focused on the upper GI tract. It is critical for gastroenterologists to recognize psychiatric comorbidities and implement appropriate measures accordingly.