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Gao RY, Gan RY, Huang JL, Liu TT, Wu BH, Wang LS, Li DF, Yao J. The influence of family support during endoscopic submucosal dissection on patient's anxiety. Front Public Health 2022; 10:992018. [PMID: 36388280 PMCID: PMC9643851 DOI: 10.3389/fpubh.2022.992018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023] Open
Abstract
Background Psychological problems may promote peptic ulcers. Ulcer-like wounds can be formed after gastric endoscopic submucosal dissection (ESD). The influence of family support on the healing of gastric ESD-induced ulcers remains largely undetermined. Objective In the present study, we aimed to assess the Hospital Anxiety and Depression Scale (HADS) scores and the incidence of post-ESD complications in patients with family support in the care process and those in the non-relative group. Materials and methods A total of 191 patients aged between 30 and 70 years who received gastric ESD were evaluated with the Chinese version of HADS. Differences in depression and anxiety between the two groups were compared using the chi-square test and t-test. Multivariable logistic regression models were used to examine whether anxiety and depression were the risk factors for post-ESD complications. Results The mean values of HADS-A (4.61 ± 2.89 vs. 5.56 ± 3.07, p = 0.042) and HADS-D (4.14 ± 3.03 vs. 4.97 ± 2.61, p = 0.048) scores were significantly lower in patients with accompanying relatives compared with those in the non-relative group. Besides, through the pre-ESD and post-ESD self-contrast, the scores of anxiety and depression in the relative-group were 0.57 and 0.56, respectively (p < 0.001), while those in the non-relative group were increased by 1.43 and 1.49, respectively (p < 0.001). Multivariable logistic regression analysis revealed that HADS-A, HADS-D scores, and age were significantly correlated with post-ESD abdominal pain (P < 0.05). Conclusions The occurrence and degree of adverse emotions such as psychological anxiety and depression in patients who received gastric ESD with accompanying relatives during hospitalization may were reduced, and the incidence of gastric post-ESD abdominal pain may was also decreased.
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Affiliation(s)
- Ruo-Yu Gao
- The Second Clinical Medical College, Jinan University, Shenzhen, China,Department of Gastroenterology, Shenzhen Luohu People's Hospital, Shenzhen, China
| | - Ri-Yun Gan
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Jia-Lan Huang
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Ting-Ting Liu
- The Second Clinical Medical College, Jinan University, Shenzhen, China,Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Ben-Hua Wu
- The Second Clinical Medical College, Jinan University, Shenzhen, China,Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Li-Sheng Wang
- The Second Clinical Medical College, Jinan University, Shenzhen, China,Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China,*Correspondence: Li-Sheng Wang
| | - De-Feng Li
- The Second Clinical Medical College, Jinan University, Shenzhen, China,Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China,De-Feng Li
| | - Jun Yao
- The Second Clinical Medical College, Jinan University, Shenzhen, China,Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China,Jun Yao
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Sex Differences in Comorbidity Combinations in the Swedish Population. Biomolecules 2022; 12:biom12070949. [PMID: 35883505 PMCID: PMC9313065 DOI: 10.3390/biom12070949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
High comorbidity rates, especially mental–physical comorbidity, constitute an increasing health care burden, with women and men being differentially affected. To gain an overview of comorbidity rates stratified by sex across a range of different conditions, this study examines comorbidity patterns within and between cardiovascular, pulmonary, skin, endocrine, digestive, urogenital, musculoskeletal, neurological diseases, and psychiatric conditions. Self-report data from the LifeGene cohort of 31,825 participants from the general Swedish population (62.5% female, 18–84 years) were analyzed. Pairwise comorbidity rates of 54 self-reported conditions in women and men and adjusted odds ratios (ORs) for their comparison were calculated. Overall, the rate of pairwise disease combinations with significant comorbidity was higher in women than men (14.36% vs. 9.40%). Among psychiatric conditions, this rate was considerably high, with 41.76% in women and 39.01% in men. The highest percentages of elevated mental–physical comorbidity in women were found for musculoskeletal diseases (21.43%), digestive diseases (20.71%), and skin diseases (13.39%); in men, for musculoskeletal diseases (14.29%), neurological diseases (11.22%), and digestive diseases (10%). Implications include the need for integrating mental and physical health care services and a shift from a disease-centered to an individualized, patient-centered focus in clinical care.
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Ronkainen J, Aro P, Jones M, Walker MM, Agréus L, Andreasson A, Talley NJ. Duodenal eosinophilia and the link to anxiety: A population-based endoscopic study. Neurogastroenterol Motil 2021; 33:e14109. [PMID: 33687126 DOI: 10.1111/nmo.14109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The concept of gut-to-brain communication via microbial or inflammatory pathways is gaining increased attention but genuine pathology directly linking gut perturbation to anxiety is lacking. We hypothesized that duodenal eosinophilia, as known to occur in functional dyspepsia (FD), may be an underlying cause of anxiety and may help explain the striking association between FD and anxiety. METHODS Randomly selected subjects from the national population register of Sweden completed the validated Abdominal Symptom Questionnaire; 1000 completed esophagogastroduodenoscopy and the Hospital Anxiety and Depression Scale questionnaire. Duodenal biopsies were obtained from 1st (D1) and 2nd portion (D2). Eligible subjects who underwent endoscopy (n = 887) were invited to participate in a 10-year follow-up study with the same questionnaires. Among endoscopy normal subjects, FD was identified by Rome criteria, and controls were symptom free. Duodenal eosinophilia was based on pre-defined cut-offs. Finding are reported as odds ratios (ORs) with 95% confidence interval and p-value. RESULTS The study population comprised 89 cases with FD and 124 healthy controls (mean age 62 years, SD 12, 34% male). Clinical anxiety at follow-up was elevated in those with D1 eosinophilia at baseline considering either new-onset anxiety (OR = 4.5, 95% CI 0.8, 23.8; p = 0.08) or follow-up anxiety adjusting for baseline anxiety (OR = 4.51 (95% CI 1.03, 19.81; p = 0.046). CONCLUSION Duodenal eosinophilia may potentially be a mechanism linked to anxiety independent of FD.
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Affiliation(s)
- Jukka Ronkainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Primary Health Care Center, Tornio, Finland
| | | | - Mike Jones
- Macquarie University, North Ryde, NSW, Australia
| | - Marjorie M Walker
- Priority Research Centre for Digestive Health and Neurogastroenterology, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Lars Agréus
- Division of Family Medicine and Primary Care, Division of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Macquarie University, North Ryde, NSW, Australia.,Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas J Talley
- Priority Research Centre for Digestive Health and Neurogastroenterology, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, Australia
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Goodwin RD, Weinberger AH, Kim JH, Wu M, Galea S. Trends in anxiety among adults in the United States, 2008-2018: Rapid increases among young adults. J Psychiatr Res 2020; 130:441-446. [PMID: 32905958 PMCID: PMC7441973 DOI: 10.1016/j.jpsychires.2020.08.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/09/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In a time of global uncertainty, understanding the psychological health of the American public is imperative. There are no current data on anxiety trends among adults in the United States (US) over time. This study aimed to investigate prevalence of anxiety among US adults from 2008 to 2018. METHODS Data from the National Survey on Drug Use and Health (NSDUH), which is an annual, cross-sectional survey on substance use and mental health in the US, were analyzed in 2020. Prevalence of past-month anxiety was estimated among those ages ≥18, by survey year from 2008 to 2018. Time trends were tested using logistic regression. RESULTS Anxiety increased from 5.12% in 2008 to 6.68% in 2018 (p < 0.0001) among adult Americans. Stratification by age revealed the most notable increase from 7.97% to 14.66% among respondents 18-25 years old (p < 0.001), which was a more rapid increase than among 26-34 and 35-49 year olds (differential time trend p < 0.001). Anxiety did not significantly increase among those ages 50 and older. Anxiety increased more rapidly among those never married and with some college education, relative to their respective counterparts. Apart from age, marital status and education, anxiety increased consistently among sociodemographic groups. CONCLUSIONS Anxiety is increasing among adults under age 50 in the US, with more rapid increase among young adults. To prepare for a healthier adulthood and given direct and indirect (via 24/7 media) exposure to anxiety-provoking world events, prophylactic measures that can bolster healthy coping responses and/or treatment seeking seem warranted on a broad scale.
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Affiliation(s)
- Renee D. Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,Corresponding author. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm 1030D, New York, NY, 10032, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - June H. Kim
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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Lexne E, Brudin L, Marteinsdottir I, Strain JJ, Nylander PO. Psychiatric symptoms among patients with acute abdominal pain. Scand J Gastroenterol 2020; 55:769-776. [PMID: 32603609 DOI: 10.1080/00365521.2020.1782464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, 'Length of stay' (LOS) and perceived health.Method: The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p < .001), especially regarding anxiety (p < .001) and depression (p = .002). Patients with organic dyspepsia reported significantly more total (p = .016), extragastrointestinal (p = .026) (chest pain; p = .017, dizziness; p = .004, palpitations; p = .005, insomnia; p = .005 and worries; p = .001), and summarized anxiety and depression symptoms (p = .001-0.002) besides poorer general health (p < .001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p = .002) but similar to the specific abdominal disorders group.Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.
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Affiliation(s)
- Erik Lexne
- Department of Clinical and Experimental Medicine, Psychiatry Section, Linköping University, Linkoping, Sweden
| | - Lars Brudin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - James J Strain
- Icahn School of Medicine at Mount Sinai Mount Sinai Medical Center, New York, NY, USA
| | - Per-Olof Nylander
- Department of Clinical and Experimental Medicine, Psychiatry Section, Linköping University, Linkoping, Sweden
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Lexne E, Brudin L, Strain JJ, Nylander PO, Marteinsdottir I. Temperament and character in patients with acute abdominal pain. Compr Psychiatry 2018; 87:128-133. [PMID: 30367986 DOI: 10.1016/j.comppsych.2018.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/31/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several conditions presenting with abdominal pain are associated with specific personality factors although it is unclear if this is true also in emergency clinic settings. OBJECTIVE To study personality factors among patients with acute abdominal pain in an emergency ward. METHODS Consecutive patients (N = 165) with abdominal symptoms at an emergency clinic were administrated the Temperament and Character Inventory (TCI). Three main groups were identified; specific abdominal diagnoses, (N = 77), non-specific abdominal pain, (N = 67) and organic dyspepsia (N = 21). TCI results were compared between clinical groups and a control group (N = 122). RESULTS As compared to individuals with specific abdominal diagnoses and controls, those with organic dyspepsia were significantly more anxious (harm avoidance), (p = 0.003), and had lower ability to cooperate (cooperativeness) (p = 0.048 and p = 0.004 respectively). They were also significantly more unpretentious (self-transcendence) compared to individuals with specific abdominal diagnoses (p = 0.048), non-specific abdominal pain (p = 0.012) and controls (p = 0.004) and evidenced less mature character (sum of self-directedness and cooperativeness) compared to those with specific abdominal diagnoses and controls (p = 0.003). CONCLUSION Individuals seeking care at an emergency clinic with organic dyspepsia showed a distinguishable pattern of personality features that distinguished them from the other comparison groups. Therefore an evaluation of personality factors may add a new dimension to the diagnostic investigation in the emergency care of abdominal pain and contribute to the optimization of the treatment of organic dyspepsia.
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Affiliation(s)
- Erik Lexne
- Linköping University, Department of Clinical and Experimental Medicine, Psychiatry Section, Linkoping, Sweden.
| | - Lars Brudin
- Linköping University, Department of Medical and Health Sciences, Linköping, Sweden
| | - James J Strain
- Icahn School of Medicine at Mount Sinai Mount Sinai Medical Center, New York 10029, USA
| | - Per-Olof Nylander
- Linköping University, Department of Clinical and Experimental Medicine, Psychiatry Section, Linkoping, Sweden
| | - Ina Marteinsdottir
- Linköping University, Department of Clinical and Experimental Medicine, Psychiatry Section, Linkoping, Sweden
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Pedras S, Carvalho R, Pereira MG. A predictive model of anxiety and depression symptoms after a lower limb amputation. Disabil Health J 2017; 11:79-85. [PMID: 28395911 DOI: 10.1016/j.dhjo.2017.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/15/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model. OBJECTIVE This study focused on the characterization of anxiety and depression levels, before and after surgery, differences in levels of depression and anxiety before and after surgery and the predictors of anxiety and depression one month after surgery, in a sample of patients with DFU. METHODS This was a longitudinal study with 179 patients with Diabetes Mellitus Type 2 and DFU indicated for amputation, screened for the presence of anxiety and depression symptoms during the hospitalization that preceded amputation and one month after surgery, during a follow-up consultation. RESULTS The results showed a significant effect of anxiety and depression symptoms at pre-surgery in the prediction of anxiety and depression symptoms one month after LLA. Patients showed higher levels of anxiety than depression symptoms at pre-surgery, although anxiety significantly decreased on month after surgery. Both anxiety and depression symptoms contributed to depression after LLA, although anxiety at pre-surgery was the only predictor of anxiety at post-surgery. CONCLUSIONS Tailored multidisciplinary interventions need to be developed providing support before and after an amputation surgery, in order to reduce anxiety and depression symptoms and promote psychological adjustment to limb loss.
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Affiliation(s)
- Susana Pedras
- School of Psychology, Applied Psychology Department, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
| | - Rui Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - M Graça Pereira
- School of Psychology, Applied Psychology Department, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
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Kim JH, Chang SM, Bae JN, Cho SJ, Lee JY, Kim BS, Cho MJ. Mental-Physical Comorbidity in Korean Adults: Results from a Nationwide General Population Survey in Korea. Psychiatry Investig 2016; 13:496-503. [PMID: 27757127 PMCID: PMC5067343 DOI: 10.4306/pi.2016.13.5.496] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aims of this study were to estimate the prevalence of mental-physical comorbidity and health-threatening risk factors in subjects with mental disorders, and the risks of mental disorders in those with physical diseases for the last 12 months in the general Korean population. METHODS Korean Epidemiologic Catchment Area study replication (KECA-R) was conducted for 6,510 adults between August 2006 and April 2007. The Korean version of Composite International Diagnostic Interview 2.1 (K-CIDI) was used in the survey. Prevalence of mental and physical disorders, and risk factors for physical health were calculated, and their associations were evaluated with adjustment for age and sex. RESULTS Subjects with any mental disorder showed significantly higher prevalence of chronic physical conditions (adjusted odds ratio, AOR=1.5 to 2.8, p<0.001) and medical risk factors including smoking, heavy drinking, overweight, and hypertension (AOR=1.5 to 4.0, p<0.001). Of those with chronic physical conditions, 21.6% had one or more comorbid mental disorder compared with 10.5% of the subjects without chronic physical disorders (AOR=2.6, p<0.001). Contrary to expectations, depressive disorders did not show significant association with hypertension and prevalence of obesity was not influenced by presence of mental disorders. Further studies should assess these findings. CONCLUSION This is the first identification of significant mental-physical comorbidity in the general Korean population. Clinicians and health care officials should keep in mind of its potential adverse effects on treatment outcome and aggravated disease-related socioeconomic burden.
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Affiliation(s)
- Ji-Hyun Kim
- Department of Psychiatry, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Sung Man Chang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Nam Bae
- Department of Psychiatry, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry and Behavioral Science, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul Metropolitan Boramae Medical Center, Seoul, Republic of Korea
| | - Byung-Soo Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Maeng Je Cho
- Department of Psychiatry and Behavioral Science, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Hsu YC, Hsu CC, Chang KH, Lee CY, Chong LW, Wang YC, Kao CH. Increased Subsequent Risk of Peptic Ulcer Diseases in Patients With Bipolar Disorders. Medicine (Baltimore) 2015; 94:e1203. [PMID: 26200637 PMCID: PMC4602988 DOI: 10.1097/md.0000000000001203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Previous studies have reported that patients with bipolar disorders (BDs) exhibit increased physical comorbidity and psychological distress. Studies have shown that schizophrenia and anxiety increase the risk of peptic ulcer diseases (PUDs). Therefore, we conducted this study to determine the association between these 2 diseases and examine the possible risk factors. We used patients diagnosed with BDs from the Taiwan National Health Insurance Research Database. A comparison cohort comprising patients without BDs was frequency matched by age, sex, and comorbidities, and the occurrence of PUDs was evaluated in both the cohorts. The BD and non-BD cohort consisted of 21,060 patients with BDs and 84,240 frequency-matched patients without BDs, respectively. The incidence of PUDs (hazard ratio, 1.51; 95% confidence interval, 1.43-1.59; P < 0.001) was higher among the patients with BDs than the control patients. Cox models showed that irrespective of comorbidities, BDs were an independent risk factor for PUDs. Patients with BDs exhibit a substantially higher risk for developing PUDs. According to our data, we suggest that, following a diagnosis of BD, practitioners could notice the occurrence of PUD and associated prevention. Further prospective clinical studies investigating the relationship between BDs and PUDs are warranted.
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Affiliation(s)
- Yi-Chao Hsu
- From the Department of Psychiatry (C-CH), Kaohsiung Veterans General Hospital, Kaohsiung; Institute of Biomedical Sciences (Y-CH), Mackay Medical College, Taipei; Department of Medical Research (K-HC), Taichung Veterans General Hospital, Taichung; School of Chinese Medicine for Post-Baccalaureate (C-YL), I-Shou University, Kaohsiung; Division of Hepatology and Gastroenterology (L-WC), Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei; Management Office for Health Data (Y-CW), China Medical University Hospital, Taichung; College of Medicine (Y-CW), China Medical University, Taichung; Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung; Graduate Institute of Clinical Medical Science and School of Medicine (C-HK), College of Medicine, China Medical University, Taichung, Taiwan
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