PREDICTORS OF DEPRESSION IN PATIENTS PRESENTING WITH DYSPEPTIC SYMPTOMS IN A GI CLINIC
AbstractBackground: The association between dyspepsia, H. pylori and psychological distress has remained atopic of intense debate over the past several decades. In Pakistan, where depression is highly prevalentand dyspepsia is possibly present in a high percentage of population, little data exist about thesecommon health problems. This study was conducted to determine the frequency and predictors ofdepression among patients presenting with dyspeptic symptoms in the Gastrointestinal (GI) Clinic of atertiary care hospital in Pakistan. Methods: Two hundred and sixty-nine consecutive patients wereenrolled in the study based on their presenting symptoms in the GI clinic at Shifa International Hospital,Islamabad. Subjects with prior history of peptic ulcer disease (PUD), gallstones and HCV infectionswere excluded from the study. Demographic and socioeconomic variables as well as dyspepticsymptoms and important causes of dyspeptic symptoms were recorded. Depression was analysed basedon the Urdu version of Beck’s Depression Inventory-II (BDI-II). The data were analysed using SPSS-10 for univariate and multivariate analyses. Results: Mild depression was associated with lowereducation status (p<0.001), lesser income (p<0.018), and lower socioeconomic status (p<0.009) as wellas rural residence (p<0.026). Smoking, alcohol-use, H. pylori infection, gender and dyspepsia were notfound to have any association with depression. On multivariate analysis, education and income groupremained significantly associated with mild depression. Clinically significant depression was found tobe associated with lower education and rural residence. Conclusion: Depression among dyspepticpatients was found to be associated with socioeconomic status rather than dyspeptic symptoms orimportant risk factors associated with dyspeptic symptoms.Keywords: Depression, H. pylori, dyspeptic symptoms, education, income
Muhammad Gadit, AA, Mugford G. Prevalence of depression
among households in three capital cities of Pakistan: need to
revise the mental health policy. PLoS ONE 2007;2(2):e209.
Gadit A, Khalid N. State of Mental health in Pakistan: service
education and research. Karachi Pakistan: Hamdard Foundation;
Simren, M, Tack J. Functional dyspepsia: evaluation and
treatment. Gastroenterol Clin North Am 2003;32(2):577–99.
Pajala M, Heikkinen M, Hintikka J. A prospective 1-year followup study in patients with functional or organic dyspepsia: changes
in gastrointestinal symptoms, mental distress and fear of serious
illness. Aliment Pharmacol Ther 2006;24(8):1241–6.
Quartero AO, Post MW, Numans ME, de Melker RA, de Wit NJ.
What makes the dyspeptic patient feel ill? A cross sectional
survey of functional health status, Helicobacter pylori infection,
and psychological distress in dyspeptic patients in general
practice. Gut 1999;45(1):15–9.
Choudhuri G, Mohindra S. Epidemiology of Helicobacter pylori
in India. Indian J Gastroenterol 2000;19(Suppl 1):S3–5,
Quartero AO, Numans ME, Post MW, de Melker RA, de Wit NJ.
One-year prognosis of primary care dyspepsia: predictive value
of symptom pattern, Helicobacter pylori and GP management.
Eur J Gastroenterol Hepatol 2002;14(1):55–60.
Shah SS, Bhatia SJ, Mistry FP. Epidemiology of dyspepsia in the
general population in Mumbai. Indian J Gastroenterol
Beck AT, Steer RA, Brown GK. Manual for the Beck Depression
Inventory-II. Psychological corporation: San Antonio, TX:
Psychological Corporation; 1996.
Steer RA, Ball R, Ranieri WF, Beck AT. Dimensions of the Beck
Depression Inventory-II in Clinically Depressed Outpatients. J
Clin Psychology 1999;55(1):117–28.
Alansari BM. Gender difference in depression among
undergraduates from seventeen Islamic countries. Social Behav
Alansari BM. Beck Depression Inventory (BDI-II) items
characteristics among undergraduate students of nineteen Islamic
countries. Social Behavior Personality 2005;33(7):675–84.
Price AB. The Sydney System: histological division. J
Gastroenterol Hepatol 1991;6(3):209–22.
Mirza I, Jenkins R. Risk factors, prevalence, and treatment of
anxiety and depressive disorders in Pakistan: systematic review.
Saeed K, Gater R, Hussain A, Mubbashar M. The prevalence,
classification and treatment of mental disorders among
attenders of native faith healers in rural Pakistan. Soc
Psychiatry Psychiatr Epidemiol 2000;35:480–5.
Budavari AI, Olden KW. Psychosocial aspects of functional
gastrointestinal disorders. Gastroenterol Clin North Am