Stress, coping, and depression in non-ulcer dyspepsia patients

Abstract

Thirty adults with upper gastrointestinal symptoms in the absence of structural organic disease diagnosed with non-ulcer dyspepsia (NUD) were compared to 30 healthy adults who had visited the hepatobiliary clinic for medical evaluation of non-organic complaints without NUD. Medical investigation in both groups were negative. Before independent gastrointestinal physicians conducted diagnostic evaluations, all subjects were evaluated for anxiety and depressive symptoms, stressful life events, coping style, and social support. The measures included Symptom Checklist 90-Revised (SCL-90-R), Beck Depression Inventory (BDI), Spielberger State–Trait Anxiety Inventory (STAI), Ways of Coping Checklist, and Interpersonal Support Evaluation List, and a self-report questionnaire, which measured the quantity of perceived stressful life events. The NUD patients reported significantly more symptoms of depression, more perceived stressful life events, less problem-focused coping, and less social support than the control subjects. Depressive symptoms were negatively correlated with interpersonal support, whereas, problem-focused coping was positively correlated with interpersonal support in the NUD patients. The two groups did not differ significantly in terms of anxiety and emotion-focused coping. The implications of these findings for the diagnosis and treatment of NUD are discussed.

Introduction

Non-ulcer dyspepsia (NUD), also known as functional dyspepsia or dyspepsia of unknown cause, refers to a complex of symptoms characterized by epigastric pain, early satiety, postprandial bloating, nausea with occasional regurgitation, and vomiting. These upper gastrointestinal symptoms are not associated with any demonstrable structural abnormality by standard diagnostic investigations (radiological, endoscopic, and histological) [1]. It is one of the most common clinical problems in medical outpatients, and is associated with considerable health and economic burden [2]. The diagnosis of functional upper gastrointestinal syndrome is common, but diagnostic uncertainty may lead to unnecessary tests and procedures [3].

NUD has been shown to be associated with psychological and psychiatric disturbance. Switz [4] reported that 60% of the patients in a typical gastroenterologist's practice had complaints that were primarily of psychological origin. In one study [5], 87% of patients with NUD received a psychiatric diagnosis. Patients with NUD have been shown to be more anxious, depressed, hypochondriacal, and neurotic than healthy controls [6], [7], [8], and more anxious and hostile than those with organic gastrointestinal disorders [9]. Gomez and Dally [10] reported that 22% of their NUD sample had “chronic tension” and a further 15% demonstrated “hysterical” symptoms. Magni et al. [5] reported that two-thirds of 30 consecutive NUD outpatients met DSM-III criteria for an anxiety disorder. Others have found significantly more depressive symptoms in NUD patients than in general population samples matched for age, sex, and social class [6]. Langeluddecke et al. [9] reported that 56% of NUD patients had significant depressive symptoms. In the Los Angeles Epidemiologic Catchment Area study [11], symptoms associated with NUD were among the three most common complaints of patients with an identified somatic disorder.

NUD has been considered by some to be a stress-related condition because patients with NUD reported more stressful life event in their lives and believed that stress was associated with exacerbation [12]. Two studies [13], [14] have found NUD to be associated with highly threatening or negative stressful life events, although two earlier studies failed to find differences between NUD patients and healthy controls in the frequency of stressful life events. However, stress maybe multifaceted, in which several mediating factors may either prevent or predispose one toward a pathological outcome. Of particular importance to clinicians are the psychosocial stressors and social support system that influence on coping and adjustment [15].

A few studies have compared NUD to specific functional somatic complaints. Nyren et al. [16] reported that the effect of NUD on societal resources includes the increased sick leave from work for patients with this disorder, which was reported to be 2.6 times higher than that of the control population. Lydeard and Jones [17] found that anxiety was not a significant predictor of consultation with a physician, but concerns that dyspeptic symptoms might signify a serious illness were important factors in this regard.

In the present study, we investigated general psychopathology, especially anxiety (state–trait), depression, and other factors that can mediate stress in patients with NUD to help in the development of appropriate approach, to psychiatrices diagnosis and management.