To determine the prevalence of anxiety and depression in patients of functional dyspepsia
presenting to Jinnah Hospital, Lahore. In addition to that we will find the association of functional dyspepsia
with demographic features in our studied population.
This descriptive cross-sectional study was carried out at department of Medicine, Jinnah Hospital
Lahore from 18-11-2017 to 17-05-2018. Demographic information and duration of disease etc. was obtained.
Hospital Anxiety and Depression Scale (HADS) score was calculated for each patient. Single-blind was
applied to reduce bias. Data was entered in SPSS version 20. Effect modifiers and confounders were controlled
through stratification. Chi Square test was applied by taking p ≤0.05.
Among total of 260 patients, male were 53.8% (n=140). The minimum age was 30 years and
maximum age was 80 years with mean and standard deviation of 54.50 ± 15.19 years. The minimum duration
was 3 months and maximum were 24 months with mean and standard deviation of 12.92 ± 6.15 months. 30.8%
(n=80) patients belong to lower class, 35%(n=91) patients belong to middle class and 34.2%(n=89) patients
belong to high class. There were 87/260 (33.5%) illiterate patients, 93/260 (35.8%) patients having matric
while 80/260 (30.8%) patients were graduate. Anxiety was present in 134/260 (51.5%) patients while
depression in 125/260 (48.1%) patients. Presence of anxiety had no significant association with demographic
features with p-values of each as >0.05.
Anxiety and depression were prevalent among patients suffering functional dyspepsia. Age,
gender, socioeconomic status, educational status, and duration of functional dyspepsia has no association with
the occurrence of anxiety and depression in in the studied population.
Dyspepsia1 is a usual symptom with a vast differential diagnosis and a diverse pathophysiology. On an average, 25% of the population suffer every year,2 however majority people do not seek medical attention.3 About twenty five percent of dyspepsia sufferers have an organic etiology at base.4 However, up to 75% have functional dyspepsia who have no underlying secondary cause on diagnostic assessment. Functional dyspepsia5 is one of the most prevailing gastrointestinal ailments with prevalence up to 40%6,7 and annual incidence of 1% to 6%.8 The most classic dyspeptic complaints comprise early satiation, postprandial fullness, epigastric pain, and bloating in upper abdomen, often associated with some more issues like nausea, epigastric burning or belching.9 Psychological distractions such as anxiety, and depression along with lifestyle characteristics have been seen to accomplished with the emergence of this mysterious disease.10-12 Rome III criteria13,14 defines the functional dyspepsia as the presence of one or more of these clinical features: early satiation, postprandial fullness, epigastric burning or pain, and no evidence of anatomical disease to describe the symptoms. These criteria should be present since last 3 months with complaints starting at least 6 months before diagnosis. A diagnosis of functional dyspepsia can only be fixed by the exclusion of other etiofactors of dyspepsia.15 A history, physical evaluation, and laboratory testing are the first steps in the assessment of a patient with new onset of dyspepsia.16 Functional dyspepsia is prevalent in our society; however, research protocols are scarce on our people. Therefore, the focus of the present study was to determine the prevalence of anxiety and depression in patients of functional dyspepsia presenting to Jinnah Hospital, Lahore. In addition to that we will find the association of functional dyspepsia with demographic features in our studied population.
This descriptive cross-sectional study17 was carried out at department of Medicine, Jinnah Hospital Lahore (JHL) from 18-11-2017 to 17-05-2018. Keeping margin of error of 6% and confidence interval of 95%, a sample size of 260 patients was required taking expected population of functional dyspepsia with depression as 42.3%.18 Data was collected after approval from Medical Ethics Committee of Allama Iqbal Medical College, JHL. Non-probability consecutive sampling technique was used. After taking the informed consent, patients of functional dyspepsia as per operational definition having age range between 30 to 80 years. Patients with organic lesions in the stomach and duodenum revealed by endoscopic examinations, patients with history of any abdominal/gastrointestinal surgery, history of smoking or alcoholism, patients with alarming symptoms (weight loss, dysphagia, or maelena), pregnant or breastfeeding women and patients ongoing psychological treatment were excluded from this study. Rome III Criteria was used to define functional dyspepsia.13,14 Anxiety19 was defined as a score greater than 7 according to Hospital Anxiety and Depression Scale. Depression19 was defined as a score greater than 7 according to Hospital Anxiety and Depression Scale. Demographic information e.g. age, sex, address, educational status, socioeconomic status, duration of disease etc. was obtained. Hospital Anxiety and Depression Scale (HADS) score was calculated for each patient. Single-blind was utilized to minimize the bias. The outcomes were recorded in predesigned questionnaire. Data was entered in SPSS version 20. Mean and standard deviation was calculated for quantitative variables (age of patients, and duration of disease were the continuous variables, for which means, and standard deviations were computed, whereas sex of patients, socioeconomic status, educational status, presence of anxiety and presence of depression were noted. Frequencies and percentages were determined for those. Effect modifiers and confounders (age, sex, duration of disease, socioeconomic and educational status) were controlled through stratification. Chi Square test was applied by taking p ≤ 0.05.
A total of 260 patients were included in this study having minimum age of 30 years and maximum age was 80 years with mean age of 54.50 ± 15.19 years. The minimum duration was 3 months and maximum were 24 months with mean of 12.92 ± 6.15 months (Table 1). Male patients were predominant (53.8%) while female patients were 120/260 (46.2%). Socio-economic status revealed that 80/260 (30.8%) patients belong to lower class, 91/260 (35%) patients belong to middle class and 89/260 (34.2%) patients belong to high class.
There were 87/260 (33.5%) illiterate patients, 93/260 (35.8%) patients having matric while 80/260 (30.8%) patients were graduate or above. Anxiety was present in 134/260 (51.5%) patients while it was absent in 126/260 (48.5%) patients. Depression was present in 125/260 (48.1%) patients while it was absent in 135/260 (51.9%) patients (Table 2). By using chi-square test it was notified that there was insignificant difference among age group and presence of anxiety having p-value = 0.707. Similarly, age group and presence of depression also have insignificant difference (p-value = 0.808). Similarly an insignificant difference was shown for association of gender with presence of anxiety (p-value 0.479) and depression (p-value 0.939). There was insignificant association between using socioeconomic status and presence of anxiety having (p-value = 0.835) and depression (p-value = 0.876). There was no significant statistical relationship between educational status with presence of anxiety (p-value = 0.204) and depression (p-value = 0.230). The duration of ailment had no statistically valuable connection with the presence of anxiety (p-value = 0.092) as well as the presence of depression (p-value = 0.143) (Table 3&4).
Table.1
| Minimum | Maximum | Mean | Std. Deviation | |
| Age (years) | 30 | 80 | 54.50 | 15.19 |
| Duration (months) | 3 | 24 | 12.92 | 6.15 |
| Qualitative variables | Frequency | Percent |
| • Gender • Male • Female | 140 120 | 53.8 46.2 |
| • Socioeconomic status • Lower class • Middle class • High Class | 80 91 89 | 30.8 35 34.2 |
| • Educational status • Illiterate • Matric • Graduate | 87 93 80 | 33.5 35.8 30.8 |
| • Presence of anxiety • Present • Absent | 134 126 | 51.5 48.5 |
| • Presence of depression • Present • Absent | 125 135 | 48.1 51.9 |
| Factors | Anxiety | Total N=260 | p-value | |
| Present (n=134) | Absent (n=126) | |||
| Gender: Male Female | 75 (55.9%) 59 (44.1%) | 65 (51.6%) 61 (48.4%) | 140 (53.8%) 120 (46.2%) | 0.479 |
| Age 55 years | 68 (50.7%) 66 (49.3%) | 61 (48.4%) 65 (51.6%) | 129 (49.6%) 131 (50.4%) | 0.707 |
| Socioeconomic status: Lower class Middle class High class | 39 (29.1%) 48 (35.8%) 47 (35.1%) | 41 (32.6%) 43 (34.1%) 42 (33.3%) | 80 (30.8%) 91 (35.0%) 89 (34.2%) | 0.835 |
| Educational status: Illiterate Matric Graduate | 45 (33.6%) 42 (31.3%) 47 (35.1%) | 42 (33.3%) 51 (40.5%) 33 (26.2%) | 87 (33.5%) 93 (35.7%) 80 (30.8%) | 0.204 |
| Duration of Illness: 12 months | 51 (38.1%) 83 (61.9%) | 61 (48.4%) 65 (51.6%) | 112 (43.1%) 148 (56.9%) | 0.092 |
*Chi-square test was utilized
Anxiety and depression were prevalent among patients suffering functional dyspepsia. Age, gender, socioeconomic status, educational status, and duration of functional dyspepsia has no association with the occurrence of anxiety and depression in in the studied population.
| Factors | Depression | Total N=260 | p-value | |
| Present (n=125) | Absent (n=135) | |||
| Gender: Male Female | 67 (53.6%) 58 (46.4%) | 73 (54.1%) 62 (45.9%) | 140 (53.8%) 120 (46.2%) | 0.939 |
| Age 55 years | 63 (50.4%) 62 (49.6%) | 66 (48.8%) 69 (51.2%) | 129 (49.6%) 131 (50.4%) | 0.808 |
| Socioeconomic status: Lower class Middle class High class | 40 (32.0%) 44 (35.2%) 41 (32.8%) | 40 (29.6%) 47 (34.8%) 48 (35.6%) | 80 (30.8%) 91 (35.0%) 89 (34.2%) | 0.876 |
| Educational status: Illiterate Matric Graduate | 42 (33.6%) 39 (31.2%) 44 (35.2%) | 45 (33.4%) 54 (40.0%) 36 (26.6%) | 87 (33.5%) 93 (35.7%) 80 (30.8%) | 0.230 |
| Duration of Illness: 12 months | 48 (38.4%) 77 (61.6%) | 64 (47.4%) 71 (52.6%) | 112 (43.1%) 148 (56.9%) | 0.143 |
*Chi-square test was utilized
The objective of the present research was to determine prevalence of anxiety and depression in patients of functional dyspepsia presenting to Jinnah Hospital, Lahore. In this regard the present descriptive cross-sectional study was carried out at the department of Medicine, Jinnah Hospital Lahore. So, two hundred and sixty patients of functional dyspepsia were included by fulfilling the inclusion and exclusion criteria by using nonprobability consecutive sampling. From 260 patients, it was observed that the minimum age was found 30 years and maximum age was 80 years with mean and standard deviation of the age was 54.50 ± 15.19 years. The minimum duration was 3 months and maximum was 24 months with mean and standard deviation 12.92 ± 6.15 months. Male patients were 53.8% while female patients were 46.2%. 30.8% patients belong to lower class, 35% patients belong to middle class and 34.2% patients belong to high class. There were 33.5% illiterate patients, 35.8% patients having matric, while 30.8% patients were graduate. Anxiety was present in 51.5% patients while it was absent in 48.5% patients. Depression was present in 48.1% patients while it was absent in 51.9% patients. In a vast research work,18 similar results to our work were found. 50.4% functional dyspeptic candidates had anxiety, whereas depression was detected in 42.3% patients. At the same time, healthy control members were found to be having depression and anxiety about 6.67% and 13.34% respectively. In another large study comprising 465 patients who filled questionnaire, 204 cases underwent upper gastrointestinal endoscopy. The prevalence rate of the age-adjusted dyspepsia was 31.9%, and it would reduce to 15.7% if concomitant acid regurgitation or heart burn are excluded. The dyspeptic patients had significantly higher chance for the presence of smoking habit, usage of NSAIDs, history to ingest antacids for symptom relief, and past history to a physician for the disease (p<0.05) than cases without dyspepsia.20 Majority of the patients who underwent endoscopic examination were found to be suffering functional dyspepsia (64.5%). The age accustomed prevalence of functional dyspepsia was 29.2% (95% CI: 21.8-36.4). In multiple regression series on dyspepsia patients, functional dyspepsia was found to be associated with older age. Other than old age, no predictor was significantly linked with functional dyspepsia.21 In our study, the results were in concordance to available literature, where there was no significant linkage between age group and presence of anxiety having p-value = 0.707. Similarly, age group and presence of depression have no statistically important link (p-value = 0.808). Significant association was not found between gender and presence of anxiety with p-value 0.479. In the same way, gender had no significant relation with the presence of depression (p-value 0.939). In a Korean study by Sung Eun Kim et al.23 53.5% (917 out of 1714) of dyspeptic patients were female. The prevalence of functional dyspepsia was 10.3%. However, our study majority dyspeptic patients were male (53.9%). In another large study comprising 839 cases,22 mean age was 49.5
Anxiety and depression were prevalent among patients suffering functional dyspepsia. Age, gender, socioeconomic status, educational status, and duration of functional dyspepsia has no association with the occurrence of anxiety and depression in in the studied population.
None