PREVALENCE OF ANXIETY AND DEPRESSION IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE: A CASE–CONTROL STUDY

*Ahmad Alkheder MD., Mohammad Ebrahim MD

ABSTRACT

Background: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder with increasing recognition of its psychosocial associations. Anxiety and depression have been reported more frequently in GERD patients compared to the general population, but few studies have systematically assessed this relationship using validated psychiatric tools while excluding comorbidities. Methods: We conducted a cross-sectional, case–control study at two public hospitals in Damascus, Syria, between May 2024 and May 2025. Adults with GERD were diagnosed clinically or endoscopically and matched 1:1 with healthy controls. Participants with chronic medical or psychiatric comorbidities were excluded. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), with clinically significant symptoms defined as scores ≥10. Poor mental health was defined as PHQ-9 ≥10 and/or GAD-7 ≥10. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated using logistic regression. Results: A total of 200 participants were enrolled (100 GERD, 100 controls). The mean age was 32 ± 10 years, and 52% were female. Compared with controls, GERD patients had a higher prevalence of depression (34.4% vs. 16.8%; OR 2.52, 95% CI 1.80–3.54; aOR 2.35, 95% CI 1.60–3.45), anxiety (19.2% vs. 7.6%; OR 3.12, 95% CI 2.02–4.80; aOR 2.84, 95% CI 1.80–4.47), and poor mental health (45.2% vs. 20.8%; OR 2.94, 95% CI 2.10–4.13; aOR 2.68, 95% CI 1.90–3.81) (all p<0.001). A severity gradient was observed, with moderate-to-severe GERD patients showing the highest PHQ-9 and GAD-7 scores. Reflux severity correlated positively with depression (r=0.34, p<0.001) and anxiety (r=0.29, p<0.001). Conclusion: GERD is independently associated with significantly increased prevalence of depression and anxiety. The severity of reflux correlates with psychological symptom burden, suggesting a dose–response relationship. These findings underscore the importance of incorporating routine mental health screening and multidisciplinary care into the management of GERD.

Keywords: Gastroesophageal reflux disease, anxiety, depression, PHQ-9, GAD-7, psychosomatic, mental health.