The Prevalence and Factors Associated With Depression and Anxiety Among Patients on Follow-up for Peptic Ulcer Disease at the Gastroenterology Clinic in Kenyatta National Hospital

Abstract

Background Peptic ulcer disease affects approximately 4 million people annually worldwide with an estimated lifetime prevalence of 5-10% in the general population. Psychological factors are great contributors in the occurrence of peptic ulcer disease through both short- and long-term effects on gastrointestinal function through autonomic disruption. From several studies done worldwide among peptic ulcer disease patients, depression and anxiety have been shown to have an impact on disease causation, disease severity, chronicity of the disease, disease recurrence, reduced remission durations, complications and reduction in overall quality of life. Identification and treatment of depression and anxiety early reduces the magnitude of disability. Data on the prevalence of depression and anxiety in peptic ulcer disease in our local setting is lacking. Objectives The main objective of this study was to determine the prevalence and factors associated with depression and anxiety among patients on follow up for peptic ulcer disease attending the gastroenterology clinic at Kenyatta National Teaching and Referral Hospital. Methodology Study Design: This was a cross sectional study Setting: The Gastroenterology clinic in Kenyatta National Hospital. Participants and methods: 285 patients with physician diagnosed peptic ulcer disease aged 18 and above on follow up at the clinic were recruited. Data was collected using a sociodemographic questionnaire, a Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7 item (GAD-7). Data Processing Statistical Analysis was done using Statistical Package for Social Sciences (SPSS) version 26. Frequency distribution charts and percentages were used in categorical data analysis. Means and standard deviation were computed for continuous variables. For multivariate analysis, logistic regression was used to determine association between depression, anxiety, sociodemographic characteristics and PUD. The resulting findings were then conveyed as odds ratios with their accompanying confidence intervals of 95% with a p value of less than 0.05 being significant. Data was then presented in pie charts, bar charts, frequency tables and written reports.

Results. This study recruited 285 patients. The mean age of the patients was 47.9 years (SD 15.3) with the youngest being 18 years and the oldest 96 years. Majority of the participants were female (60.0%), had college / university level of education, were married (54.4%), and were employed (59.3%). On how long they have lived with peptic ulcer disease, slightly more than half of them had lived with the disease for a duration of between 1.0 to 5.0 years (52.6%). (53%) of the participants reported some drug use with alcohol accounting for (97.4%). The prevalence of depression in PUD was found to be at 22.1% and that of anxiety in PUD was 7.7%. For those with depression in PUD, the majority were between 25-50 years, female, had a university or college education, were married, employed, reported some drug use and had had PUD between 1-5 years. For those with anxiety in PUD, the majority were greater than 50 years, female, married, unemployed, had had a college or university education, reported some drug use and had had PUD for 1-5 years. Conclusion The prevalence of depression is relatively high among patients with Peptic Ulcer disease at KNH gastroenterology clinic and this is similar to statistics reported in similar settings. This is however not the case for Generalized anxiety disorder among the same patients. In light of this strong positive correlation between depression and peptic ulcer disease simple screening tools like the PHQ9 should be administered. There is also need of involving a multidisciplinary team in management of PUD patients for holistic patient care. This could include the primary physicians, nutritionists, psychologists and psychiatrists