Anxiety and depression were prevalent among gastroenterology outpatients, with detection rates of 26.5% and 12.2% respectively, and were significantly associated with specific gastrointestinal diagnoses and poor sleep quality.
Key Findings
Results
The overall detection rates of anxiety and depression among gastroenterology outpatients were 26.5% and 12.2%, respectively.
A total of 931 patients were included in the final analysis.
Data were collected from gastroenterology outpatients at three central hospitals from June 2021 to June 2022.
Anxiety was assessed using the Hamilton Anxiety Scale and depression using the Hamilton Depression Scale.
Data were collected via face-to-face interviews by professional researchers at each center.
Results
Poor sleep quality was the strongest risk factor associated with both anxiety and depression among gastroenterology outpatients.
Poor sleep was associated with anxiety (AOR: 5.578, 95% CI: 3.859–8.063).
Poor sleep was associated with depression (AOR: 8.572, 95% CI: 4.952–14.840).
Sleep quality was assessed using the Pittsburgh Sleep Quality Index.
Poor sleep had the highest adjusted odds ratio of all identified risk factors for both conditions.
Results
Bile reflux was significantly associated with both anxiety and depression, with particularly strong associations.
Bile reflux was associated with anxiety (AOR: 3.509, 95% CI: 2.413–5.103).
Bile reflux was associated with depression (AOR: 5.409, 95% CI: 3.190–9.173).
Bile reflux had the second strongest association with depression after poor sleep.
Results
Atrophic gastritis with intestinal metaplasia or intraepithelial neoplasia was significantly associated with anxiety.
AOR for anxiety: 3.814 (95% CI: 1.399–10.402).
This was the second strongest gastrointestinal diagnosis-related risk factor for anxiety after bile reflux.
This condition was not identified as a significant independent risk factor for depression in the multivariate analysis.
Results
Liver disease was significantly associated with both anxiety and depression.
Liver disease was associated with anxiety (AOR: 2.401, 95% CI: 1.073–5.374).
Liver disease was associated with depression (AOR: 3.177, 95% CI: 1.183–8.531).
Liver disease was one of only three factors significantly associated with both anxiety and depression, alongside bile reflux and poor sleep.
Results
Several gastrointestinal conditions were significantly associated with anxiety but not depression in multivariate analysis.
Gastroesophageal reflux was associated with anxiety (AOR: 1.559, 95% CI: 1.084–2.244).
Dyspepsia was associated with anxiety (AOR: 2.194, 95% CI: 1.302–3.696).
Biliary tract disease was associated with anxiety (AOR: 1.584, 95% CI: 1.042–2.410).
None of these three conditions reached statistical significance as independent risk factors for depression.
Results
Physical exercise time of 150 minutes or more per week was inversely associated with depression.
AOR for depression: 0.550 (95% CI: 0.324–0.934).
This was identified through multivariate logistic regression as a protective factor.
Physical exercise ≥150 min/week was the only protective factor identified for depression in the multivariate analysis.
Physical exercise was not reported as a significant independent protective factor for anxiety.
Methods
The study used a multicenter cross-sectional design with face-to-face interviews and validated psychometric scales.
The study was conducted across three central hospitals.
The Hamilton Anxiety Scale, Hamilton Depression Scale, and Pittsburgh Sleep Quality Index were used.
Univariate and multivariate logistic regression were performed to identify associated risk factors.
The study period spanned from June 2021 to June 2022.
931 patients were finally included for analysis.
What This Means
This research suggests that anxiety and depression are common among patients visiting gastroenterology clinics in China, with more than one in four patients experiencing anxiety (26.5%) and about one in eight experiencing depression (12.2%). The study surveyed 931 patients across three hospitals over one year, using established clinical rating scales to measure psychological symptoms and sleep quality. Certain digestive diseases — including bile reflux, liver disease, gastroesophageal reflux, dyspepsia, biliary tract disease, and a more advanced form of stomach lining damage (atrophic gastritis with intestinal metaplasia or intraepithelial neoplasia) — were linked to higher odds of anxiety or depression.
Poor sleep quality stood out as the strongest risk factor, being associated with more than five times the odds of anxiety and more than eight times the odds of depression. Bile reflux was also strongly linked to both conditions. On the positive side, getting at least 150 minutes of physical exercise per week was associated with lower odds of depression, suggesting a potential protective role for regular physical activity.
This research suggests that stomach and digestive problems and mental health conditions frequently co-occur, and that gastroenterologists may benefit from routinely screening their patients for anxiety and depression — particularly those with bile reflux, liver disease, or poor sleep. The findings also highlight regular physical activity as a potentially modifiable factor that could support mental well-being in this patient population.
Dong Q, Li S, Zhu X, Lin K, Li Y, Wang S, et al.. (2026). Prevalence of anxiety, depression and associated risk factors in gastroenterology outpatients: a multicenter cross-sectional study.. BMC gastroenterology. https://doi.org/10.1186/s12876-025-04590-8