title: Psychosocial factors and their association with reflux oesophagitis, Barrett's oesophagus and oesophageal adenocarcinoma.
abstract: OBJECTIVE
  To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma (OAC), as well as the reflux-mediated precursor pathway.
  
  
  METHODS
  An all-Ireland population-based case-control study recruited 230 reflux oesophagitis (RO), 224 Barrett's oesophagus (BO) and 227 OAC patients and 260 controls. Each case/control group completed measures of stress, depression, self-efficacy, self-esteem, repression and social support. A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.
  
  
  RESULTS
  Compared to controls, OAC patients were almost half as likely to report high stress levels over their lifetime (P = 0.010, OR 0.51; 95%CI: 0.29-0.90) and 36% less likely to report having experienced depression (OR 0.64; 95%CI: 0.42-0.98). RO patients reported significantly higher stress than controls particularly during middle- and senior-years (P for trends < 0.001). RO patients were 37% less likely to report having been highly emotionally repressed (OR 0.63; 95%CI: 0.41-0.95). All case groups (OAC, RO and BO) were more likely than controls to report having had substantial amounts of social support (OR 2.84; 95%CI: 1.63-4.97; OR 1.97; 95%CI: 1.13-3.44 and OR 1.83; 95%CI: 1.03-3.24, respectively).
  
  
  CONCLUSIONS
  The improved psychological profile of OAC patients may be explained by response shift. The role of psychological factors in the development of OAC requires further investigation.
authors.affiliation: Centre for Public Health, Queen's University Belfast, Belfast BT12 6BJ, Northern Ireland, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Denver
authors.forename: Michael
authors.initials: M
authors.lastname: Donnelly
authors.forename: Liam J
authors.initials: LJ
authors.lastname: Murray
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Anderson
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000523:psychology*; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology / Q000523:psychology*; D016009:Chi-Square Distribution; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000523:psychology*; D004942:Esophagitis, Peptic / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012094:Repression, Psychology; D012189:Retrospective Studies; D012307:Risk Factors; D012649:Self Concept; D020377:Self Efficacy; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology
keywords: Adjustment; Barrett’s oesophagus; Oesophageal adenocarcinoma; Psychological; Psychosocial factors; Reflux oesophagitis
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