title: Risk of psychiatric disorders following gastroesophageal reflux disease: a nationwide population-based cohort study.
abstract: BACKGROUND
  Recent studies have shown that the peripheral inflammation may cause the up-regulation of central nervous system inflammation and therefore possibly plays a vital role in the pathophysiology of subsequent psychiatric disorders.
  
  
  OBJECTIVE
  We explored the relationship between gastroesophageal reflux disease (GERD) and the subsequent development of psychiatric disorders including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.
  
  
  METHODS
  We investigated patients who were diagnosed with GERD according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised patients without GERD who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on the diagnoses of psychiatrists.
  
  
  RESULTS
  The GERD cohort consisted of 3813 patients, and the comparison cohort comprised 15,252 matched control patients without GERD. The risks of depressive disorder (HR=3.37, 95% confidence interval [CI]=2.49-4.57), anxiety disorder (HR=2.99, 95% CI=2.12-4.22), and sleep disorder (HR=2.69, 95% CI=1.83-3.94), were higher in the GERD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive, anxiety, and sleep disorders remained significantly increased in all of the stratified follow-up durations (0-1, ≥1year).
  
  
  CONCLUSIONS
  GERD may increase the risks of subsequent depressive, anxiety, and sleep disorders. These psychiatric disorders have a negative effect on people's quality of life. Clinicians should pay a particular attention to psychiatric comorbidities in GERD patients.
authors.affiliation: Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Chia-Yi Branch, Chia-Yi, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Zi-Hong
authors.initials: ZH
authors.lastname: You
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Perng
authors.affiliation: Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Hu
authors.affiliation: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ti
authors.initials: T
authors.lastname: Lu
authors.affiliation: Department of Psychiatry, Yuanshan & Su'ao Branch, Taipei Veterans General Hospital, Yilan, Taiwan.
authors.forename: Pan-Ming
authors.initials: PM
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Yang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Tsai
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Shin
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. Electronic address: trickleman@gmail.com.
authors.forename: Hon-Jhe
authors.initials: HJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D016208:Databases, Factual; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000523:psychology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
keywords: Anxiety disorder; Depression disorder; Gastroesophageal reflux disease; Psychiatric disorders; Sleep disorder