title: The association between gastroesophageal reflux disease with sleep quality, depression, and anxiety in a cohort study of Australian men.
abstract: OBJECTIVE
  Previous clinical studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) with anxiety and depression; however, few population-based studies have controlled for sleep disorders. The current study aimed to assess the relationship between GERD and anxiety, depression, and sleep disorders in a community-based sample of Australian men.
  
  
  METHODS
  Participants comprised a subset of 1612 men (mean age: 60.7 years, range: 35-80) who participated in the Men Androgen Inflammation Lifestyle Environment and Stress Study during the years 2001-2012, who had complete GERD measures (Gastresophageal Reflux Disease Questionnaire), and were not taking medications known to impact gastrointestinal function (excluding drugs taken for acid-related disorders). Current depression and anxiety were defined by (i) physician diagnosis, (ii) symptoms of depression (Beck Depression Inventory and Centre for Epidemiological Studies Depression Scale) or anxiety (Generalized Anxiety Disorder-7), and/or current depressive or anxiolytic medication use. Previous depression was indicated by past depressive diagnoses/medication use. Data on sleep quality, daytime sleepiness, and obstructive sleep apnea were collected along with several health, lifestyle, and medical factors, and these were systematically evaluated in both univariate and multivariable analyses.
  
  
  RESULTS
  Overall, 13.7% (n = 221) men had clinically significant GERD symptoms. In the adjusted models, an association between GERD and anxiety (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.0-6.8) and poor sleep quality (OR 1.8; 95% CI 1.2-2.9) was observed; however, no effect was observed for current depression (OR 1.5; 95% CI 0.8-2.7). After removing poor sleep quality from the model, an independent association between current depression (OR 2.6; 95% CI 1.7-3.8) and current anxiety (OR 3.2; 95% CI 1.8-6.0) and GERD was observed, but not for previous depression (OR 1.4; 95% CI 0.7-2.8).
  
  
  CONCLUSIONS
  In this sample of urban-dwelling men, we observed a strong independent association between GERD, anxiety, and current depression, the latter appearing to be partly mediated by poor sleep quality. Patients presenting with GERD should have concurrent mental health assessments in order to identify potential confounders to the successful management of their symptoms.
authors.affiliation: Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.|Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Zhi Xiang
authors.identifier: http://orcid.org/0000-0002-4328-749X
authors.initials: ZX
authors.lastname: On
authors.affiliation: Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Grant
authors.affiliation: Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.|Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Zumin
authors.identifier: http://orcid.org/0000-0002-3099-3299
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.|Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: IMPACT SRC, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.|Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia.
authors.forename: Amie C
authors.initials: AC
authors.lastname: Hayley
authors.affiliation: Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: anxiety; depression; gastroesophageal reflux disease; sleep quality