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Peptic Ulcer and Mental Disorders Among Adults in the Community: The Role of Nicotine and Alcohol Use Disorders

From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York (R.D.G., K.M.K.); Department of Psychiatry, University of California San Diego, San Diego, California (M.B.S.); Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida (N.J.T).

Address correspondence and reprint requests to Renee D. Goodwin, PhD, MPH, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St., Room 1706, New York, NY 10032. E-mail: rdg66{at}columbia.edu

Objective: Previous studies have documented links between peptic ulcer disease (PUD) and mood and anxiety disorders among adults in the community. Several substance use disorders (e.g., nicotine and alcohol dependence) are highly comorbid with mood/anxiety disorders and have been also linked with PUD. No previous study has examined the potentially explanatory role of substance use disorders in the link between mood and anxiety disorders and PUD. The objective of the study is to examine relationships between a range of mental disorders and PUD among adults in the United States and to examine the potentially explanatory role of substance use disorders in these links.

Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US adults 18 years of age and over (n = 43,098). Diagnostic and Statistical Manual for Mental Disorders IV diagnoses of mood, anxiety, and substance use disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV, and PUD status was assessed via self-report.

Results: Findings show that mood/anxiety disorders were associated with PUD. Specifically, generalized anxiety disorder (GAD) (Odds ratio (OR) = 3.43) was most strongly associated with PUD, followed by panic disorder (OR = 3.11), dysthymia (OR = 3.59), and bipolar disorder (OR = 2.91). The relationships between most mood/anxiety disorders and PUD were substantially attenuated after adjusting for nicotine and alcohol dependence.

Conclusions: Mood/anxiety disorders are associated with increased rates of PUD; nicotine and alcohol dependence seems to play a substantial role in explaining the link with PUD.

Key Words: peptic ulcer • nicotine • alcohol • mental disorders • mood disorders • anxiety disorders

Abbreviations: PUD = peptic ulcer disease; NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; NIAAA = National Institute on Alcohol Abuse and Alcoholism; AUDADIS-IV = Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV; DSM-IV = Diagnostic and Statistical Manual for Mental Disorders IV; GAD = generalized anxiety disorder.