Stress, coping, and depression in non-ulcer dyspepsia patients Sang-Yeol Lee a, *, Min-Cheol Park a , Suck-Chei Choi b , Yong-Ho Nah b , Susan E. Abbey c , Gary Rodin c a Department of Psychiatry, University of Wonkwang, 144-23, Dongsan-dong, Iksan, Chonbuk 570-060, Republic of Korea b Department of Gastroenterology, University of Wonkwang, Chonbuk 570-060, Republic of Korea c Department of Psychiatry, Toronto General Hospital, Eaton Wing 8 North, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4 Received 10 March 1999; accepted 22 March 2000 Abstract Thirty adults with upper gastrointestinal symptoms in the absence of structural organic disease diagnosed with non-ulcer dyspepsia (NUD) were compared to 30 healthy adults who had visited the hepatobiliary clinic for medical evaluation of non- organic complaints without NUD. Medical investigation in both groups were negative. Before independent gastrointestinal physicians conducted diagnostic evaluations, all subjects were evaluated for anxiety and depressive symptoms, stressful life events, coping style, and social support. The measures included Symptom Checklist 90-Revised (SCL-90-R), Beck Depression Inventory (BDI), Spielberger State ± Trait Anxiety Inventory (STAI), Ways of Coping Checklist, and Interpersonal Support Evaluation List, and a self-report questionnaire, which measured the quantity of perceived stressful life events. The NUD patients reported significantly more symptoms of depression, more perceived stressful life events, less problem-focused coping, and less social support than the control subjects. Depressive symptoms were negatively correlated with interpersonal support, whereas problem-focused coping was positively correlated with interpersonal support in the NUD patients. The two groups did not differ significantly in terms of anxiety and emotion-focused coping. The implications of these findings for the diagnosis and treatment of NUD are discussed. D 2000 Elsevier Science Inc. All rights reserved. Keywords: Non-ulcer dyspepsia; Stress; Coping; Depression Introduction Non-ulcer dyspepsia (NUD), also known as functional dyspepsia or dyspepsia of unknown cause, refers to a complex of symptoms characterized by epigastric pain, early satiety, postprandial bloating, nausea with occa- sional regurgitation, and vomiting. These upper gastro- intestinal symptoms are not associated with any demonstrable structural abnormality by standard diagnos- tic investigations (radiological, endoscopic, and histologi- cal) [1]. It is one of the most common clinical problems in medical outpatients, and is associated with consider- able health and economic burden [2]. The diagnosis of functional upper gastrointestinal syndrome is common, but diagnostic uncertainty may lead to unnecessary tests and procedures [3]. NUD has been shown to be associated with psycho- logical and psychiatric disturbance. Switz [4] reported that 60% of the patients in a typical gastroenterologist's practice had complaints that were primarily of psycholo- gical origin. In one study [5], 87% of patients with NUD received a psychiatric diagnosis. Patients with NUD have been shown to be more anxious, depressed, hypochon- driacal, and neurotic than healthy controls [6±8], and more anxious and hostile than those with organic gastro- intestinal disorders [9]. Gomez and Dally [10] reported that 22% of their NUD sample had ``chronic tension'' and a further 15% demonstrated ``hysterical'' symptoms. Magni et al. [5] reported that two-thirds of 30 consecu- tive NUD outpatients met DSM-III criteria for an anxiety disorder. Others have found significantly more depressive symptoms in NUD patients than in general population samples matched for age, sex, and social class [6]. Langeluddecke et al. [9] reported that 56% of NUD patients had significant depressive symptoms. In the * Corresponding author. Tel.: 82-63-840-6106; fax: 82-63-840-6169. 0022-3999/00/$ ± see front matter D 2000 Elsevier Science Inc. All rights reserved. PII:S0022-3999(00)00148-3 Journal of Psychosomatic Research 49 (2000) 93 ± 99