Population-attributable fraction of psychiatric and physical disorders for suicide among older adults in Taiwan.

BACKGROUND: This study aimed to estimate the population-attributable fraction (PAF) of psychiatric and physical disorders for suicide among older adults, focusing on sex- and age-specific factors. METHODS: Data from Taiwan's National Health Insurance Research Data and National Death Registry included 9136 cases of suicide in individuals aged 65+, with 89,439 matched controls. Physical and psychiatric disorders were identified through diagnostic records. Conditional logistic regression assessed risk factors, and PAF was calculated using disorder prevalence and adjusted odds ratios. RESULTS: Major suicide risk factors among older adults were depressive disorders, anxiety disorders, and sleep disorders. Physical disorders like hypertension, peptic ulcers, and cancer also showed significant PAF values. The combined PAF of physical disorders equaled that of psychiatric disorders. Psychiatric disorders had a greater impact on women and the youngest-old adults, while physical disorders had a higher contribution among men, middle-old adults, and oldest-old adults. LIMITATIONS: Relying solely on claim data to identify psychiatric and physical disorders may underestimate their prevalence and associations with suicide due to unrecorded cases of individuals not seeking help and the absence of key risk factors like social isolation and family support. CONCLUSIONS: This study identifies preventable or treatable risk factors for older adult suicide, emphasizing the need to target specific psychiatric and physical disorders in suicide prevention efforts while taking into account sex- and age-specific considerations. It also underscores the importance of establishing social welfare support systems to address the unique challenges older adults face.

Clinical outcomes, medical costs, and medication usage patterns of different somatic symptom disorders and functional somatic syndromes: a population-based study in Taiwan.

BACKGROUND: Somatic symptom disorders (SSD) and functional somatic syndromes (FSS) are often regarded as similar diagnostic constructs; however, whether they exhibit similar clinical outcomes, medical costs, and medication usage patterns has not been examined in nationwide data. Therefore, this study focused on analyzing SSD and four types of FSS (fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, functional dyspepsia). METHODS: This population-based matched cohort study utilized Taiwan's National Health Insurance (NHI) claims database to investigate the impact of SSD/FSS. The study included 2 615 477 newly diagnosed patients with SSD/FSS and matched comparisons from the NHI beneficiary registry. Healthcare utilization, mortality, medical expenditure, and medication usage were assessed as outcome measures. Statistical analysis involved Cox regression models for hazard ratios, generalized linear models for comparing differences, and adjustment for covariates. RESULTS: All SSD/FSS showed significantly higher adjusted hazard ratios for psychiatric hospitalization and all-cause hospitalization compared to the control group. All SSD/FSS exhibited significantly higher adjusted hazard ratios for suicide, and SSD was particularly high. All-cause mortality was significantly higher in all SSD/FSS. Medical costs were significantly higher for all SSD/FSS compared to controls. The usage duration of all psychiatric medications and analgesics was significantly higher in SSD/FSS compared to the control group. CONCLUSION: All SSD/FSS shared similar clinical outcomes and medical costs. The high hazard ratio for suicide in SSD deserves clinical attention.

Effect of tibolone vs hormone replacement therapy on climacteric symptoms and psychological distress.

BACKGROUND: The objective was to elucidate the effect of tibolone vs hormone replacement therapy (HRT) on climacteric symptoms and psychological distress. METHODS: All consecutive women with climacteric symptoms were allocated to receive tibolone (2.5 mg) or estradiol valerate (1 mg) plus medroxyprogesterone acetate (2.5 mg). RESULTS: The improvement in "feeling dizzy or faint" after tibolone treatment was more prominent than that after HRT (-0.7 ± 0.8 vs -0.0 ± 0.9, p = 0.004). In addition, other climacteric symptoms, including anxiety, depression, somatic symptoms, and vasomotor symptoms, and sexual function improved after tibolone and HRT, but there were no between-group differences. Psychological distress assessment demonstrated that somatic complaints, obsessive-compulsive symptoms, depressive symptoms, hostility, additional symptoms, and the General Symptom Index improved after tibolone treatment and HRT, but there were no between-group differences. Personality traits assessment revealed that neuroticism improved after tibolone treatment. CONCLUSION: Tibolone seems more beneficial than HRT in treating symptoms of dizziness and faintness. Both tibolone and HRT could improve psychological distress.

Associations between antenatal education program and mental health outcomes in Taiwan: A population-based cohort study.

Universal antenatal education has been offered to expectant mothers in Taiwan since 2014. Depression screening is included in the offered education sessions. This study aimed to examine the association of antennal education and depression screening with mental health outcomes, including perinatal depression diagnosis and psychiatrist visits. Data was obtained from the antenatal education records and Taiwan's National Health Insurance claims database. A total of 789,763 eligible pregnant women were included in the current study. The psychiatric-related outcomes were measured between antenatal education and the six-month after delivery. It was found that the antenatal education was widely used in Taiwan, and the attendance rate has increased to 82.6% since its launch. The attenders were more likely to be from disadvantaged backgrounds, and 5.3% of them were screened positive for depressive symptoms. They were also more likely to visit a psychiatrist but less likely to be diagnosed with depression than the non-attenders. Factors including young age, high healthcare utilization, and comorbid psychiatric disorder history were consistently associated with depression symptoms, perinatal depression diagnoses and psychiatrist visits. Further research is needed to understand the reasons for the nonattendance at antenatal education programmes and the barriers to utilizing mental health services.

The psychological features of distinct somatic syndromes: A cluster analysis according to population-based somatic symptom profiles in Taiwan.

BACKGROUND: Functional somatic syndromes (such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome) are often comorbid. Whether these syndromes are distinct constructs and whether they have different psychological features are interesting questions. We perform a cluster analysis based on a nationwide survey in Taiwan to answer these questions. METHODS: A score of at least 5 on the Patient Health Questionnaire-15 (PHQ-15, measuring somatic symptoms) indicated somatic syndromes and the data of 550 subjects were included. According to the gastrointestinal, pain-fatigue and cardiovascular subdimension scores of the PHQ-15, we performed a two-step cluster analysis. The demographic data and the cluster scores of the Health Anxiety Questionnaire and the Patient Health Questionnaire-4 (measuring depression and anxiety) were compared. Multinomial logistic and multiple linear regression analyses were used to clarify the associations between clusters/somatic symptoms and demographics/psychological features. RESULTS: Four clusters were generated and named according to their somatic features: "high gastrointestinal symptoms", "high pain-fatigue and comorbid somatic symptoms", "middle to high pain-fatigue symptoms" and "high cardiovascular symptoms". The high pain-fatigue and comorbid somatic symptom cluster had the highest levels of extent to which symptoms interfere with a person's life, depression and anxiety. The high cardiovascular symptom cluster was featured by high excessive worry over health and illness and low educational level. The high gastrointestinal symptom cluster had relatively low psychopathologies. CONCLUSION: The results of this population-based analysis supported the existence of distinct somatic syndromes that are not parts of a single whole somatic syndrome and have different psychological features.

Ten-year trends in depression care in Taiwan.

BACKGROUND/PURPOSE: The number of psychiatrists working in community clinics in Taiwan has increased dramatically in the recent decade. This study aimed to investigate the trend of prevalence and incidence of depressive disorders and assess the quality of depression care between 2007 and 2016 in Taiwan. METHODS: We used the claims database derived from Taiwan's National Health Insurance (NHI) program, in which approximately 23.0 million individuals were enrolled, translating to a coverage rate of 99%. Patients with depressive disorders were identified based on International Classification of Diseases codes. The process indicators of depression care quality included visit, duration, and dose adequacy. The outcome indicators included the rate of psychiatric hospitalisation, emergency visit, self-harm hospitalisation, and suicide. RESULTS: The prevalence of treated depressive disorders increased from 1.61% in 2007 to 1.92% in 2016, i.e., a 25% increase, whereas the incidence of first-ever or recurrent depressive disorder did not change significantly. The number of patients treated by psychiatrists and in community clinics also increased. The quality of depression care improved, the proportion of patients receiving minimum psychiatric clinic follow-up and adequate medication increased, and the rate of emergency visits, psychiatric hospitalisation, and self-harm hospitalisation declined. CONCLUSION: The community-based psychiatric services increased and the quality indicators of depression care in Taiwan improved during 2007-2016. The causality warrants further investigations.

Occupational and Non-occupational Injuries Can Result in Prolonged Augmentation of Psychiatric Disorders.

BACKGROUND: The long-term effects of occupational injury (OI) on psychiatric diseases are unclear. This study assessed and compared the effects of OI, no injury (control), and non-OI (NOI) on the development of psychiatric diseases. METHODS: We used Taiwan's National Health Insurance Research Database to investigate the incidence of psychiatric disorders in OI, NOI, and control groups. The subjects were aged 20-50 years, actively employed in 2000, and did not have history of injury or psychiatric disorders. All subjects were followed from 2000 and were classified into OI, NOI, and control groups according to occurrence of target injury later on. Individuals in each group were matched by age, sex, insurance premium before the index date, and year of the index date. Psychiatric disease-free days were compared among the groups using survival analysis and Cox regression. RESULTS: We included a total of 12,528 patients for final analysis, with 4,176 in each group. Compared with the control group, the OI group had an increased occurrence of trauma and stress-related disorder, depressive disorders, anxiety disorders, and alcohol and other substance dependence. These increases were similar to those in the NOI group. Elevated cumulative incidence rate of any psychiatric disorders was observed among those with OI or NOI up to 10 years after injury. CONCLUSION: We confirmed that OI and NOI induced psychiatric disorders. These findings highlight the need for workers' compensation mechanisms to consider long-term psychological care among injured workers.

Comparison of cystatin C-based and creatinine-based glomerular filtration rate in the prediction of postoperative residual hypertension in aldosterone-producing adenoma patients after adrenalectomy.

Renal function is associated with postoperative residual hypertension in aldosterone-producing adenoma(APA) patients. Cystatin C-based glomerular filtration rate (GFR) can more accurately estimate renal function than creatinine-based methods. However, which renal function estimation method can more accurately predict postoperative hypertension in APA patients is still unknown. We recruited 180 APA patients who underwent adrenalectomy. Preoperative creatinine and cystatin C-based GFRs were calculated. Residual hypertension was defined as persistent hypertension > 140/90 mmHg or requiring anti-hypertensive medications 1 year after surgery. Sixty-five(36.1%) of the 180 APA patients had residual hypertension. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis showed a combination of creatinine and cystatin method CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-cystatin GFR was significantly associated with residual postoperative hypertension and had the largest area under the ROC curve, which was statistically larger than that of Cockcroft-Gault creatinine-based GFR. In both net reclassification index and integrated discrimination index models, CKD-EPI creatinine-cystatin GFR significantly improved the discriminatory power of CG-GFR. Among these renal function estimations used in the presented study, creatinine-cystatin combined GFR was a precise method to predict residual postoperative hypertension in APA patients received adrenalectomy. These finding may help identify those patients with higher risk of residual hypertension after operation.

Length of stay in relation to the risk of inpatient and post-discharge suicides: A national health insurance claim data study.

BACKGROUND: This study aimed to compare the predictors of suicides among psychiatric inpatients and recently discharged patients and to examine the association between the length of stay and suicides. METHODS: Data from psychiatric inpatients were extracted from the National Health Insurance databank and merged with information from the Cause of Death data using unique identification numbers. Poisson regression analyses were used to estimate the incidence rate ratio for inpatient and post-discharge suicides, which included the variables of sex, age, psychiatric diagnosis, and number of admissions in the preceding year. The associations between length of stay and inpatient and post-discharge suicide were examined using multivariate Poisson regression analyses that were adjusted for these variables. RESULTS: A diagnosis of affective disorders and a higher number of previous admissions increased both inpatient and post-discharge suicides. Patients older than 15-24 years had a significantly lower inpatient suicide risk but were more likely to die by suicide post-discharge. The risk of suicide both during the inpatient stay and post-discharge statistically significantly decreased when the length of stay was longer. LIMITATIONS: As there were variations in societal, environmental, and facility-level factors that might have influenced the association between length of stay and suicide, the generalization of our findings to different settings may be impeded. CONCLUSIONS: This study provides additional evidence that hospitalization helps to reduce the suicide risk. It suggests that medical professionals should be alert to inpatient suicide and that they should determine the optimal length of stay considering post-discharge suicide.

Targeted treatment of primary aldosteronism - The consensus of Taiwan Society of Aldosteronism.

BACKGROUND/PURPOSE: Even with the increasing recognition of primary aldosteronism (PA) as a cause of refractory hypertension and an issue of public health, the consensus of its optimal surgical or medical treatment in Taiwan has not been reached. Our objective was to develop a clinical practice guideline that is feasible for real-world management of PA patients in Taiwan. METHODS: The Taiwan Society of Aldosteronism (TSA) Task Force recognized the above-mentioned issues and reached this Taiwan PA consensus at its inaugural meeting, in order to provide updated information of internationally acceptable standards, and also to incorporate our local disease characteristics and constraints into PA management. RESULTS: In patients with lateralized PA, including aldosterone producing adenoma (APA), laparoscopic adrenalectomy is the 'gold standard' of treatment. Mini-laparoscopic and laparoendoscopic single-site approaches are feasible only in highly experienced surgeons. Patients with bilateral adrenal hyperplasia or those not suitable for surgery should be treated by mineralocorticoid receptor antagonists. The outcome data of PA patient management from the literature, especially from PA patients in Taiwan, are reviewed. Mental health screening is helpful in early detection and management of psychopathology among PA patients. CONCLUSION: We hope this consensus will provide a guideline to help medical professionals to manage PA patients in Taiwan to achieve a better quality of care.

Suicide deaths among patients with end-stage renal disease receiving dialysis: A population-based retrospective cohort study of 64,000 patients in Taiwan.

BACKGROUND: Patients with end-stage renal disease (ESRD) who receive dialysis may experience increased distress and risk of suicide. METHODS: This population-based retrospective cohort study linked Taiwan's national register of ESRD patients on dialysis and the cause-of-death mortality data file. A separate multiple-cause-of-death data file was used to investigate the detailed suicide methods used. Standardized mortality ratios (SMRs) were calculated for the overall patient group and by sex, age, year of initiating dialysis, method of suicide, and time since initiation of dialysis. RESULTS: Among 63,854 ESRD patients on dialysis, 133 died by suicide in Taiwan in 2006-2012; the suicide rate was 76.3 per 100,000 patient-years. The SMR for suicide was 2.38 (95% confidence interval [CI] 1.99-2.82) in this patient group. Suicide risk was highest in the first year of dialysis (SMR = 3.15, 95% CI 2.39-4.08). The risk of suicide by cutting was nearly 20 times (SMR = 19.91, 95% CI 12.88-29.39) that of the general population. Detailed information on death certificates indicated that three quarters of patients who killed themselves by cutting cut vascular accesses used for hemodialysis. LIMITATIONS: Information on risk factors such as socioeconomic position and mental disorders was unavailable. CONCLUSION: In a country where the national health insurance program covers most expenses associated with dialysis treatment, the suicide risk in ESRD patients on dialysis still increased nearly 140%. Adequate support for ESRD patients initiating dialysis and the assessment of risk of cutting vascular access as a potential means of suicide could be important strategies for suicide prevention.

Impact of universal health coverage on suicide risk in newly diagnosed cancer patients: Population-based cohort study from 1985 to 2007 in Taiwan.

BACKGROUND: National Health Insurance (NHI), launched in 1995 in Taiwan, lightens patient's financial burdens but its effect on the suicide risk in cancer patients is unclear. We aimed to investigate the impacts of the NHI on the suicide in newly diagnosed cancer patients. METHODS: We identified patients with newly diagnosed cancer from the nationwide Taiwan Cancer Registration from 1985 to 2007, and ascertained suicide deaths from the national database of registered deaths between 1985 and 2009. Standardized mortality ratio (SMR) of suicide risk among patients with cancer was calculated, and the suicide risk ratios were examined by gender, age group, and prognosis. RESULTS: For the 916 337 registered cancer patients with 4 300 953 person-years, 2 543 died by suicide, with a suicide rate of 59.1 per 100 000 person-years. Compared to the general population, cancer patients had an SMR of 2.47 for suicide, with a higher figure for males (2.73), age 45 to 64 (2.89), and cancer of poor prognosis (3.19). The suicide risk was highest in the first 2 years after the initial diagnosis. Comparing the cohorts of the period before (1985 to 1992) and after (1996 to 2007) the launch of NHI, we saw a reduction in the SMR within the first 2 years after cancer diagnosis (20%), with more prominent reduction for females (29%), age under 45 (69%), and cancer of good prognosis (33%). CONCLUSIONS: A universal health coverage relieving both physical and psychological distress may account for the post-NHI reduction of immediate suicide risk in patients of newly diagnosed cancer.

Predictive validity of a five-item symptom checklist to screen psychiatric morbidity and suicide ideation in general population and psychiatric settings.

BACKGROUND/PURPOSE: Suicide is a major concern in public health worldwide. Early identification of individuals at risk is critical for suicide prevention. The present study revised the 5-item Brief Symptom Rating Scale (BSRS-5) to a checklist format (BSRS-5R) and validated the BSRS-5R into a screening tool for psychiatric morbidity and suicide ideation in the general public. METHODS: The study participants consisted of two subsets of sample from community residents and psychiatric patients. The community subjects were recruited from stratified proportional randomization sampling in a nationwide community survey, while the psychiatric patients were from psychiatric outpatient service and psychiatric daycare unit in a teaching hospital in northern Taiwan. All participants responded to the questionnaire investigating the BSRS-5, personal experience with suicide, and demographic information. RESULTS: In total, 2147 community respondents and 700 respondents from psychiatric settings completed the survey questions. The BSRS-5R was highly correlated to BSRS-5 with good internal consistency in our study sample. For the community subjects, receiver operating characteristic curve analysis revealed an optimal cutoff of 2/3 for BSRS-5R to discriminate psychiatric morbidity or suicide ideation. The BSRS-5R could also identify psychiatric morbidity in psychiatric outpatients and daycare patients. In addition, the cutoff of 4/5 for BSRS-5R to determine suicide ideation yielded moderately good predictive validity in psychiatric outpatients and in daycare patients. CONCLUSION: The BSRS-5R was validated as an efficient checklist to screen for psychiatric morbidity and suicide ideation in the general public. The result is valuable in translating into general medical and community settings for early detection of suicide ideation.

Sertraline alleviated osmophobia caused by partial hypopituitarism with isolated ACTH deficiency.

OBJECTIVE: Hyperosmia may be an early manifestation of hypocortisolism and may be mistakenly diagnosed as osmophobia. However, sertraline therapy incidentally alleviated the phobic symptoms and hindered accurate diagnosis. CASE REPORT: A 41-year-old man was diagnosed as having osmophobia. Initial sertraline treatment relieved the symptoms, but its cessation resulted in recurrence of osmophobia. Endocrinological examinations revealed severe hypocortisolism and partial hypopituitarism with isolated adrenocorticotropic hormone deficiency. After prednisolone supplementation, his condition dramatically improved. CONCLUSION: We recommend that, before intervention with selective serotonin reuptake inhibitors is performed, the hypothalamic-pituitary-adrenal axis be evaluated in psychiatric patients presenting with co-occurring olfactory change.

Factors of early suicide after discharge: a national linkage study for suicide victims in Taiwan.

Patients recently discharged from psychiatric inpatient care have a higher suicide rate. The study aimed to identify the characteristics associated with early suicide of those patients discharged from psychiatric wards in Taiwan. The results indicated that among 672 suicide victims who died within one year post-discharge from psychiatric wards in Taiwan between 2000 and 2004, diagnosis of schizophrenia, shorter disease duration, and co-morbidity with cancer were all significantly associated with suicide occurring within one month of discharge. Clinical diagnosis of psychiatric disorders, recent psychiatric diagnosis, and co-morbidity with severe physical illnesses should receive special monitoring for potential suicide after discharge.

Acoustic neuroma identified after electroconvulsive therapy in a patient with recurrent major depression and undifferentiated somatoform disorder.

Little is known about the safety of electroconvulsive therapy (ECT) in patients with brain tumors, especially in patients with acoustic neuroma, which is difficult to diagnose early. For patients with somatoform disorder, physicians may alter the sensitivity to the somatic complaints, making it even more difficult to make an early diagnosis of "silent" brain tumors. This report describes a rare case involving treatment of refractory major depression and somatoform disorder that developed into increased intracranial pressure after ECT, possibly due to an undiagnosed acoustic neuroma. It is suggested that for patients with refractory major depression with somatoform disorders, the threshold of suspicion for silent tumors should be lowered and pre-ECT brain imaging study should be performed, specifically when the pattern of symptoms of the central nervous system-related somatoform syndrome changes.

Prevalence of suicidal ideation and associated risk factors in the general population.

BACKGROUND/PURPOSE: Suicide is an important public health problem and one of the leading causes of death worldwide. The present study investigated the prevalence of suicidal ideation (SI) and its associated risk factors in the general population. METHODS: A nationwide community survey was conducted using a computer-aided telephone interview system with residents aged >or= 15 years, who were selected by a stratified, proportional randomization method. The questionnaire comprised demographic variables, five items of psychopathology selected from the Brief Symptom Rating Scale (BSRS-5) and questions about personal experience with suicide. In total, 2054 respondents, 1002 male (48.8%), and 1052 female (51.2%), completed the survey. RESULTS: The weighted prevalence of SI was 2.84% in the past week, 5.50% in the past year, and 18.49% during a lifetime. Significant risk factors for SI in the last week included presence of SI over the past year [odds ratio (OR) =1763.6], SI during the lifetime (OR =267.6), psychiatric morbidity (OR = 30.3), depression (OR =26.1), inferiority (OR =11.2), hostility (OR = 10.9), anxiety (OR = 10.5), insomnia (OR =6.7), history of seeking help for psychological distress (OR = 7.9), divorce (OR =6.4), unemployment (OR = 5.0) and having suicidal behavior in relatives or friends (OR =3.8). Stepwise multiple regression analysis demonstrated that the five symptom items of BSRS-5 and unemployment significantly predicted 25.3% of the variance of SI. Using the BSRS-5 score 3 or 4 as a cut-off to predict SI, the rate of accurate classification was 85.88%, with sensitivity of 0.83 and specificity of 0.86. CONCLUSION: A telephone interview survey containing the BSRS-5 items is an efficient way to identify determinants of SI in the general population.

Absent response to niacin skin patch is specific to schizophrenia and independent of smoking.

This study investigated the differences in niacin skin flush responses between patients with schizophrenia, bipolar mania, and normal controls. We applied niacin patches of three concentrations (0.001 M, 0.01 M, and 0.1 M) to the skin of 61 patients with schizophrenia, 18 patients with bipolar mania, and 40 normal controls for 5 min. Flush responses were rated at 5, 10 and 15 min after application. Flush responses were significantly different among three groups at the concentrations of 0.1 M and 0.01 M at all of the three rating time points. The use of nicotine did not have significant influences on the flush responses. Absent response was significantly more prevalent in the schizophrenia group than in the other two groups, but was not significantly different between the bipolar and the control group. The greatest degree of differentiation in flush responses among groups occurred at the 0.01 M concentration, and the rating time point of 10 min with 49.2% of schizophrenic patients but only 7.5% of controls and 11.1% of bipolar patients not showing a flush response. The niacin skin test for schizophrenia had 49.2% sensitivity and 92.5% specificity compared with controls. This study found that absent response to niacin skin patch was specific to schizophrenia and independent of smoking status.

Comparative analysis between psychological and endoscopic profiles in patients with gastroesophageal reflux disease: a prospective study based on screening endoscopy.

BACKGROUND: Associations between psychological and endoscopic profiles are not clearly validated among the heterogeneous patients with gastroesophageal reflux disease (GERD). The purpose of the present paper was therefore to identify any associations by means of cross-sectional study. METHODS: Consecutive participants in a health screening program were enrolled. Definition and severity of erosive esophagitis were assessed with Los Angeles classification. Frequency and severity of psychological symptoms were measured with a 30-item Brief Symptom Rating Scale (BSRS) and personality traits with a short form of the Maudsley Personality Inventory (MPI). Statistic analyses were performed based on the presence of GERD symptoms or endoscopic esophagitis. RESULTS: A total of 4600 participants were recruited. There were 1331 subjects (29%) with manifestations suggesting GERD, including non-erosive reflux disease (NERD) in 488 (10.6%), symptomatic erosive esophagitis (SEE) in 164 (3.6%), and asymptomatic erosive esophagitis (AEE) in 679 (14.8%). The BSRS parameters were significantly higher in symptomatic subjects (i.e. NERD and SEE subjects; P < 0.001); neuroticism scores were also higher (P < 0.001), but extroversion scores (P < 0.001) were lower than those of asymptomatic subjects. Following logistic regression analysis, independent risk factors for GERD symptoms were female gender (odds ratio [OR]: 1.596; 95% confidence interval [CI]: 1.303-1.955) and higher neuroticism scores (OR: 1.046; 95%CI: 1.032-1.06). For erosive esophagitis, independent risk factors were male gender (OR: 2.943; 95%CI: 2.359-3.671) and higher body mass index scores (OR: 1.098; 95%CI: 1.069-1.127). CONCLUSIONS: Psychological characteristics predict likelihood of GERD symptoms but not structural state of esophagus. Male gender and obesity are risk factors for erosive esophagitis; whereas female gender and neuroticism are more likely to be associated with GERD symptoms.