Psychosocial and Behavioral Risk Factors of Peptic Ulcer Disease: A Case-Control Study

Background: Peptic ulcer disease (PUD) is influenced by physiological, psychological, and lifestyle factors. While H. pylori infection and NSAID use are known etiologies, the impact of stress, depression, and unhealthy habits remains underexplored. This study evaluated the association of stress and depression with PUD in Sindh. Method: This case-control study included 278 participants (139 cases, 139 controls). Data were collected through patient history and validated surveys. Stress was assessed using the Perceived Stress Scale (PSS), depression via the Patient Health Questionnaire-9 (PHQ-9), smoking exposure through pack-years, and alcohol dependence using the Alcohol Use Disorders Identification Test (AUDIT). Statistical analyses, including t-tests and chi-square tests, were performed to determine significant associations between PUD and various risk factors. Results: The mean age was 43 ± 8.3 years, with cases being significantly older than controls (p=0.001). Depression was more prevalent in PUD cases (p=0.001), with 57.9% reporting moderate-to-severe symptoms. High stress (≥27 on PSS) was significantly associated with PUD (p<0.001). PUD cases had greater smoking history (12.7 ± 5.7 vs. 7.2 ± 4.1 pack-years, p=0.001) and alcohol use (p=0.001). NSAID use increased PUD risk (p<0.001). Urban residency (p=0.001), sedentary lifestyle (p=0.001), and poor sleep (p=0.001) were significantly associated with PUD. Stress correlated with alcohol use (r=0.46), smoking (r=0.49), and poor sleep (r=0.61). Conclusions: Stress, depression, and unhealthy behaviors significantly contribute to PUD risk. Addressing these modifiable factors through stress management and lifestyle interventions may reduce disease burden. Further studies are needed to validate these findings in larger populations.