Relationship between anxiety/depression and nausea: causal or associative? Reply

I thank Dr. Jagadisha for the comments on my article in General Hospital Psychiatry (GHP 24:81–86;2002) about the relationship between psychological factors and nausea. We report a strong association between nausea and anxiety and depression, but I agree that it is not possible from our findings to say anything conclusively about nausea as a causal factor for psychiatric problems. We believe that for some patients anxiety can be a result of worries about unexplained gastrointestinal complaints, while for other patients the symptoms are a part of anxiety or a depressive condition. The practical consequences for the clinician must still be to focus on anxiety and depression in patients with gastrointestinal complaints with no organic cause.

We had no possibility to rule out organic causes for nausea in our study. However, as mentioned in the article the prevalence of organic gastrointestinal conditions in the community is low (1–2%) so even if these patients had been taken into account in the analyses, it is unlikely that a contribution from them could have influenced the conclusion of the study.

About the comment on degree of nausea, both “minor” and “major” complaints were taken into account in the prevalence data. In the logistic regression analyses, only subjects with major complaints were taken into consideration.

Yours sincerely,