The association between psychological status and the development of early gastric cancer from atrophic gastritis

This study aimed to explore whether there may be a potential link between psychological factors and the occurrence of early-stage gastric cancer (EGC) among individuals diagnosed with atrophic gastritis (AG). A total of 258 individuals receiving care in the Department of Gastroenterology at The Affiliated Hospital of Xuzhou Medical University between March 2020 and November 2024 were included in this cross-sectional observational study, including 173 patients diagnosed with AG and 85 with EGC. Diagnostic confirmation was based on findings from both endoscopic procedures and histological examinations. Psychological well-being was evaluated through the application of the Kessler psychological distress scale (K6) alongside the Center for epidemiologic studies depression scale (CES-D). At the time of enrollment, clinical profiles, demographic characteristics, and laboratory indices were recorded. Comparative analyses were conducted between groups, and both univariate and multivariable logistic regression models were employed to examine potential factors associated with EGC. What's more, receiver operating characteristic (ROC) curve analysis was utilized to explore the discriminative capacity of psychological assessments. Compared to the AG group, patients with EGC exhibited significantly higher K6 (10.36 ± 5.54 vs 5.82 ± 5.25, P < .001) and CES-D scores (12.99 ± 7.70 vs 9.01 ± 7.27, P < .001), with a greater proportion exceeding clinical cutoffs (K6 ≥ 13: 30.59% vs 12.72%; CES-D ≥ 16: 41.18% vs 21.39%). Multivariate logistic regression identified Helicobacter pylori infection (OR = 3.960, P = .003), concave-type lesion morphology (OR = 107.086, P < .001), K6 score (OR = 1.192, P < .001), and CES-D score (OR = 1.097, P = .001) as independent predictors of progression from AG to EGC. ROC analysis demonstrated moderate predictive value for the K6 (AUC = 0.729) and CES-D (AUC = 0.652) scores individually, with improved discriminative ability when combined (AUC = 0.763). Among individuals with AG, psychological distress and depressive tendencies showed a potential association with early-stage gastric malignancy. While not conclusive, these observations imply that incorporating mental health screening tools, such as the K6 and CES-D scales, could offer supplementary value in the broader context of evaluating patients who might carry an increased likelihood of disease progression.