Hand-washing frequency, gastric histopathology, and depressive symptom burden in adults undergoing upper gastrointestinal endoscopy: a structural equation modeling study

Abstract Depressive symptoms are common among patients referred for upper gastrointestinal endoscopy, but their relation to mucosal pathology is unclear. We examined whether gastric histopathological severity links lifestyle exposures to depressive symptom burden in 442 adults undergoing endoscopy at two tertiary care hospitals in Pakistan, 320 of whom had gastric biopsies. Depressive symptom burden (five DSM-5-derived items) and gastric severity (four Updated Sydney System markers) were modeled as latent variables using structural equation modeling. An abrupt shift in patient characteristics and histology grades during recruitment was identified and adjusted for. In the primary model (CFI = 0.971; RMSEA = 0.040), less frequent hand washing was associated with higher depressive symptom burden (β = 0.23, 95% CI 0.06–0.39) but not with gastric severity (β = −0.11, 95% CI − 0.25 to 0.03). Gastric severity was not associated with symptom burden (β = 0.14, 95% CI − 0.06 to 0.35), and the indirect effect through gastric severity was null. The hand-washing association persisted in all six sensitivity analyses, whereas an apparent hand-washing–pathology association appeared only without adjustment for recruitment period. Depressive symptom burden in these patients was unrelated to mucosal pathology but tracked reduced self-care, supporting symptom screening irrespective of endoscopic findings.