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Published in: The Patient - Patient-Centered Outcomes Research 1/2016

01-02-2016 | Original Research Article

Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study

Authors: Ghassan Mourad, Anna Strömberg, Peter Johansson, Tiny Jaarsma

Published in: The Patient - Patient-Centered Outcomes Research | Issue 1/2016

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Abstract

Background

Patients with non-cardiac chest pain (NCCP) suffer from recurrent chest pain and make substantial use of healthcare resources.

Objective

To explore the prevalence of depressive symptoms, cardiac anxiety, and fear of body sensations in patients discharged with a NCCP diagnosis; and to describe how depressive symptoms, cardiac anxiety, and fear of body sensations are related to each other and to healthcare-seeking behavior.

Methods

Cross-sectional design. Data were collected between late October 2013 and early January 2014 in 552 patients with NCCP from four hospitals in southeast Sweden, using the Patient Health Questionnaire-9, Cardiac Anxiety Questionnaire, and Body Sensations Questionnaire.

Results

About 26 % (n = 141) of the study participants reported at least moderate depressive symptoms, 42 % (n = 229) reported at least moderate cardiac anxiety, and 62 % (n = 337) reported some degree of fear of body sensations. We found strong positive relationships between depressive symptoms and cardiac anxiety (r s = 0.49; P < 0.01), depressive symptoms and fear of body sensations (r s = 0.50; P < 0.01), and cardiac anxiety and fear of body sensations (r s = 0.56; P < 0.01). About 60 % of the participants sought care because of chest pain once, 26 % two or three times, and the rest more than three times. In a multivariable regression analysis, and after adjustment for multimorbidity, cardiac anxiety was the only variable independently associated with healthcare-seeking behavior.

Conclusion

Patients with NCCP and many healthcare consultations had high levels of depressive symptoms and cardiac anxiety, and moderate levels of fear of body sensations. Cardiac anxiety had the strongest relationship with healthcare-seeking behavior and may therefore be an important target for intervention to alleviate suffering and to reduce healthcare use and costs.
Literature
1.
go back to reference Eslick GD. Classification, natural history, epidemiology, and risk factors of noncardiac chest pain. Dis Mon. 2008;54:593–603.PubMedCrossRef Eslick GD. Classification, natural history, epidemiology, and risk factors of noncardiac chest pain. Dis Mon. 2008;54:593–603.PubMedCrossRef
2.
go back to reference Eslick GD, Talley NJ. Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities. Aliment Pharmacol Ther. 2004;20:909–15.PubMedCrossRef Eslick GD, Talley NJ. Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities. Aliment Pharmacol Ther. 2004;20:909–15.PubMedCrossRef
3.
4.
go back to reference Ruddox V, Mathisen M, Otterstad JE. Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome—a systematic literature search. BMC Med 2012;10:58. doi:10.1186/1741-7015-10-58. Ruddox V, Mathisen M, Otterstad JE. Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome—a systematic literature search. BMC Med 2012;10:58. doi:10.​1186/​1741-7015-10-58.
6.
go back to reference Webster R, Norman P, Goodacre S, et al. The prevalence and correlates of psychological outcomes in patients with acute non-cardiac chest pain: a systematic review. Emerg Med J. 2012;29:267–73.PubMedCrossRef Webster R, Norman P, Goodacre S, et al. The prevalence and correlates of psychological outcomes in patients with acute non-cardiac chest pain: a systematic review. Emerg Med J. 2012;29:267–73.PubMedCrossRef
7.
go back to reference Reid S, Wessely S, Crayford T, et al. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. BMJ. 2001;322:767.PubMedPubMedCentralCrossRef Reid S, Wessely S, Crayford T, et al. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. BMJ. 2001;322:767.PubMedPubMedCentralCrossRef
9.
go back to reference Eifert GH, Hodson SE, Tracey DR, et al. Heart-focused anxiety, illness beliefs, and behavioral impairment: comparing healthy heart-anxious patients with cardiac and surgical inpatients. J Behav Med. 1996;19:385–99.PubMedCrossRef Eifert GH, Hodson SE, Tracey DR, et al. Heart-focused anxiety, illness beliefs, and behavioral impairment: comparing healthy heart-anxious patients with cardiac and surgical inpatients. J Behav Med. 1996;19:385–99.PubMedCrossRef
10.
go back to reference Klimes I, Mayou RA, Pearce MJ, et al. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med. 1990;20:605–11.PubMedCrossRef Klimes I, Mayou RA, Pearce MJ, et al. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med. 1990;20:605–11.PubMedCrossRef
11.
go back to reference Esler JL, Bock BC. Psychological treatments for noncardiac chest pain: recommendations for a new approach. J Psychosom Res. 2004;56:263–9.PubMedCrossRef Esler JL, Bock BC. Psychological treatments for noncardiac chest pain: recommendations for a new approach. J Psychosom Res. 2004;56:263–9.PubMedCrossRef
12.
go back to reference Fagring AJ, Lappas G, Kjellgren KI, et al. Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987–2006 from the Swedish hospital and death registries. Heart. 2010;96:1043–9.PubMedCrossRef Fagring AJ, Lappas G, Kjellgren KI, et al. Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987–2006 from the Swedish hospital and death registries. Heart. 2010;96:1043–9.PubMedCrossRef
13.
go back to reference Leise MD, Locke GR 3rd, Dierkhising RA, et al. Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: cardiac outcomes and health care utilization. Mayo Clin Proc. 2010;85:323–30.PubMedPubMedCentralCrossRef Leise MD, Locke GR 3rd, Dierkhising RA, et al. Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: cardiac outcomes and health care utilization. Mayo Clin Proc. 2010;85:323–30.PubMedPubMedCentralCrossRef
14.
go back to reference Eslick GD. Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain. Dis Mon. 2008;54:604–12.PubMedCrossRef Eslick GD. Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain. Dis Mon. 2008;54:604–12.PubMedCrossRef
15.
go back to reference Mourad G, Jaarsma T, Hallert C, et al. Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease. Heart Lung. 2012;41:446–55.PubMedCrossRef Mourad G, Jaarsma T, Hallert C, et al. Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease. Heart Lung. 2012;41:446–55.PubMedCrossRef
16.
go back to reference Eslick GD, Coulshed DS, Talley NJ. Review article: the burden of illness of non-cardiac chest pain. Aliment Pharmacol Ther. 2002;16:1217–23.PubMedCrossRef Eslick GD, Coulshed DS, Talley NJ. Review article: the burden of illness of non-cardiac chest pain. Aliment Pharmacol Ther. 2002;16:1217–23.PubMedCrossRef
17.
go back to reference Forberg JL, Henriksen LS, Edenbrandt L, et al. Direct hospital costs of chest pain patients attending the emergency department: a retrospective study. BMC Emerg Med. 2006;6:6.PubMedPubMedCentralCrossRef Forberg JL, Henriksen LS, Edenbrandt L, et al. Direct hospital costs of chest pain patients attending the emergency department: a retrospective study. BMC Emerg Med. 2006;6:6.PubMedPubMedCentralCrossRef
18.
go back to reference Groarke J, O’Brien J, Go G, et al. Cost burden of non-specific chest pain admissions. Ir J Med Sci. 2013;182:57–61.PubMedCrossRef Groarke J, O’Brien J, Go G, et al. Cost burden of non-specific chest pain admissions. Ir J Med Sci. 2013;182:57–61.PubMedCrossRef
19.
go back to reference Mourad G, Alwin J, Stromberg A, et al. Societal costs of non-cardiac chest pain compared with ischemic heart disease—a longitudinal study. BMC Health Serv Res 2013;13:403. doi:10.1186/1472-6963-13-403. Mourad G, Alwin J, Stromberg A, et al. Societal costs of non-cardiac chest pain compared with ischemic heart disease—a longitudinal study. BMC Health Serv Res 2013;13:403. doi:10.​1186/​1472-6963-13-403.
20.
go back to reference White KS, Raffa SD, Jakle KR, et al. Morbidity of DSM-IV axis I disorders in patients with noncardiac chest pain: psychiatric morbidity linked with increased pain and health care utilization. J Consult Clin Psychol. 2008;76:422–30.PubMedCrossRef White KS, Raffa SD, Jakle KR, et al. Morbidity of DSM-IV axis I disorders in patients with noncardiac chest pain: psychiatric morbidity linked with increased pain and health care utilization. J Consult Clin Psychol. 2008;76:422–30.PubMedCrossRef
21.
go back to reference Hadlandsmyth K, Rosenbaum DL, Craft JM, et al. Health care utilisation in patients with non-cardiac chest pain: a longitudinal analysis of chest pain, anxiety and interoceptive fear. Psychol Health. 2013;28:849–61.PubMedPubMedCentralCrossRef Hadlandsmyth K, Rosenbaum DL, Craft JM, et al. Health care utilisation in patients with non-cardiac chest pain: a longitudinal analysis of chest pain, anxiety and interoceptive fear. Psychol Health. 2013;28:849–61.PubMedPubMedCentralCrossRef
22.
go back to reference Hadlandsmyth K, White KS, Krone RJ. Quality of life in patients with non-CAD chest pain: associations to fear of pain and psychiatric disorder severity. J Clin Psychol Med Settings. 2013;20:284–93.PubMedCrossRef Hadlandsmyth K, White KS, Krone RJ. Quality of life in patients with non-CAD chest pain: associations to fear of pain and psychiatric disorder severity. J Clin Psychol Med Settings. 2013;20:284–93.PubMedCrossRef
23.
go back to reference Smeijers L, van de Pas H, Nyklicek I, et al. The independent association of anxiety with non-cardiac chest pain. Psychol Health. 2014;29:253–63.PubMedCrossRef Smeijers L, van de Pas H, Nyklicek I, et al. The independent association of anxiety with non-cardiac chest pain. Psychol Health. 2014;29:253–63.PubMedCrossRef
24.
go back to reference Webster R, Norman P, Goodacre S, et al. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department. Psychol Health 2014;29(11):1265–82. Webster R, Norman P, Goodacre S, et al. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department. Psychol Health 2014;29(11):1265–82.
25.
go back to reference Kriegsman DM, Penninx BW, van Eijk JT, et al. Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly: a study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol. 1996;49:1407–17.PubMedCrossRef Kriegsman DM, Penninx BW, van Eijk JT, et al. Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly: a study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol. 1996;49:1407–17.PubMedCrossRef
27.
go back to reference Eifert GH, Thompson RN, Zvolensky MJ, et al. The Cardiac Anxiety Questionnaire: development and preliminary validity. Behav Res Ther. 2000;38:1039–53.PubMedCrossRef Eifert GH, Thompson RN, Zvolensky MJ, et al. The Cardiac Anxiety Questionnaire: development and preliminary validity. Behav Res Ther. 2000;38:1039–53.PubMedCrossRef
29.
go back to reference Chambless DL, Caputo GC, Bright P, et al. Assessment of fear of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. J Consult Clin Psychol. 1984;52:1090–7.PubMedCrossRef Chambless DL, Caputo GC, Bright P, et al. Assessment of fear of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. J Consult Clin Psychol. 1984;52:1090–7.PubMedCrossRef
30.
go back to reference Jonsbu E, Dammen T, Morken G, et al. Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: a randomized controlled trial. J Psychosom Res. 2011;70:117–23.PubMedCrossRef Jonsbu E, Dammen T, Morken G, et al. Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: a randomized controlled trial. J Psychosom Res. 2011;70:117–23.PubMedCrossRef
31.
go back to reference Hoyer J, Eifert GH, Einsle F, et al. Heart-focused anxiety before and after cardiac surgery. J Psychosom Res. 2008;64:291–7.PubMedCrossRef Hoyer J, Eifert GH, Einsle F, et al. Heart-focused anxiety before and after cardiac surgery. J Psychosom Res. 2008;64:291–7.PubMedCrossRef
32.
go back to reference Kroenke K, Spitzer RL, Williams JB, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345–59.PubMedCrossRef Kroenke K, Spitzer RL, Williams JB, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345–59.PubMedCrossRef
33.
go back to reference Fischer D, Kindermann I, Karbach J, et al. Heart-focused anxiety in the general population. Clin Res Cardiol. 2012;101:109–16.PubMedCrossRef Fischer D, Kindermann I, Karbach J, et al. Heart-focused anxiety in the general population. Clin Res Cardiol. 2012;101:109–16.PubMedCrossRef
35.
go back to reference Ruwaard J, Broeksteeg J, Schrieken B, et al. Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: a randomized controlled trial with a three-year follow-up. J Anxiety Disord. 2010;24:387–96.PubMedCrossRef Ruwaard J, Broeksteeg J, Schrieken B, et al. Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: a randomized controlled trial with a three-year follow-up. J Anxiety Disord. 2010;24:387–96.PubMedCrossRef
36.
go back to reference Goodacre S, Mason S, Arnold J, et al. Psychologic morbidity and health-related quality of life of patients assessed in a chest pain observation unit. Ann Emerg Med. 2001;38:369–76.PubMedCrossRef Goodacre S, Mason S, Arnold J, et al. Psychologic morbidity and health-related quality of life of patients assessed in a chest pain observation unit. Ann Emerg Med. 2001;38:369–76.PubMedCrossRef
38.
go back to reference Leeuw M, Goossens ME, Linton SJ, et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30:77–94.PubMedCrossRef Leeuw M, Goossens ME, Linton SJ, et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30:77–94.PubMedCrossRef
40.
go back to reference Aikens JE, Zvolensky MJ, Eifert GH. Differential fear of cardiopulmonary sensations in emergency room noncardiac chest pain patients. J Behav Med. 2001;24:155–67.PubMedCrossRef Aikens JE, Zvolensky MJ, Eifert GH. Differential fear of cardiopulmonary sensations in emergency room noncardiac chest pain patients. J Behav Med. 2001;24:155–67.PubMedCrossRef
41.
go back to reference van Beek MH, Mingels M, Voshaar RC, et al. One-year follow up of cardiac anxiety after a myocardial infarction: a latent class analysis. J Psychosom Res. 2012;73:362–8.PubMedCrossRef van Beek MH, Mingels M, Voshaar RC, et al. One-year follow up of cardiac anxiety after a myocardial infarction: a latent class analysis. J Psychosom Res. 2012;73:362–8.PubMedCrossRef
42.
go back to reference Rosman L, Whited A, Lampert R, et al. Cardiac anxiety after sudden cardiac arrest: severity, predictors and clinical implications. Int J Cardiol. 2014;181C:73–6. Rosman L, Whited A, Lampert R, et al. Cardiac anxiety after sudden cardiac arrest: severity, predictors and clinical implications. Int J Cardiol. 2014;181C:73–6.
43.
go back to reference Husser D, Bollmann A, Kuhne C, et al. Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life. Eur J Pain. 2006;10:51–5.PubMedCrossRef Husser D, Bollmann A, Kuhne C, et al. Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life. Eur J Pain. 2006;10:51–5.PubMedCrossRef
44.
go back to reference McLeod CC, Klabunde CN, Willis GB, et al. Health care provider surveys in the United States, 2000–2010: a review. Eval Health Prof. 2013;36:106–26.PubMedCrossRef McLeod CC, Klabunde CN, Willis GB, et al. Health care provider surveys in the United States, 2000–2010: a review. Eval Health Prof. 2013;36:106–26.PubMedCrossRef
45.
go back to reference Nakash RA, Hutton JL, Jorstad-Stein EC, et al. Maximising response to postal questionnaires—a systematic review of randomised trials in health research. BMC Med Res Methodol. 2006;6:5.PubMedPubMedCentralCrossRef Nakash RA, Hutton JL, Jorstad-Stein EC, et al. Maximising response to postal questionnaires—a systematic review of randomised trials in health research. BMC Med Res Methodol. 2006;6:5.PubMedPubMedCentralCrossRef
46.
go back to reference Edwards P, Roberts I, Clarke M, et al. Methods to increase response rates to postal questionnaires. Cochrane Database Syst Rev 2007;(2):MR000008. Edwards P, Roberts I, Clarke M, et al. Methods to increase response rates to postal questionnaires. Cochrane Database Syst Rev 2007;(2):MR000008.
47.
go back to reference Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res 2009;9:160. doi:10.1186/1472-6963-9-160. Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res 2009;9:160. doi:10.​1186/​1472-6963-9-160.
Metadata
Title
Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study
Authors
Ghassan Mourad
Anna Strömberg
Peter Johansson
Tiny Jaarsma
Publication date
01-02-2016
Publisher
Springer International Publishing
Published in
The Patient - Patient-Centered Outcomes Research / Issue 1/2016
Print ISSN: 1178-1653
Electronic ISSN: 1178-1661
DOI
https://doi.org/10.1007/s40271-015-0125-0

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