Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department

Abstract

Objective: Many patients who attend an emergency department (ED) with chest pain receive a diagnosis of non-cardiac chest pain (NCCP), and often suffer poor psychological outcomes and continued pain. This study assessed the role of illness representations in explaining psychological distress and continued chest pain in patients attending an ED. Methods: ED NCCP patients (N = 138) completed measures assessing illness representations, anxiety, depression and quality of life (QoL) at baseline, and chest pain at one month. Results: Illness representations explained significant amounts of the variance in anxiety (Adj. R² = .38), depression (Adj. R² = .18) and mental QoL (Adj. R² = .36). A belief in psychological causes had the strongest associations with outcomes. At one month, 28.7% of participants reported experiencing frequent pain, 13.2% infrequent pain and 58.1% no pain. Anxiety, depression and poor QoL, but not illness representations, were associated with continued chest pain. Conclusions: The findings suggest that (i) continued chest pain is related to psychological distress and poor QoL, (ii) interventions should be aimed at reducing psychological distress and improving QoL and (iii) given the associations between perceived psychological causes and psychological distress/QoL, NCCP patients in the ED might benefit from psychological therapies to manage their chest pain.

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

“…A possible mechanism for this can be psychological distress, although there could be physical causes that have not been detected yet. Several studies demonstrate an association between depressive symptoms, anxiety, fear of body sensations and NCCP, and highlight the negative impact these factors have on patients´ health-related quality of life, daily life, pain experience, and healthcare seeking behaviour [6,[20][21][22][23][24]. Yet, the relationship between these psychological factors in patients with NCCP is not fully elucidated.…”

Cost‐effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea

“…3,44 Moreover, qPTP might have cumulative cost reductions for patients who return for similar symptoms that are medically unexplained. 45 In the predicate trial of ED patients with chest pain and dyspnea, an astounding 31% returned to an ED within 90 days of enrollment, most for similar symptoms, without a tangible medical cause.…”

Ótilgreindir brjóstverkir og tengsl við viðvarandi verkjaupplifun og vanlíðan

“…5,9 Þessir sjúklingar búa engu að síður við minni heilsutengd lífsgaeði, 10 meðal annars vegna þess að 42-56% þeirra hafa áframhaldandi brjóstverki eftir útskrift. 11,12 Að auki er minni virkni, langvarandi lyfjanotkun, tilfinningalegt álag, fjarvera frá vinnu og tíðar endurkomur á sjúkrahús áberandi meðal þeirra. 4 Sjúklingar með ótilgreinda brjóstverki virðast hafa slakari skilning á ástandi sínu og hvernig þeir geti tekist á við brjóstverk sinn samanborið við hjartasjúklinga.…”

“…Algengi slíkra verkjaupplifana var sambaerilegt við rannsóknir með skemmri og lengri eftirfylgnitíma, 12,30 sem bendir til þess að um algengt vandamál sé að raeða sem líklega veldur sjúklingum ama og áhyggjum. Slíkur verkjavandi er sérstaklega alvarlegur þar sem áframhaldandi brjóstverkir hafa verið tengdir við verri andlega líðan meðal sjúklinga með ótilgreinda brjóst-verki.…”

“…Slíkur verkjavandi er sérstaklega alvarlegur þar sem áframhaldandi brjóstverkir hafa verið tengdir við verri andlega líðan meðal sjúklinga með ótilgreinda brjóst-verki. 12 Í þessari rannsókn voru slíkir viðvarandi verkir einmitt tengdir við meiri kvíða og þunglyndi, óháð áhrifum aldurs, kyns og tímalengdar frá útskrift. Slík tengsl fundust hins vegar ekki meðal hjartasjúklinga sem er athyglisvert í ljósi þess að ekki maeldist munur á áhyggjum af áframhaldandi verkjum milli sjúk-lingahópa.…”