Psychosocial profile in men and women with unexplained chest pain

Abstract

Abstract. Jerlock M, Kjellgren KI, Gaston-Johansson F, Lissner L, Manhem K, Rosengren A, Welin C (Institute of Health and Care Sciences; Johns Hopkins University; the Sahlgrenska Academy; Sahlgrenska University Hospital ⁄ Ö stra, Gothenburg; Sweden). Psychosocial profile in men and women with unexplained chest pain. J Intern Med 2008; 264: 265-274.Objective. The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL).Design and subjects. The study was conducted at a university hospital in Sweden including 231 patients aged 25-69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study.Results. Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36.Conclusions. In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women.

Complaints of neurotic patients that are of interest for a cardiologist

“…An analysis of the reported life events and circumstances indicates an association of cardiac pain with abandonment experience in childhood and perhaps with the fear of separation (sometimes considered to be associated with panic anxiety), and also with parent hostility or lack of partner support in the adult life, as also indicated by study findings of other authors [2,3]. Palpitations in women seem to be more strongly associated with current relationship status and the history of its development, either early or dysfunctionally motivated (which also suggests associations with separation issues, family problems and symbols of sexual desire), while in men these associations mostly include financial situation and power and competition issues (these findings are also in agreement with the cited literature data [16,17]). In both genders, pain in the heart area was associated with disturbed communication, either anger inhibition in conflict situations ("quiet days"), similarly to observations by Alvarenga et al [6], or quarrels.…”

“…It also useful for non-psychiatrist physicians to associate patient personal events and circumstances with symptoms (e.g., [14,15]). Among patients with non-cardiac chest pain, immigrant status, work problems (in men) and problems with home/family relations (in women) are reported two to three times more frequently compared to other patients [16,17].…”

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

“…[20][21][22][23][24][25] However, in patients where there is a relation between NCCP and depressive symptoms, the direction of causality between NCCP and depressive symptoms is far from clear as to whether depressive symptoms are the cause or consequence of the chest pain. Furthermore, the impact of depressive 5 symptoms on health-care utilization in patients with NCCP is unknown since research in this area is limited.…”

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

“…Patients with NCCP have been shown to experience similar levels of psychological distress (20,52) or higher levels than cardiac patients (53)(54)(55). Psychological distress includes fear, anxiety, depression, uncertainty, mental strain at work, stress, loss of strength (47,49,(54)(55)(56), as well as sleep problems and negative life events (serious illness or death of a close relative) (49,57). The uncertainty and stress could partly be due to different explanations of the chest pain by different doctors or no adequate explanation at all (47,58).…”

“…NCCP negatively influences patients' quality of life and everyday life (35,(47)(48)(49), including interruption of daily activities and absence from work (6). Compared to other patients with chronic pain, such as AP, fibromyalgia and whiplash injury, patients with NCCP and fibromyalgia have the most impaired quality of life, particularly in the pain and mental dimensions (31).…”