The associations between psychological distress and health-related quality of life in patients with non-cardiac chest pain

Abstract

Background: Recurrent chest pain episodes with no clear explanation may affect patients' psychological wellbeing and health-related quality of life (HRQoL) negatively. Despite the fact that a significant amount of patients with non-cardiac chest pain (NCCP) might have a history of Cardiac Disease (CD), there is today a lack of knowledge on how CD influences the association between psychological wellbeing and HRQoL in patients with NCCP. Therefore, the aim of this study is to describe HRQoL in patients with NCCP, with or without history of CD, and to explore the association between HRQoL and cardiac anxiety, depressive symptoms, fear of body sensations and somatization. Methods: Five hundred fifty-two patients discharged with NCCP from four hospitals in Southeast Sweden completed the EQ-5D, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9, Body Sensations Questionnaire, and Patient Health Questionnaire-15. Results: Fifty precent reported at least moderate problems regarding pain/discomfort and 25% reported at least moderate problems in the HRQoL dimensions mobility, usual activities, and anxiety/depression. Patients with NCCP and history of CD reported significantly lower HRQoL (p ≤ 0.05) compared to patients with NCCP without CD. In the total study population, cardiac anxiety, depressive symptoms, and somatization had weak significant negative associations (beta = 0.187-0.284, p < 0.001) with HRQoL. In patients with history of CD, the association between depressive symptoms and HRQoL was moderate (beta = − 0.339, p < 0.001), compared to weak association in patients without CD (beta = − 0.193, p < 0.001). On the other hand, the association between cardiac anxiety and HRQoL was weak in both patients with history of CD (beta = − 0.156, p = 0.05), and in those without (beta = − 0.229, p < 0.001). Conclusions: Patients with NCCP, in particular those with history of CD, reported low levels of HRQoL, which was associated with psychological distress. This should be considered when developing psychological interventions aiming to improve HRQoL in patients with NCCP.

Determinants of depression in non-cardiac chest pain patients: a cross sectional study

“…factors, somatization, type D personality, fear of body sensations, and pain intensity were significant. In line with previous studies which have shown that depression is common among NCCP patients [1,5], 73.9% of the NCCP patients in our study, based on the PHQ-9 questionnaire, were suffering from mild to moderate or severe depression (Table 1). It is noteworthy that the level of depression in patients with NCCP is similar to patients who are diagnosed with a heart problem after experiencing chest pain [2].…”

“…It is noteworthy that the level of depression in patients with NCCP is similar to patients who are diagnosed with a heart problem after experiencing chest pain [ 2 ]. Depression and NCCP are both associated with disability and reduced quality of life, so their comorbidity can have a much more negative effect on the patient’s condition [ 5 ].…”

“…In addition to financial burden and comparable to cardiac disease, NCCP negatively influences the quality of life and everyday life such as interruption of daily activities and occupational disability [ 5 , 6 ]. Several studies have supported the relationship between NCCP and psychological impairment such as depression, anxiety, and somatization [ 1 , 5 ].…”

“…In addition to financial burden and comparable to cardiac disease, NCCP negatively influences the quality of life and everyday life such as interruption of daily activities and occupational disability [ 5 , 6 ]. Several studies have supported the relationship between NCCP and psychological impairment such as depression, anxiety, and somatization [ 1 , 5 ]. It seems that type D personality in these patients is common, which is associated with the occurrence of psychological disorders and increases their risk of depression; however, few studies have considered this relationship [ 7 ].…”

How is type D personality associated with the major psychological outcomes in noncardiac chest pain patients?

“…In the United States, for instance, the cost associated with these medical services is estimated to be between 8 and 13 billion dollars each year (Castonguay et al, 2020). In addition to NCCP's financial burden and its comparability to that of cardiac diseases, NCCP also negatively influences the quality of everyday life in those suffering from it, by different means, including interruption of daily activities and occupational disability (Israel et al, 2015;Mourad et al, 2020).…”