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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

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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.

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Acknowledgments

This study was supported by the County Council of Östergötland, Sweden, and the Medical Research of Southeast Sweden (FORSS). Special thanks are due to Kristofer Årestedt for advice on the statistics and to Sofia McGarvey for a language check.

Conflict of interest

The authors declare that they have no competing interests to disclose.

Author contributions

All authors contributed to the conception and design of the study. Ghassan Mourad collected the data and performed the statistical analysis in discussion with the other authors. All authors contributed to the analysis and interpretation of the data, and to the drafting of the manuscript. Ghassan Mourad had the main responsibility and is the guarantor for the study.

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Authors and Affiliations

  1. Department of Social and Welfare Studies, Linköping University, Kungsgatan 40, 601 74, Norrköping, Sweden

    Ghassan Mourad & Tiny Jaarsma

  2. Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden

    Anna Strömberg & Peter Johansson

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  1. Ghassan Mourad
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  2. Anna Strömberg
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  3. Peter Johansson
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  4. Tiny Jaarsma
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Correspondence to Ghassan Mourad.

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Mourad, G., Strömberg, A., Johansson, P. et al. 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. Patient 9, 69–77 (2016). https://doi.org/10.1007/s40271-015-0125-0

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