1
|
Gonzalez-Ibarra F, Cruz-Ruiz M, Llanes JM, Achem SR, Fass R. The Role of Psychological Factors in Noncardiac Chest Pain of Esophageal Origin. J Neurogastroenterol Motil 2024; 30:272-280. [PMID: 38972864 PMCID: PMC11238108 DOI: 10.5056/jnm23166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 07/09/2024] Open
Abstract
Background/Aims Noncardiac chest pain (NCCP) of esophageal origin is a challenging clinical problem of diverse etiology that affects more than 80 million Americans yearly. We assess the prevalence and impact of psychological disorders on NCCP of esophageal origin, describe possible mechanisms associated with this condition, and review psychological therapy options. Methods Online search using PubMed and Medline from January 1, 1966, to April 30, 2023. Results Psychological disorders have been reported in up to 79% of patients with NCCP of esophageal origin. Several psychological disturbances have been identified with this condition, including depression, anxiety, panic disorder, phobias, and obsessive-compulsive and somatoform disorders. It is unclear whether the psychological disorders trigger the chest pain or vice versa. Multiple psychological mechanisms have been linked to chest pain and may contribute to its pathogenesis and severity. These mechanisms include cardiophobia, poor coping strategies, negative social problem solving, stress and perceived control, hypervigilance to cardiopulmonary sensations, altered pain perception, and alexithymia. Psychological therapies for NCCP of esophageal origin include cognitive behavioral therapy, hypnotherapy, physical and relaxation training, breathing retraining, and alternative medicine. Among the therapeutic options, cognitive behavioral therapy has been shown to be an effective treatment for NCCP of esophageal origin. Conclusion This review raises awareness about the high prevalence of psychological disorders in NCCP of esophageal origin and highlights the need for clinical trials and trained therapists to address the management of this taxing clinical problem.
Collapse
Affiliation(s)
| | | | - Joel Murillo Llanes
- Department of Research, Sinaloa Health Services, Women’s Hospital, Sinaloa, Mexico
| | - Sami R Achem
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Ronnie Fass
- Digestive Health Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Cleveland, OH, USA
| |
Collapse
|
2
|
Kopitar L, Kokol P, Stiglic G. Hybrid visualization-based framework for depressive state detection and characterization of atypical patients. J Biomed Inform 2023; 147:104535. [PMID: 37926393 DOI: 10.1016/j.jbi.2023.104535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Depression is a global concern, with a significant number of people affected worldwide, particularly in low- and middle-income countries. The rising prevalence of depression emphasizes the importance of early detection and understanding the origins of such conditions. OBJECTIVE This paper proposes a framework for detecting depression using a hybrid visualization approach that combines local and global interpretation. This approach aims to assist in model adaptation, provide insights into patient characteristics, and evaluate prediction model suitability in a different environment. METHODS This study utilizes R programming language with the Caret, ggplot2, Plotly, and Dalex libraries for model training, visualization, and interpretation. Data from the NHANES repository was used for secondary data analysis. The NHANES repository is a comprehensive source for examining health and nutrition of individuals in the United States, and covers demographic, dietary, medication use, lifestyle choices, reproductive and mental health data. Penalized logistic regression models were built using NHANES 2015-2018 data, while NHANES 2019-March 2020 data was used for evaluation at the global-specific and local level interpretation. RESULTS The prediction model that supports this framework achieved an average AUC score of 0.748 (95% CI: 0.743-0.752), with minimal variability in sensitivity and specificity. CONCLUSION The built-in prediction model highlights chest pain, the ratio of family income to poverty, and smoking status as crucial features for predicting depressive states in both the original and local environments.
Collapse
Affiliation(s)
- Leon Kopitar
- Faculty of Health Sciences, University of Maribor, Zitna ulica 15, Maribor, 2000, Slovenia; Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroska cesta 46, Maribor, 2000, Slovenia.
| | - Peter Kokol
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroska cesta 46, Maribor, 2000, Slovenia
| | - Gregor Stiglic
- Faculty of Health Sciences, University of Maribor, Zitna ulica 15, Maribor, 2000, Slovenia; Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroska cesta 46, Maribor, 2000, Slovenia; Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| |
Collapse
|
3
|
Connors JN, Kroenke K, Monahan P, Chernyak Y, Pettit K, Hayden J, Montgomery C, Brenner G, Millard M, Holmes E, Musey P. Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial. Contemp Clin Trials 2023; 124:107020. [PMID: 36423863 DOI: 10.1016/j.cct.2022.107020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. OBJECTIVES The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. METHODS The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. DISCUSSION PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
Collapse
Affiliation(s)
- Jill Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Patrick Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kate Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julie Hayden
- National Alliance on Mental Illness (NAMI) of Greater Indianapolis, Inc., Indianapolis, IN, United States
| | - Chet Montgomery
- Patient Advisory Committee, Community Member, Indianapolis, IN, United States
| | - George Brenner
- Continuing the Care, LLC, Indianapolis, IN, United States
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
| |
Collapse
|
4
|
Bahremand M, Komasi S. Which symptoms are the psychopathological core affecting the manifestation of pseudo-cardiac symptoms and poor sleep quality in young adults? Symptoms of personality disorders versus clinical disorders. Front Psychol 2022; 13:1011737. [PMID: 36571031 PMCID: PMC9784461 DOI: 10.3389/fpsyg.2022.1011737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background Diagnosing and identifying the psychological origin of pseudo-cardiac symptoms and comorbid conditions such as poor sleep quality is very difficult due to its extensive and complex nature. The present study was conducted to determine the contribution of symptoms of personality disorders (PDs) and clinical disorders (CDs; i.e., psychological symptoms measured using the Symptom Checklist-90) to the manifestation of pseudo-cardiac symptoms and poor sleep quality. Methods Subjects in this cross-sectional study were 953 (64.3% female; 28.8 ± 6.2 years) community samples in the west of Iran who were selected by convenience sampling. After applying the inclusion criteria, data were collected using the Symptom Checklist-90 (SCL-90-R), the Personality Diagnostic Questionnaire (PDQ-4), and the Scale for Pseudo-Cardiac Symptoms and Poor Sleep Quality (SPSQ). Pearson correlations, factor analytical techniques, and hierarchical regression models were used to examine associations between symptoms of PDs/CDs and outcome factors. Results Factor analytical techniques confirmed both the integrated structure of symptoms of PDs and CDs. Both pseudo-cardiac symptoms and poor sleep quality were more strongly associated with symptoms of CDs than PDs. The results of the hierarchical analysis show that the CDs factor alone could explain the total variance of both pseudo-cardiac symptoms (change in R2 = 0.215 vs. 0.009; p < 0.001) and poor sleep quality (change in R2 = 0.221 vs. 0.001; p < 0.001). Conclusion The different capabilities of two unique factors for the symptoms of PDs and CDs were confirmed by factor analytical methods and regression analysis techniques. Although each of the symptoms of PDs and CDs independently contributes to the manifestation of pseudo-cardiac symptoms and poor sleep quality, the CDs factor is the psychopathological core.
Collapse
Affiliation(s)
- Mostafa Bahremand
- Department of Cardiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeid Komasi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran,*Correspondence: Saeid Komasi,
| |
Collapse
|
5
|
Wilkinson M, Venning A, Redpath P, Ly M, Brown S, Battersby M. Can low intensity cognitive behavioural therapy for non‐cardiac chest pain presentations to an emergency department be efficacious? A pilot study. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Megan Wilkinson
- College of Medicine & Public Health, Department of Psychiatry, Flinders University, Adelaide, South Australia
| | - Anthony Venning
- College of Medicine & Public Health, Department of Psychiatry, Flinders University, Adelaide, South Australia
| | - Paula Redpath
- College of Medicine & Public Health, Department of Psychiatry, Flinders University, Adelaide, South Australia
| | - Marleesa Ly
- College of Medicine & Public Health, Department of Psychiatry, Flinders University, Adelaide, South Australia
| | - Sharon Brown
- Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, South Australia
| | - Malcolm Battersby
- College of Medicine & Public Health, Department of Psychiatry, Flinders University, Adelaide, South Australia
| |
Collapse
|
6
|
Kamali SH, Imanipour M, Emamzadeh Ghasemi HS, Razaghi Z. Effect of Programmed Family Presence in Coronary Care Units on Patients' and Families' Anxiety. J Caring Sci 2020; 9:104-112. [PMID: 32626673 PMCID: PMC7322404 DOI: 10.34172/jcs.2020.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/27/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Hospitalization of patients in the intensive care units always has negative consequences such as anxiety and concern for patients and their families. This study aimed to investigate the effect of programmed family presence in intensive care units on patients’ and families’ anxiety. Methods: This was a quasi-experimental study conducted in Iran. The eligible patients and a member of their families were assigned into two groups (N = 80) through convenience sampling. The family members in the experimental group were allowed to attend twice a day for 15 minutes in a planned way beside the patient and contribute to their clinical primary care. In the control group, the family members had a strict limitation to visit their patients based on the usual policy. Anxiety in both groups at the beginning and on the third day of patient’s admission was measured, using Spielberger’s questionnaire. The data were analyzed with SPSS version13. Results: The mean score of anxiety in the control group did not show significant difference in patients and in families, however it had decreased significantly in the experimental group after the intervention for both patients and families. The results showed that mean differences between the two groups was statistically significant in patients and families. Conclusion: The planned presence of the family of patients in coronary care unit (CCU) played a crucial role in reducing the anxiety of patients and their family. Furthermore, it is recommended that strategies of visiting policy in intensive care units (ICUs) should be revised and the possibility be provided for the families’ planned presence and participation in the patient care.
Collapse
Affiliation(s)
- Seyyedeh Halimeh Kamali
- Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences; Tehran, Iran
| | - Masoomeh Imanipour
- Department of Critical Care Nursing and Management, Nursing and Midwifery Care Research Center; Tehran University of Medical Sciences; Tehran; Iran
| | - Hormat Sadat Emamzadeh Ghasemi
- Department of Critical Care Nursing and Management; School of Nursing and Midwifery, Tehran University of Medical Sciences; Tehran; Iran
| | - Zahra Razaghi
- Laser Application in Medical Sciences Research Center; Shahid Beheshti University of Medical Sciences; Tehran; Iran
| |
Collapse
|
7
|
Mourad G, Alwin J, Jaarsma T, Strömberg A, Johansson P. The associations between psychological distress and health-related quality of life in patients with non-cardiac chest pain. Health Qual Life Outcomes 2020; 18:68. [PMID: 32160887 PMCID: PMC7066800 DOI: 10.1186/s12955-020-01297-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/13/2020] [Indexed: 12/21/2022] Open
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.
Collapse
Affiliation(s)
- Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Jenny Alwin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
8
|
Caponnetto P. Psychological and psychopathological sequelae in cardiovascular acute disease. Ment Illn 2018; 10:7887. [PMID: 30746058 PMCID: PMC6342026 DOI: 10.4081/mi.2018.7887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022] Open
Abstract
The burden of mental illness is profound and growing. Each year, almost one in three adults in the non-institutionalized community has a diagnosable mental or addictive disorder, and this figure climbs to approximately 40% among emergency departments patients. We described the principal cardiovascular acute disease and their emotional and behavioral consequences where psychological intervention could improve the care pathway and clinical outcome. Peer-reviewed articles from Medline, Psycinfo, Web of Science, Scopus, and Cochrane library, about psychological and psychopathological sequelae in cardiovascular acute disease were searched. The psychological and psychopathological sequelae associated to stroke include emotional and behavioral changes and cognitive impairment. Fear, symptoms of depression, anxiety or specific post-traumatic symptoms like intrusions, hyper-arousal and/or cognitive avoidance are common in people suffering of cardiovascular acute disease treated at emergency departments. In emergency departments, health personnel must recognize psychological and psychopathological sequelae in cardiovascular acute disease in order to develop effective interventions for these patients. Identify factors that are associated with both psychological distress and physical distress and promote interventions aimed at reducing psychological distress and improving psychological health empowerment is an important element to consider in order to offer the best care to vulnerable population as that suffering of cardiovascular acute disease.
Collapse
Affiliation(s)
- Pasquale Caponnetto
- Center for Prevention and Care of the Tabagism, University-Hospital "Policlinico V. Emanuele", University of Catania, Italy; Department of Clinical and Experimental Biomedicine, University of Catania, Italy; Institute for Social Marketing, University of Stirling, UK
| |
Collapse
|
9
|
Musey PI, Patel R, Fry C, Jimenez G, Koene R, Kline JA. Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain. Am J Cardiol 2018; 122:1133-1141. [PMID: 30086878 DOI: 10.1016/j.amjcard.2018.06.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/16/2022]
Abstract
Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits.
Collapse
Affiliation(s)
- Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Roma Patel
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Colin Fry
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Guadalupe Jimenez
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rachael Koene
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| |
Collapse
|
10
|
Abstract
Noncardiac chest pain is an angina-type discomfort without indication of ischemia. Diagnosis can be difficult because of its heterogeneous nature. Classification varies by specialty; gastroenterology uses the terminology gastroesophageal reflux disease related versus non-gastroesophageal reflux disease related. Other disciplines recognize noncardiac chest pain etiologies as having gastrointestinal, musculoskeletal, psychiatric, or pulmonary/other as underlying etiologies. Diagnostics yield a specific cause for effective treatment, which is aimed at the underlying etiology, but it is not always possible. Some patients with noncardiac chest pain have comorbidities and ongoing pain that lead to decreased quality of life and continued health care use.
Collapse
Affiliation(s)
- Sharron Rushton
- Duke University School of Nursing, DUMC Box 3322, Durham, NC 27710, USA.
| | - Margaret J Carman
- Georgetown University School of Nursing and Health Studies, St. Mary's Hall, 3700 Reservoir Road Northwest, Washington, DC 20007, USA
| |
Collapse
|
11
|
Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms. Heart Lung Circ 2017; 26:1310-1316. [DOI: 10.1016/j.hlc.2017.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/09/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
|
12
|
Qintar M, Spertus JA, Tang Y, Buchanan DM, Chan PS, Amin AP, Salisbury AC. Noncardiac chest pain after acute myocardial infarction: Frequency and association with health status outcomes. Am Heart J 2017; 186:1-11. [PMID: 28454822 DOI: 10.1016/j.ahj.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/01/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The frequency of noncardiac chest pain (CP) hospitalization after acute myocardial infarction (AMI) is unknown, and its significance from patients' perspectives is not studied. OBJECTIVES To assess the frequency of noncardiac CP admissions after AMI and its association with patients' self-reported health status. METHODS We identified cardiac and noncardiac CP hospitalizations in the year after AMI from the 24-center TRIUMPH registry. Hierarchical repeated-measures regression was used to identify the association of these hospitalizations with patients' self-reported health status using the Seattle Angina Questionnaire Quality of Life domain (SAQ QoL) and Short Form 12 (SF-12) physical (PCS) and mental (MCS) component summary scores. RESULTS Of 3,099 patients, 318 (10.3%) were hospitalized with CP, of whom 92 (28.9%) were hospitalized for noncardiac CP. Compared with patients not hospitalized with CP, noncardiac CP hospitalization was associated with poorer health status (SAQ QoL-adjusted differences: -8.9 points [95% CI -12.1 to -5.6]; SF-12 PCS: -2.5 points [95% CI -4.2 to -0.8] and SF-12 MCS: -3.5 points [95% CI -5.1 to -1.9]). The SAQ QoL for patients hospitalized with noncardiac CP was similar to patients hospitalized with cardiac CP (adjusted difference: 0.6 points [95% CI -3.2 to 4.5]; SF-12 PCS (0.9 points [95% CI -1.1 to 2.9]), but was worse with regard to SF-12 MCS (adjusted difference: -2.0 points [95% CI -3.9 to -0.2]). CONCLUSIONS Noncardiac CP accounted for a third of CP hospitalizations within 1 year of AMI and was associated with similar disease-specific QoL as well as general physical and mental health status impairment compared with cardiac CP hospitalization.
Collapse
Affiliation(s)
- Mohammed Qintar
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Donna M Buchanan
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - Amit P Amin
- Washington University School of Medicine, Saint Louis, MO
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
| |
Collapse
|
13
|
Musey PI, Kline JA. Emergency Department Cardiopulmonary Evaluation of Low-Risk Chest Pain Patients with Self-Reported Stress and Anxiety. J Emerg Med 2016; 52:273-279. [PMID: 27998631 DOI: 10.1016/j.jemermed.2016.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chest pain is a high-risk emergency department (ED) chief complaint; the majority of clinical resources are directed toward detecting and treating cardiopulmonary emergencies. However, at follow-up, 80%-95% of these patients have only a symptom-based diagnosis; a large number have undiagnosed anxiety disorders. OBJECTIVE Our aim was to measure the frequency of self-identified stress or anxiety among chest pain patients, and compare their pretest probabilities, care processes, and outcomes. METHODS Patients were divided into two groups: explicitly self-reported anxiety and stress or not at 90-day follow-up, then compared on several variables: ultralow (<2.5%) pretest probability, outcome rates for acute coronary syndrome (ACS) and pulmonary embolism (PE), radiation exposure, total costs at 30 days, and 90-day recidivism. RESULTS Eight hundred and forty-five patients were studied. Sixty-seven (8%) explicitly attributed their chest pain to "stress" or "anxiety"; their mean ACS pretest probability was 4% (95% confidence interval 2.9%-5.7%) and 49% (33/67) had ultralow pretest probability (0/33 with ACS or PE). None (0/67) were diagnosed with anxiety. Seven hundred and seventy-eight did not report stress or anxiety and, of these, 52% (403/778) had ultralow ACS pretest probability. Only one patient (0.2%; 1/403) was diagnosed with ACS and one patient (0.4%; 1/268) was diagnosed with PE. Patients with self-reported anxiety had similar radiation exposure, associated costs, and nearly identical (25.4% vs. 25.7%) ED recidivism to patients without reported anxiety. CONCLUSIONS Without prompting, 8% of patients self-identified "stress" or "anxiety" as the etiology for their chest pain. Most had low pretest probability, were over-investigated for ACS and PE, and not investigated for anxiety syndromes.
Collapse
Affiliation(s)
- Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
14
|
Donnelly TT, Al Suwaidi JM, Al-Qahtani A, Asaad N, Qader NA, Singh R, Fung TS, Mueed I, Sharara S, El Banna N, Omar S. Depression in Cardiovascular Patients in Middle Eastern Populations: A Literature Review. J Immigr Minor Health 2016; 17:1259-76. [PMID: 24923859 DOI: 10.1007/s10903-014-0052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) is increasing in Middle Eastern countries. Depression is associated with increased morbidity and mortality rates among cardiovascular (CV) patients. Early detection of and intervention for depression among CV patients can reduce morbidity and mortality and save health care costs. Public information on mental health care needs of Arab CV patients living in Middle East regions is scattered and limited. This literature review surveyed and summarized research studies to learn what is known about the relationship between depression and CVD in Middle Eastern populations. The information will raise awareness among health care professionals and policy makers regarding the clinical significance of depression in Arab CV patients. It might contribute to development of culturally appropriate and effective mental health care services. Multiple databases were searched and 60 articles were assessed, including studies that investigated depression in Arab CV patient populations, physiological mechanisms of depression-CVD comorbidity, and intervention strategies that affect CV risk in depressed Arab patients. We discuss the extent to which this issue has been explored in Arab populations living in Middle East regions and Arab populations living abroad. We recommend that more comprehensive and in-depth research studies be conducted with Arab cardiac patients to enable implementation of culturally appropriate and effective mental health care interventions.
Collapse
Affiliation(s)
- Tam Truong Donnelly
- University of Calgary-Qatar, P.O. Box 23133, Al Rayyan Campus, Al Forousiya Road, Doha, Qatar,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Vestergaard KR, Jespersen CB, Arnadottir A, Sölétormos G, Schou M, Steffensen R, Goetze JP, Kjøller E, Iversen KK. Prevalence and significance of troponin elevations in patients without acute coronary disease. Int J Cardiol 2016; 222:819-825. [DOI: 10.1016/j.ijcard.2016.07.166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
|
16
|
Webster R, Thompson AR, Norman P, Goodacre S. The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain. PSYCHOL HEALTH MED 2016; 22:1-11. [PMID: 26924523 PMCID: PMC5105082 DOI: 10.1080/13548506.2016.1144891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.
Collapse
Affiliation(s)
- Rosie Webster
- a Research Department of Primary Care and Population Health , University College London , Royal Free Campus, Rowland Hill Street, London , NW3 2PF , UK.,b Department of Psychology , University of Sheffield , UK
| | - Andrew Robert Thompson
- c Department of Psychology , University of Sheffield , Western Bank, Sheffield , S10 2TN , UK
| | - Paul Norman
- d Department of Psychology , University of Sheffield , UK
| | - Steve Goodacre
- e School of Health and Related Research , University of Sheffield , UK
| |
Collapse
|
17
|
Hassan HA, Suriya MO, Al-Aseri ZA, Hasan M, Khalid N, Sheikh SA. Feasibility of using Arabic Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression among patients attending Accident and Emergency at a University Hospital setting in Riyadh, Saudi Arabia. Pak J Med Sci 2015; 31:1366-71. [PMID: 26870098 PMCID: PMC4744283 DOI: 10.12669/pjms.316.6849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/01/2014] [Accepted: 09/06/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of using Arabic Hospital Anxiety and Depression Scale (HADS) to assess depression and anxiety among patients attending accident and emergency (A & E) at a University Hospital setting in Riyadh, Saudi Arabia. METHODS In this prospective observational study translated questionnaire of HADS was used for patients aged 18 years or above who presented to A & E at King Khalid University Hospital in Riyadh, Saudi Arabia. The study included 257 patients as per an agreed inclusion criteria. The study quantified depression and anxiety and its association with demographic and or illness related variables using SPSS. RESULTS Out of 257 participants, the dominant age group, ranged between 18-30 years (40.9%) with female participants (55.3%) outweigh the male among all. The overall occurrence of depression was 27.2% (95% Confidence Interval (CI): 21.8 % to 32.6%) and anxiety was 23% (17.8% to 28.2%CI). Marital, educational and economic status of participants, were statistically significantly associated (p<0.05) with the levels of anxiety whereas age, marital, education, economic and employment status were associated (p<0.05) with the levels of depression. CONCLUSION In the A & E setting at University Hospital in Saudi Arabia, comorbid depression and anxiety is not uncommon as enumerated by using HADS. The identified cases could then be sent for appropriate psychiatric treatment promptly not only to improve quality of individual care but also to reduce the overall health care costs in local context.
Collapse
Affiliation(s)
- Hosam A. Hassan
- Hosam A. Hassan, MBBCh, MRCPI. Assistant Professor and Consultant, Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - M. Owais Suriya
- M. Owais Suriya, MBBS, DTCD, MRCP (UK), MRCGP (UK) FCEM (UK). Research Fellow College of Medicine, University of Saskatchewan. 107, Wiggins Road S7N 5E5, Saskatoon, Canada
| | - Zohair Ahmed Al-Aseri
- Zohair Ahmed Al-Aseri, FRCPc, EM & CC. Associate Professor, Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Mujtaba Hasan
- Mujtaba Hasan, MBBS, BSc, FCPS, FCCP, DTP Assistant Professor of Medicine, Consultant Physician, University College of Medicine, University of Lahore, Pakistan
| | - Najeeb Khalid
- Najeeb Khalid, MBBS (PK), MD (UK). Consultant Psychiatrist & HonSr Lecturer, Cardiff & Vale University Health Board, Cardiff, United Kingdom
| | - Shaffi Ahmed Sheikh
- Shaffi Ahmed Sheikh, Ph.D. Associate Professor, Dept. Of Family & Community Medicine, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
18
|
Al Aseri ZA, Suriya MO, Hassan HA, Hasan M, Sheikh SA, Al Tamimi A, Alshathri M, Khalid N. Reliability and validity of the Hospital Anxiety and Depression Scale in an emergency department in Saudi Arabia: a cross-sectional observational study. BMC Emerg Med 2015; 15:28. [PMID: 26459412 PMCID: PMC4603646 DOI: 10.1186/s12873-015-0051-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety are prevalent psychiatric comorbidities that are known to have a negative impact on a patient's general prognosis. But screening for these potential comorbidities in a hospital's accident and emergency department has seldom been undertaken, particularly in Saudi Arabia and elsewhere in the Middle East. The Hospital Anxiety and Depression Scale (HADS) has been extensively used to evaluate these psychiatric comorbidities in various clinical settings at all levels of health care services except for the accident and emergency department. This study therefore aimed to assess the reliability and validity of the HADS for anxiety and depression among patients at a hospital accident and emergency department in Saudi Arabia. METHODS This cross-sectional observational study was conducted from January to December 2012. The participants were 257 adult patients (aged 16 years and above) who presented at the accident and emergency department of King Khalid University Hospital, Riyadh, Saudi Arabia, who met our inclusion criteria. We used an Arabic translation of the HADS. We employed factor analysis to determine the underlying factor structure of that instrument in assessing reliability and validity. RESULTS We found the Arabic version of the HADS to be acceptable for 95% of the subjects. We used Cronbach's alpha coefficient to evaluate reliability, and it indicated a significant correlation with both the anxiety (0.73) and depression (0.77) subscales of the HADS, thereby supporting the validity of the instrument. By means of factor analysis, we obtained a two-factor solution according to the two HADS subscales (anxiety and depression), and we observed a statistically significant correlation (r = 0.57; p < 0.0001) between the two subscales. CONCLUSION The HADS can be used effectively in an accident and emergency department as an initial screening instrument for anxiety and depression. It thus has great potential as part of integrated multidisciplinary care.
Collapse
Affiliation(s)
- Zohair A Al Aseri
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - M Owais Suriya
- Fellow Community Health, College of Medicine, University of Saskatchewan, 107, Wiggins Road, S7N 5E5, Saskatoon, Canada.
| | - Hosam A Hassan
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Mujtaba Hasan
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Shaffi Ahmed Sheikh
- Department of Family and Community Medicine, College of Medicine King Khalid University Hospital KSU, PO Box 230155, Riyadh, 11321, Kingdom of Saudi Arabia.
| | - Adel Al Tamimi
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Mashhoor Alshathri
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Najeeb Khalid
- Cardiff and Vale University Health Board, Cardiff, UK.
| |
Collapse
|
19
|
Webster R, Thompson AR, Norman P. 'Everything's fine, so why does it happen?' A qualitative investigation of patients' perceptions of noncardiac chest pain. J Clin Nurs 2015; 24:1936-45. [PMID: 25988506 PMCID: PMC4959531 DOI: 10.1111/jocn.12841] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
Abstract
Aims and objectives To examine patients' perceptions and experiences of noncardiac chest pain, within the framework of the common sense model. Background Patients with noncardiac chest pain have good physical prognosis, but frequently suffer prolonged pain and psychological distress. The common sense model may provide a good framework for examining outcomes in patients with noncardiac chest pain. Design Qualitative thematic analysis with semi‐structured interviews. Methods In 2010, participants recruited from an emergency department (N = 7) with persistent noncardiac chest pain and distress were interviewed using a semi‐structured schedule, and data were analysed using thematic analysis. Results Seven themes were identified; six of which mapped onto core dimensions of the common sense model (identity, cause, timeline, consequences, personal control, treatment control). Contrary to previous research on medically unexplained symptoms, most participants perceived psychological factors to play a causal role in their chest pain. Participants' perceptions largely mapped onto the common sense model, although there was a lack of coherence across dimensions, particularly with regard to cause. Conclusion Patients with noncardiac chest pain lack understanding with regard to their condition and may be accepting of psychological causes of their pain. Relevance to clinical practice Brief psychological interventions aimed at improving understanding of the causes of noncardiac chest pain and providing techniques for managing pain and stress may be useful for patients with noncardiac chest pain.
Collapse
Affiliation(s)
- Rosie Webster
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Andrew R Thompson
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| |
Collapse
|
20
|
Tully PJ, Cosh SM, Baumeister H. The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. J Psychosom Res 2014; 77:439-48. [PMID: 25455809 DOI: 10.1016/j.jpsychores.2014.10.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD. METHODS A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible). RESULTS Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio=1.94, 95% CI 1.45-2.60, P<.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies. CONCLUSIONS The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.
Collapse
Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany.
| | - Suzanne M Cosh
- Clinic of Psychiatry and Psychotherapy II, University of Ulm, Gunzburg, Germany
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
| |
Collapse
|
21
|
Webster R, Norman P, Goodacre S, Thompson A, McEachan R. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department. Psychol Health 2014; 29:1265-82. [PMID: 24831735 PMCID: PMC4192860 DOI: 10.1080/08870446.2014.923885] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/07/2014] [Indexed: 12/30/2022]
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.
Collapse
Affiliation(s)
- R. Webster
- Department of Psychology, University of Sheffield, Sheffield, UK
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - P. Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - S. Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A.R. Thompson
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - R.R.C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hopsitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK
| |
Collapse
|
22
|
Sanner JE, Frazier L, Udtha M. Self-reported depressive symptoms in women hospitalized for acute coronary syndrome. J Psychiatr Ment Health Nurs 2013; 20:913-20. [PMID: 23379757 PMCID: PMC4593302 DOI: 10.1111/jpm.12038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 12/23/2022]
Abstract
The purpose of this cross-sectional observational study was to explore depressive symptoms, among 377 women, during hospitalization for acute coronary syndrome (ACS). Women were screened for depressive symptoms using the Beck Depression Inventory-II (BDI-II). Pearson chi-squared tests for independence were used for comparisons between categorical variables and t-tests for independent samples were used for comparisons between continuous variables. Tukey's honestly significant difference test along with one-way anova test was used to conduct multiple comparisons between the three defined age groups ranging from 29-49, 50-64 to ≥65 years. A total of 118 women screened positive for depression (BDI-II score ≥ 14). The percentage of women that met the criteria for a positive depression screening was significantly different between the three age groups. The proportion of depressed women who reported feelings of sadness, past failures, punishment, self-dislike, agitation, worthlessness, sleep disturbances and irritability varied significantly by age group. Study findings indicate that symptom experience and severity may differ across a lifetime. These results support the need to understand the complexity of depressive symptoms experienced by women. The ability to understand and recognize depressive symptoms in women, with ACS, may assist healthcare professionals with the management of a modifiable cardiovascular risk factor.
Collapse
Affiliation(s)
- J. E. Sanner
- Assistant Professor in Nursing Systems at the University of Texas Health Science Center at Houston School of Nursing 6901 Bertner Ave, Suite 612, Houston, Texas 77030; office number 713-500-2047;
| | - L. Frazier
- Dean and Professor at the University of Arkansas for Medical Sciences College of Nursing.
| | - M. Udtha
- Research Coordinator at the University of Texas Health Science Center at Houston School of Nursing.
| |
Collapse
|
23
|
Smeijers L, van de Pas H, Nyklicek I, Notten PJ, Pedersen SS, Kop WJ. The independent association of anxiety with non-cardiac chest pain. Psychol Health 2013; 29:253-63. [DOI: 10.1080/08870446.2013.843681] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
24
|
Muschalla B, Glatz J, Linden M. Heart-related anxieties in relation to general anxiety and severity of illness in cardiology patients. PSYCHOL HEALTH MED 2013; 19:83-92. [DOI: 10.1080/13548506.2013.774428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Mourad G, Jaarsma T, Hallert C, Strömberg A. Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease. Heart Lung 2012; 41:446-55. [PMID: 22652167 DOI: 10.1016/j.hrtlng.2012.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 03/09/2012] [Accepted: 04/08/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We compared depressive symptoms and healthcare utilization in patients admitted for noncardiac chest pain, acute myocardial infarction, and angina pectoris after hospitalization and at 1-year follow-up. METHODS One hundred and thirty-one patients with noncardiac chest pain, 66 with acute myocardial infarction, and 70 with angina pectoris completed a depression screening questionnaire and the Montgomery Åsberg Depression Rating Scale. Healthcare utilization data were collected from a population-based, diagnosis-related database. RESULTS More than 25% of respondents reported depressive symptoms, regardless of diagnosis. At follow-up, 9% had recovered, 19% were still experiencing depressive symptoms, and 13% had developed depressive symptoms. Noncardiac patients with chest pain had similar primary care contacts, but fewer hospital admissions, than patients with an acute myocardial infarction. Patients with angina pectoris and depressive symptoms used the most healthcare services. CONCLUSIONS Depressive symptoms were common. Patients with noncardiac chest pain used as much primary care as did patients with an acute myocardial infarction. Interventions should focus on identifying and treating depressive symptoms.
Collapse
Affiliation(s)
- Ghassan Mourad
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.
| | | | | | | |
Collapse
|
26
|
Shankman SA, Nadelson J, McGowan SK, Sovari AA, Vidovich MI. The predictive power of depression screening procedures for veterans with coronary artery disease. Vasc Health Risk Manag 2012; 8:233-8. [PMID: 22566744 PMCID: PMC3346269 DOI: 10.2147/vhrm.s29424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Depression leads to a worse outcome for patients with coronary artery disease (CAD). Thus, accurately identifying depression in CAD patients is imperative. In many veterans affairs (VA) hospitals, patients are screened for depression once a year using the patient health questionnaire (PHQ-9). Although the PHQ-9 is generally considered a specific and sensitive measure of depression, there is reason to believe that these screening procedures may miss a large number of cases of depression within CAD patients and cardiology patients more generally. The goal of this study was to provide data as to the predictive power of this depression screening procedure by (a) comparing the prevalence rate of depression identified by the PHQ-9 to known prevalence rates and (b) examining whether patients identified as “depressed” also had conditions that consistently co-occur with depression (eg, post-traumatic stress disorder [PTSD], other medical issues). Participants were 813 consecutive patients who received an angiogram in the cardiac catheterization laboratory at a large VA Medical Center. Prevalence of depression was 6.9% in the overall sample and less than 6% when the sample was restricted to CAD patients with significant stenosis. Depression was significantly associated with PTSD, smoking, and alcohol problems. However, depression was not associated with other medical problems such as diabetes, renal failure, peripheral vascular disease, or anemia. In conclusion, the low prevalence rate of depression and lack of associations with comorbid medical problems may suggest that the VA’s depression screening procedures have low sensitivity for identifying depression in CAD patients. It is recommended that clinicians treating CAD regularly screen for depression and do not rely on archival depression screens.
Collapse
Affiliation(s)
- Stewart A Shankman
- Department of Psychiatry and Psychology, University of Illinois, Chicago, IL 60612, USA
| | | | | | | | | |
Collapse
|
27
|
Lutwak N, Dill C. A depressed post-menopausal woman. J Emerg Med 2011; 43:815-9. [PMID: 21764538 DOI: 10.1016/j.jemermed.2011.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 09/25/2010] [Accepted: 05/20/2011] [Indexed: 01/24/2023]
Abstract
BACKGROUND Post-menopausal women are at significant risk for coronary artery disease, have increased rates of depression compared to their male counterparts, and often present atypically with coronary insufficiency. The symptoms of depression and coronary ischemia overlap greatly. Complaints like fatigue, body aches, and sleep disturbance reported by a depressed elderly woman may be cardiac related and need to be investigated seriously without physician bias. OBJECTIVES To ensure that clinicians are cautious when evaluating older women with a history of depression who are presenting with atypical complaints. CASE REPORT A 61-year-old woman with history of depression presented to the Emergency Department with multiple complaints atypical for acute coronary syndrome. She had an immediate electrocardiogram and troponin-T Biosite point-of-care test (Biosite Incorporated, San Diego, CA) performed, which were positive for cardiac ischemia and myocardial infarction. The patient underwent immediate cardiac catheterization, which revealed occlusion of the mid left circumflex. After aspiration of thrombus and balloon dilatation of the site, a bare metal stent was deployed, restoring excellent flow. The patient did well medically but her depression worsened after the procedure and continues despite psychiatric intervention. CONCLUSION For years there have been gender differences in medical treatment of coronary artery disease, and often women's complaints are not investigated aggressively. Post-menopausal women are at great risk for cardiac ischemia and depression, and their symptoms, which are often atypical, may not be diagnosed as anginal equivalents. In addition, depression is an independent risk factor for cardiovascular disease and, if it occurs after myocardial infarction, may lead to poor quality of life and increased morbidity and mortality. Patients who have had a coronary event must be thoroughly evaluated for signs of depression and receive the necessary treatment.
Collapse
Affiliation(s)
- Nancy Lutwak
- Department of Emergency Services, VA New York Harbor Healthcare Center, New York, New York 10010, USA
| | | |
Collapse
|
28
|
Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Motil 2011; 17:110-23. [PMID: 21602987 PMCID: PMC3093002 DOI: 10.5056/jnm.2011.17.2.110] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 03/17/2011] [Accepted: 03/28/2011] [Indexed: 12/24/2022] Open
Abstract
Noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause. Noncardiac chest pain is a prevalent disorder resulting in high healthcare utilization and significant work absenteeism. However, despite its chronic nature, noncardiac chest pain has no impact on patients' mortality. The main underlying mechanisms include gastroesophageal reflux, esophageal dysmotility and esophageal hypersensitivity. Gastroesophageal reflux disease is likely the most common cause of noncardiac chest pain. Esophageal dysmotility affects only the minority of noncardiac chest pain patients. Esophageal hypersensitivity may be present in non-GERD-related noncardiac chest pain patients regardless if esophageal dysmotility is present or absent. Psychological co-morbidities such as panic disorder, anxiety, and depression are also common in noncardiac chest pain patients and often modulate patients' perception of disease severity.
Collapse
Affiliation(s)
- Ronnie Fass
- Section of Gastroenterology, Department of Medicine, Southern Arizona VA Health Care System, Tucson, Arizona, USA.
| | | |
Collapse
|