Chest pain, depression and anxiety in coronary heart disease: Consequence or cause? A prospective clinical study in primary care.

Autor: de Heer EW; Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, 5042 Tilburg, The Netherlands; Tilburg School of Behavioural and Social Sciences, Tranzo Department, Tilburg University, 5073 Tilburg, The Netherlands. Electronic address: e.deheer@ggzbreburg.nl., Palacios JE; Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF London, UK., Adèr HJ; Johannes van Kessel Advising, 1273, SB Huizen, The Netherlands., van Marwijk HWJ; Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, BN1 9PX Brighton, UK., Tylee A; Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF London, UK., van der Feltz-Cornelis CM; Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, 5042 Tilburg, The Netherlands; Tilburg School of Behavioural and Social Sciences, Tranzo Department, Tilburg University, 5073 Tilburg, The Netherlands; Mental Health and Addictions Research Group, Department of Health Sciences, University of York, YO10 5DD York, UK.
Jazyk: angličtina
Zdroj: Journal of psychosomatic research [J Psychosom Res] 2020 Feb; Vol. 129, pp. 109891. Date of Electronic Publication: 2019 Dec 10.
DOI: 10.1016/j.jpsychores.2019.109891
Abstrakt: Objective: To examine if chest pain increases the risk of depression and anxiety, or, on the other hand, depression and anxiety increase the risk of chest pain onset in patients with coronary heart disease (CHD).
Design: Prospective clinical study.
Setting: 16 general practices in the Greater London Primary Care Research Network.
Participants: 803 participants with a confirmed diagnosis of CHD at baseline on the Quality and Outcomes Framework (QOF) CHD registers.
Main Outcome Measures: Rose Angina Questionnaire, HADS depression and anxiety subscales and PHQ-9 were assessed at seven time points, each 6 months apart. Multi-Level Analysis (MLA) and Structural Equation Modelling (SEM) were applied.
Results: Chest pain predicts both more severe anxiety and depression symptoms at all time points until 30 months after baseline. However, although anxiety predicted chest pain in the short term with a strong association, this association did not last after 18 months. Depression had only a small, negative association with chest pain.
Conclusions: In persons with CHD, chest pain increases the risk of both anxiety and depression to a great extent. However, anxiety and depression have only limited effects on the risk for chest pain. This evidence suggests that anxiety and depression tend to be consequences rather than causes of cardiac chest pain. Intervention studies that support persons with CHD by providing this information should be devised and evaluated, thus deconstructing potentially catastrophic cognitions and strengthening emotional coping.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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