TY - JOUR
T1 - Chest pain, depression and anxiety in coronary heart disease
T2 - Consequence or cause? A prospective clinical study in primary care
AU - de Heer, Eric W.
AU - Palacios, Jorge E.
AU - Adèr, Herman J.
AU - van Marwijk, Harm W.J.
AU - Tylee, Andre
AU - van der Feltz-Cornelis, Christina M.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
KW - Anxiety
KW - Chest pain
KW - Coronary heart disease
KW - Depression
UR - http://www.scopus.com/inward/record.url?scp=85076734415&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychores.2019.109891
DO - 10.1016/j.jpsychores.2019.109891
M3 - Article
AN - SCOPUS:85076734415
SN - 0022-3999
VL - 129
JO - Journal of Psychosomatic Research
JF - Journal of Psychosomatic Research
M1 - 109891
ER -