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

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 -