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.
Highlights
Acute chest pain accounts for approximately 700,000 emergency department (ED) attendances each year in England and Wales (Goodacre et al, 2005), but between 30 and 60% of these patients do not receive a cardiac diagnosis for their pain (Eken et al, 2010; Mayou & Thompson, 2002)
The findings suggest that (i) continued chest pain is related to psychological distress and poor quality of life (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, non-cardiac chest pain (NCCP) patients in the ED might benefit from psychological therapies to manage their chest pain
The results suggest that both illness representations and psychological distress may be important targets for intervention in patients with NCCP as illness representations were associated with psychological distress and psychological distress was related to continued chest pain
Summary
Anxiety-related disorders are often proposed as a cause for NCCP (Beitman et al, 1987; Jonsbu et al, 2009), and higher levels of anxiety have been related to increased health care use in NCCP patients (Hadlandsmyth, Rosenbaum, Craft, Gervino, & White, 2013). These findings suggest that it may be important to address the NCCP, and the psychological distress associated with it
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