Non-Heart-Attack Chest Pain May Trigger Depression

NEW YORK (Reuters Health) - People who visit the emergency department for chest pain and are sent home may continue to feel anxiety and depression up to one month later, new study findings show. In fact, their reduced quality of life may be similar to that reported by their peers who experience heart attack, UK researchers report.

Patients who have suffered a heart attack are often evaluated and treated for anxiety and depression, lead study author Dr. Steve Goodacre of Northern General Hospital in the UK noted in a prepared statement. But once patients with chest pain are told their hearts are healthy, he said, ``it is often thought...their anxiety would subside, but this study demonstrates this may not be the case.''

To investigate, Goodacre and his team studied 168 patients who visited the emergency department between October 1999 and April 2000 with complaints ranging from nonspecific chest pain to musculoskeletal pain. Nine were diagnosed with anxiety but since none received a diagnosis for their chest pain, they were all referred to a chest pain observation unit.

At the time of their admission into the observation unit, 19% of the study participants reported moderate anxiety and 13% reported moderate depression, according to findings published in the October issue of Annals of Emergency Medicine. They also reported significantly reduced quality of life in all of the areas evaluated, including vitality, pain, mental health, and physical and social functioning.

One month later, anxiety, depression, and quality of life scores remained similar to those reported at the beginning of the study. The only significant improvement was in the participants' reports of pain, while mental health quality of life scores deteriorated.

Despite this lack of improvement, the majority (86%) of participants said they were either ``quite reassured'' or ''completely reassured'' by their assessment at the observation unit. The remaining few reported that they were only slightly reassured or not reassured at all.

``This study has highlighted the need for further research in this area,'' Goodacre and his team conclude. ``Chest pain is a common symptom and we have shown that it is associated with considerable psychologic morbidity (disease) and impairment of quality of life. Assessment of acute chest pain should include consideration of possible psychologic illness,'' they add.

SOURCE: Annals of Emergency Medicine 2001;38:369-376.