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

E. W. de Heer*, J. E. Palacios, H. J. Adèr, H. W. J. van Marwijk, A. Tylee, C. M. van der Feltz-Cornelis

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

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.
Original languageEnglish
Article number109891
JournalJournal of Psychosomatic Research
Volume129
DOIs
Publication statusPublished - 2020

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