Depression, Anxiety Associated With Recurrent Chest Pain

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Researchers sought to determine whether psychological states are associated with recurrent chest pain.

Depression is associated with recurrent chest pain in adults regardless of the presence of coronary artery disease, according to the results of a study published in the American Heart Journal.

In this prospective cohort study, researchers evaluated 365 patients with acute chest pain and low-to moderate-cardiac risk who were admitted to the emergency department. Once infarction was ruled out, participants underwent cardiac stress testing. To determine the association between psychiatric conditions and recurrent chest pain at 30 days post-discharge, participants completed the Patient Health Questionnaire (PHQ8), Clinical Anxiety Scale (CAS), and Perceived Stress Scale (PSS).

A total of 36% of participants (n=131) reported recurrent chest pain within 30 days. Compared with participants who did not report recurrent chest pain, those who did had higher mean scores of depression (evaluated by PHQ8; 6.78 vs 4.61), anxiety (evaluated by CAS; 46.3 vs 41.3), and perceived stress (evaluated by PSS; 17.4 vs 16.1).

After adjustment for sociodemographic and clinical variables, depression increased the risk for recurrent chest pain (odds ratio [OR] 2.11; 95% CI, 1.18-3.79). Perceived stress (OR 0.96; 95% CI, 0.60-1.53) and anxiety (OR 1.59; 95% CI, 0.80-3.20) were not associated with an increased risk for recurrent chest pain.

Depression, anxiety, and perceived stress scores were all positively correlated with increasing chest pain frequency, and the relationship was significant for depression (P <.001). The researchers noted that patients with chest pain 1 to 3 times daily had average PHQ8 scores twice those of patients without recurrent chest pain.

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Although baseline antidepressant use increased the risk for recurrent chest pain (OR 2.82), patients taking antidepressants with controlled depression (defined as PHQ8 <10) did not have a significantly increased risk for chest pain (OR 1.89).

The study authors concluded that the study “underscores the impact of depression in patients who present with chest pain with and without history of [coronary artery disease]…. Approaches to screen and manage depression early in the [emergency department] chest pain center may have significant implications in curtailing recidivism and [improving] quality of life for these patients.”


Kim Y, Soffler M, Paradise S, et al. Depression is associated with recurrent chest pain with or without coronary artery disease: A prospective cohort study in the emergency department. Am Heart J. 2017;191:47-54.