The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Determinants of depression in non-cardiac chest pain patients: a cross sectional study

  • Roohafza, Hamidreza (Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Yavari, Niloufar (Students' Research Committee, School of Medicine, Isfahan University of Medical Sciences) ;
  • Feizi, Awat (Department of Biostatistics and Epidemiology, School of Health and Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Khani, Azam (Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Saneian, Parsa (Students' Research Committee, School of Medicine, Isfahan University of Medical Sciences) ;
  • Bagherieh, Sara (Students' Research Committee, School of Medicine, Isfahan University of Medical Sciences) ;
  • Sattar, Fereshteh (Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Sadeghi, Masoumeh (Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences)
  • Received : 2021.01.20
  • Accepted : 2021.04.06
  • Published : 2021.10.01
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Abstract

Background: Non-cardiac chest pain (NCCP) is a common patient complaint imposing great costs on the healthcare system. It is associated with psychological factors such as depression. The aim of the present study is determining depression predictors in NCCP patients. Methods: The participants of this cross-sectional study were 361 NCCP patients. Patients filled out questionnaires concerning their sociodemographic, lifestyle, and clinical factors (severity of pain, type D personality, somatization, cardiac anxiety, fear of body sensations, and depression). Results: Based on multiple ordinal logistic regression, lack of physical activity (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.09-2.87), sleep quality (OR, 2.98; 95% CI, 1.15-7.69), being a smoker (OR, 1.33; 95% CI, 2.41-4.03), present pain intensity (OR, 1.08; 95% CI, 1.05-1.11), type D personality (OR, 2.43; 95% CI, 1.47-4.03), and somatization (OR, 1.22; 95% CI, 1.15-1.3) were significant predictors of depression in NCCP patients. Additionally, multiple linear regression showed that being unmarried (β = 1.51, P = 0.008), lack of physical activity (β = 1.22, P = 0.015), sleep quality (β = 2.26, P = 0.022), present pain intensity (β = 0.07, P = 0.045), type D personality (β = 1.87, P < 0.001), somatization (β = 0.45, P < 0.001), and fear of bodily sensation (β = 0.04, P = 0.032) increased significantly depression scores in NCCP patients. Conclusions: Physicians should consider the predictors of depression in NCCP patients which can lead to receiving effective psychological consultations and reducing the costs and ineffectual referrals to medical centers.

Keywords

Acknowledgement

The authors would like to thank all patients who participated to the study and Mr. Ali Karami for his contribution to collect data.

References

  1. Meresh E, Piletz J, Halaris A. Noncardiac chest pain: systematic review of the literature on prognosis. Res Rep Clin Cardiol 2018; 9: 1-9. https://doi.org/10.2147/RRCC.S155441
  2. Schroeder S, Achenbach S, Korber S, Nowy K, de Zwaan M, Martin A. Cognitive-perceptual factors in noncardiac chest pain and cardiac chest pain. Psychosom Med 2012; 74: 861-8. https://doi.org/10.1097/PSY.0b013e31826ae4ae
  3. Mourad G, Alwin J, Stromberg A, Jaarsma T. Societal costs of non-cardiac chest pain compared with ischemic heart disease--a longitudinal study. BMC Health Serv Res 2013; 13: 403. https://doi.org/10.1186/1472-6963-13-403
  4. Castonguay J, Turcotte S, Fleet RP, Archambault PM, Dionne CE, Denis I, et al. Physical activity and disability in patients with noncardiac chest pain: a longitudinal cohort study. Biopsychosoc Med 2020; 14: 12. https://doi.org/10.1186/s13030-020-00185-9
  5. Mourad G, Alwin J, Jaarsma T, Stromberg A, Johansson P. The associations between psychological distress and healthrelated quality of life in patients with non-cardiac chest pain. Health Qual Life Outcomes 2020; 18: 68. https://doi.org/10.1186/s12955-020-01297-0
  6. Israel JI, White KS, Gervino EV. Illness perceptions, negative emotions, and pain in patients with noncardiac chest pain. J Clin Psychol Med Settings 2015; 22: 77-89. https://doi.org/10.1007/s10880-015-9419-6
  7. Kuijpers PM, Denollet J, Wellens HJ, Crijns HM, Honig A. Noncardiac chest pain in the emergency department: the role of cardiac history, anxiety or depression and Type D personality. Eur J Cardiovasc Prev Rehabil 2007; 14: 273-9. https://doi.org/10.1097/HJR.0b013e32801da0fc
  8. Malhi GS, Mann JJ. Depression. Lancet 2018; 392: 2299-312. https://doi.org/10.1016/S0140-6736(18)31948-2
  9. Lee HJ, Choi EJ, Nahm FS, Yoon IY, Lee PB. Prevalence of unrecognized depression in patients with chronic pain without a history of psychiatric diseases. Korean J Pain 2018; 31: 116-24. https://doi.org/10.3344/kjp.2018.31.2.116
  10. Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence? J Neuroendocrinol 2001; 13: 1009-23. https://doi.org/10.1046/j.0007-1331.2001.00727.x
  11. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163: 2433-45. https://doi.org/10.1001/archinte.163.20.2433
  12. Mendelsohn C. Smoking and depression--a review. Aust Fam Physician 2012; 41: 304-7.
  13. Roshanaei-Moghaddam B, Katon WJ, Russo J. The longitudinal effects of depression on physical activity. Gen Hosp Psychiatry 2009; 31: 306-15. https://doi.org/10.1016/j.genhosppsych.2009.04.002
  14. Sivertsen B, Lallukka T, Petrie KJ, Steingrimsdottir OA, Stubhaug A, Nielsen CS. Sleep and pain sensitivity in adults. Pain 2015; 156: 1433-9. https://doi.org/10.1097/j.pain.0000000000000131
  15. Otto MW, Dougher MJ, Yeo RA. Depression, pain, and hemispheric activation. J Nerv Ment Dis 1989; 177: 210-8. https://doi.org/10.1097/00005053-198904000-00004
  16. Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry 2007; 29: 417-24. https://doi.org/10.1016/j.genhosppsych.2007.06.005
  17. Zhang YL, Liang W, Chen ZM, Zhang HM, Zhang JH, Weng XQ, et al. Validity and reliability of Patient Health Questionnaire-9 and Patient Health Questionnaire-2 to screen for depression among college students in China. Asia Pac Psychiatry 2013; 5: 268-75. https://doi.org/10.1111/appy.12103
  18. Dadfar M, Kalibatseva Z, Lester D. Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. Trends Psychiatry Psychother 2018; 40: 144-51. https://doi.org/10.1590/2237-6089-2017-0116
  19. Roohafza H, Feizi A, Gharipour M, Khani A, Dianatkhah M, Sarrafzadegan N, et al. Development and validation of a socioeconomic status short-form questionnaire (SES-SQ). ARYA Atheroscler 2021; 17: 2355.
  20. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987; 30: 191-7. https://doi.org/10.1016/0304-3959(87)91074-8
  21. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975; 1: 277-99. https://doi.org/10.1016/0304-3959(75)90044-5
  22. Adelmanesh F, Arvantaj A, Rashki H, Ketabchi S, Montazeri A, Raissi G. Results from the translation and adaptation of the Iranian Short-Form McGill Pain Questionnaire (I-SF-MPQ): preliminary evidence of its reliability, construct validity and sensitivity in an Iranian pain population. Sports Med Arthrosc Rehabil Ther Technol 2011; 3: 2. https://doi.org/10.1186/1758-2555-3-2
  23. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med 2005; 67: 89-97. https://doi.org/10.1097/01.psy.0000149256.81953.49
  24. Bagherian R, Bahrami Ehsan H. Psychometric properties of the Persian version of Type D personality scale (DS14). Iran J Psychiatry Behav Sci 2011; 5: 12-7.
  25. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002; 64: 258-66. https://doi.org/10.1097/00006842-200203000-00008
  26. Dadfar M, Asgharnejadfarid AA, Hosseini AF, Esfahani MN, Lester D, Kalibatseva Z. Measuring somatic symptoms with the PHQ-15: a comparative study of three Iranian samples. Ment Health Relig Cult 2020; 23: 289-301.
  27. Eifert GH, Thompson RN, Zvolensky MJ, Edwards K, Frazer NL, Haddad JW, et al. The Cardiac Anxiety Questionnaire: development and preliminary validity. Behav Res Ther 2000; 38: 1039-53. https://doi.org/10.1016/S0005-7967(99)00132-1
  28. Raiesdana N, Kamali E, Soleimani M, Mir Mohammad khani M. Assessment of situational and heart focused anxiety in patients with coronary artery disease before angiography. Koomesh 2017; 19: 199-206.
  29. Mourad G, Stromberg A, Johansson P, Jaarsma T. Depressive symptoms, cardiac anxiety, and fear of body sensations in patients with non-cardiac chest pain, and their relation to healthcare-seeking behavior: a cross-sectional study. Patient 2016; 9: 69-77. https://doi.org/10.1007/s40271-015-0125-0
  30. Dean J, Keshavan M. The neurobiology of depression: an integrated view. Asian J Psychiatr 2017; 27: 101-11. https://doi.org/10.1016/j.ajp.2017.01.025
  31. Boone D, Kim SY. Family strain, depression, and somatic amplification in adults with chronic pain. Int J Behav Med 2019; 26: 427-36. https://doi.org/10.1007/s12529-019-09799-y
  32. Lipowski ZJ. Somatization and depression. Psychosomatics 1990; 31: 13-21. https://doi.org/10.1016/S0033-3182(90)72212-8
  33. Michal M, Wiltink J, Grande G, Beutel ME, Brahler E. Type D personality is independently associated with major psychosocial stressors and increased health care utilization in the general population. J Affect Disord 2011; 134: 396-403. https://doi.org/10.1016/j.jad.2011.05.033
  34. de Vroege L, de Heer EW, van der Thiel E, van den Broek KC, van Eck van der Sluijs JF, van der Feltz-Cornelis CM. Type D personality, concomitant depressive and anxiety disorders, and treatment outcomes in somatic symptom and related disorders: an observational longitudinal cohort study. Front Psychiatry 2019; 10: 417. https://doi.org/10.3389/fpsyt.2019.00417
  35. Sher L. Type D personality: the heart, stress, and cortisol. QJM 2005; 98: 323-9. https://doi.org/10.1093/qjmed/hci064
  36. Zhang JM, An J. Cytokines, inflammation, and pain. Int Anesthesiol Clin 2007; 45: 27-37. https://doi.org/10.1097/AIA.0b013e318034194e
  37. Lankhorst MA. Smoking and chronic pain. J Pain Palliat Care Pharmacother 2016; 30: 326-7. https://doi.org/10.1080/15360288.2016.1231737
  38. Cuellar NG, Ratcliffe SJ, Chien D. Effects of depression on sleep quality, fatigue, and sleepiness in persons with restless legs syndrome. J Am Psychiatr Nurses Assoc 2006; 12: 262-71. https://doi.org/10.1177/1078390306295070