Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain, anxiety and interoceptive fear

Hadlandsmyth, Katherine; Rosenbaum, Diane L.; Craft, Jennifer M.; Gervino, Ernest V.; White, Kamila S.

doi:10.1080/08870446.2012.762100

Cited by 28 publications

(40 citation statements)

References 33 publications

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“…Past studies suggest that anxiety disorders are associated with greater utilization of a variety of healthcare services [29,30]. Patients who reported higher overall anxiety in this study may have more health anxiety or concern about their weight, motivating treatment use.…”

Section: Discussionmentioning

confidence: 60%

Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting

McVay

Yancy

Scott

et al. 2016

Behav. Med. Pract. Policy Res.

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Low enrollment in behavioral weight loss treatments limits their impact. We aimed to identify factors associated with treatment initiation. The participants were outpatients (n = 198) at Veterans Affairs (VA) healthcare facilities who were referred to a free VA-based behavioral weight loss treatment. Participants were assessed on psychosocial factors potentially relevant to treatment initiation. Subsequent treatment initiation was determined via medical record review. Study participants were 77 % male, 60 % African American, and 54 % initiated treatment. In multivariable analyses, treatment initiation was associated with being single, higher anxiety, and patients' perceptions that referring provider supported their weight autonomy. Endorsement of treatment barriers was not associated with treatment initiation. Treatments offering in-person sessions and mood management components were rated as more preferred. Initiation of behavioral weight loss treatments may increase if patients believe that providers respect their weight control autonomy and if healthcare organizations offer treatments that match patients' preferences.

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Section: Discussionmentioning

confidence: 60%

Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting

McVay

Yancy

Scott

et al. 2016

Behav. Med. Pract. Policy Res.

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“…A possible mechanism for this can be psychological distress, although there could be physical causes that have not been detected yet. Several studies demonstrate an association between depressive symptoms, anxiety, fear of body sensations and NCCP, and highlight the negative impact these factors have on patients´ health-related quality of life, daily life, pain experience, and healthcare seeking behaviour [6,[20][21][22][23][24]. Yet, the relationship between these psychological factors in patients with NCCP is not fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

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

Mourad

Strömberg

Johansson

et al. 2015

Patient

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Results: About 26 % (n=141) of the study participants reported at least moderate depressive symptoms, 42 % (n=229) reported at least moderate cardiac anxiety, and 62 % (n=337) reported some degree of fear of body sensations. We found a strong positive relationship between depressive symptoms and cardiac anxiety (rs=0.49, p<.01), depressive symptoms and fear of body sensations (rs=0.50, p<.01), and cardiac anxiety and fear of body sensations (rs=0.56, p<.01). About 60 % of the participants sought care due to chest pain once, 26 % 2-3 times, and the rest more than 3 times. In a multivariable regression analysis, and after adjusting for multi-morbidity, cardiac anxiety was the only variable independently associated with healthcare seeking behaviour. Conclusions:Patients with NCCP and many healthcare consultations had high levels of depressive symptoms and cardiac anxiety, and moderate levels of fear of body sensations.Cardiac anxiety had the strongest relationship with healthcare seeking behaviour, and may 2 therefore be an important target for intervention to alleviate suffering and reduce healthcare use and costs. Key points for decision makers• Patients with non-cardiac chest pain and many healthcare consultations experience high levels of depressive symptoms and cardiac anxiety, and moderate levels of fear of body sensations.• Depressive symptoms, cardiac anxiety and fear of body sensations are strongly related to each other and to healthcare seeking behaviour.• Cardiac anxiety influence healthcare seeking behaviour the most and should therefore be targeted with interventions to improve patient outcomes and reduce healthcare costs.3

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“…Uncertainty about the cause for the pain can lead to anxiety (73,75). Anxiety disorders are a risk factor for future development of depression (75) and are associated with healthcare utilization (13). Anxiety is also related to continued chest pain in patients with NCCP (22) and increased attention to cardiopulmonary symptoms (38,62).…”

Section: Cardiac Anxietymentioning

confidence: 99%

“…Due to recurrent chest pain, many patients with NCCP are not satisfied or convinced by the 'ruled out' cardiac diagnosis, as they have not received another explanation for the chest pain (11,12). They therefore tend to misinterpret their pain as cardiac-related and react with fear and avoidance of activities, leading to disability, impaired quality of life, cardiac-related anxiety, increased chest pain, and high and inappropriate use of medical care (4,5,13,14). Avoidance behaviour can lead to maintenance and exacerbation of fear and pain (15,16).…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have demonstrated an association between depressive symptoms, anxiety, fear of body sensations and NCCP, and highlighted the negative impact these factors have on patients' health-related quality of life, daily life, pain experience, and healthcare seeking behaviour (13,14,(19)(20)(21)(22). However, the relationship between these psychological factors and their association with healthcare seeking behaviour needs further exploration.…”

Section: Introductionmentioning

confidence: 99%

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Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

Mourad¹

2015

Linköping University Medical Dissertations

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Introduction: More than half of all patients seeking care for chest pain do not have a cardiac cause for this pain. Despite recurrent episodes of chest pain, many patients are discharged without a clear explanation of the cause for their pain. A lack of explanation may result in a misinterpretation of the pain as being cardiac-related, causing worry and uncertainty, which in turn leads to substantial use of healthcare resources. Psychological distress has been associated with non-cardiac chest pain (NCCP), but there is limited research regarding the relationship between different psychological factors and their association with healthcare utilization. There is a need for interventions to support patients to manage their chest pain, decrease psychological distress, and reduce healthcare utilization and costs. Aim: The overall aim of this thesis was to improve care for patients with non-cardiac chest pain by describing related psychological distress, healthcare utilization and societal costs, and by evaluating an Internet-delivered cognitive behavioural intervention. Designs and methods: This thesis presents results from four quantitative studies. Studies I and II had a longitudinal descriptive and comparative design. The studies used the same initial cohort. Patients were consecutively approached within 2 weeks from the day of discharge from a general hospital in southeast Sweden. In study I, 267 patients participated (131 with NCCP, 66 with acute myocardial infarction (AMI), and 70 with angina pectoris (AP)). Out of these, 199 patients (99 with NCCP, 51 with AMI, 49 with AP) participated in study II. Participants were predominantly male (about 60 %) with a mean age of 67 years. Data was collected on depressive symptoms (Study I), healthcare utilization (Study I, II), and societal costs (Study II). Study III had a cross-sectional explorative and descriptive design. Data was collected consecutively on depressive symptoms, cardiac anxiety and fear of body sensations in 552 patients discharged with diagnoses of NCCP (51 % women, mean age 64 years) from four hospitals in southeast Sweden. Patients were approached within one month from the day of discharge. Study IV was a pilot randomized controlled study including nine men and six women with a median age of 66 years, who were randomly assigned to an intervention (n=7) or control group (n=8). The intervention consisted of a four-session guided Internet-delivered cognitive behavioural therapy (CBT) program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. Data was collected on chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. Results: Depressive symptoms were prevalent in 20 % (Study IV) and 25 % (Study I, III) of the patients, and more than half of the patients still experienced depressive symptoms one year later (Study I). There were no significant differences in prevalence and severity of depressive symptoms between patients diagnosed with NCCP, AMI or AP. Living a...

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Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain, anxiety and interoceptive fear

Cited by 28 publications

References 33 publications

Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting

Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting

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

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

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