Psychological morbidity and illness appraisals of patients with cardiac and non-cardiac chest pain attending a rapid access chest pain clinic: a longitudinal cohort study.
OBJECTIVE
To assess the psychological morbidity and illness beliefs in newly referred patients with chest pain, and to compare the psychological morbidity of patients with pain of cardiac origin with that of patients with pain of non-cardiac origin.


METHODS
Longitudinal cohort study.


METHODS
Rapid Access Chest Pain Clinic in a tertiary referral centre in Leicester, United Kingdom.


METHODS
246 patients with acute, undifferentiated, chest pain followed up 1 week and 2 months subsequent to clinic attendance.


METHODS
Levels of affective disturbance, health anxiety and illness perception.


RESULTS
Levels of anxiety before clinic attendance exceeded community norms but did not differentiate the two groups. However, after clinic attendance levels of anxiety for those with a non-cardiac diagnosis significantly exceeded those of patients whose pain was of cardiac origin and remained above community norms 2 months hence. Non-cardiac patients viewed their condition as significantly less controllable and less understandable than those whose pain was cardiac in origin. Levels of depression for those with cardiac pain also significantly increased to above community norms after clinic attendance.


CONCLUSIONS
Clinical levels of psychological morbidity are evident in the immediate and long-term aftermath of a visit to a Rapid Access Chest Pain Clinic, despite early access and provision of reassurance. More structured interventions appear necessary to deal with both distress and illness beliefs that may influence future healthcare use.
Robertson
N
N
School of Psychology, University of Leicester, UK. nr6@le.ac.uk
Javed
N
N
Samani
N J
NJ
Khunti
K
K
D001007:Anxiety / Q000523:psychology*; D002637:Chest Pain / Q000175:diagnosis / Q000523:psychology*; D004812:Epidemiologic Methods; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012017:Referral and Consultation; D012647:Self-Assessment