title: 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.
abstract: BACKGROUND
  Patients with non-cardiac chest pain (NCCP) suffer from recurrent chest pain and make substantial use of healthcare resources.
  
  
  OBJECTIVE
  To explore the prevalence of depressive symptoms, cardiac anxiety, and fear of body sensations in patients discharged with a NCCP diagnosis; and to describe how depressive symptoms, cardiac anxiety, and fear of body sensations are related to each other and to healthcare-seeking behavior.
  
  
  METHODS
  Cross-sectional design. Data were collected between late October 2013 and early January 2014 in 552 patients with NCCP from four hospitals in southeast Sweden, using the Patient Health Questionnaire-9, Cardiac Anxiety Questionnaire, and Body Sensations Questionnaire.
  
  
  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 strong positive relationships between depressive symptoms and cardiac anxiety (r s = 0.49; P < 0.01), depressive symptoms and fear of body sensations (r s = 0.50; P < 0.01), and cardiac anxiety and fear of body sensations (r s = 0.56; P < 0.01). About 60 % of the participants sought care because of chest pain once, 26 % two or three times, and the rest more than three times. In a multivariable regression analysis, and after adjustment for multimorbidity, cardiac anxiety was the only variable independently associated with healthcare-seeking behavior.
  
  
  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 behavior and may therefore be an important target for intervention to alleviate suffering and to reduce healthcare use and costs.
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Kungsgatan 40, 601 74, Norrköping, Sweden. ghassan.mourad@liu.se.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Mourad
authors.affiliation: Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Strömberg
authors.affiliation: Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Johansson
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Kungsgatan 40, 601 74, Norrköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D002637:Chest Pain / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057566:Self Report; D012959:Socioeconomic Factors; D013548:Sweden
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