Anxiety is Prevailing in Non-Cardiac Chest Pain Subjects, while Somatisation is Not A Comparative Study in the Emergency Department

Objective: The main purpose of this study was to verify if non-cardiac chest pain (NCCP) subjects recruited in an Emergency Department were more anxious, depressive or burdened by somatoform symptoms as compared with cardiac chest pain (CCP) subjects, and with subjects without chest pain (WOCP). Methods: We included patients with chest pain not attributable to a gastro-oesophageal reflux disorder. NCCP subjects were negative at ECG examination and at troponin test at baseline and after three months. A number of instruments were administered, measuring anxiety and depression (HADS), somatisation (somatisation scale of SCL- 90, TAS-20), and the health-related QoL (SF-12), along with other scales measuring the social and experiential profile. Results: We recruited 435 subjects (of which NCCP were 44.8%) in the Emergency Department, while other 147 subjects were recruited in a primary care clinic. The logistic regression showed that the levels of HADS anxiety in the three groups were dissimilar, even when adjusted for confounding variables: taking NCCP as reference category, adjusted ORs were 0.64 for CCP (IC95% 0.42 – 0.96) and 0.23 for WOCP (IC95% 0.13 – 0.40). When considering the somatisation construct, CCP and NCCP subjects reported similar somatic symptom complaints, higher than WOCP subjects. Moreover, even if NCCP subjects showed higher TAS-20 scores than WOCP subjects, these scores were below the range of a possible alexithymia. As for the physical health-related QoL (SF-12, subscale PCS-12), regression analyses showed that the PCS-12 mean score of NCCP was higher than that of CCP (ß -2.31; IC95% -4.14 to -0.48) and lower than that of WOCP (ß 2.24; IC95% 0.12 – 4.37). Conclusion : NCCP subjects are characterised from an elevated anxiety, together with a better physical well-being, when compared with subjects who have a cardiac failure. The somatisation construct seems less useful to distinguish NCCP from CCP subjects. Consequently, anxiety should be the major target of our mental-health intervention when treating subjects with chest pain.