Date of Award

January 2015

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Basmah Safdar

Subject Area(s)

Medicine, Mental health

Abstract

SYMPTOMS OF DEPRESSION ARE LINKED TO SUBSEQUENT RECURRENT CHEST PAIN IN PATIENTS ADMITTED TO AN EMERGENCY DEPARTMENT CHEST PAIN UNIT. Summer A. Paradise, Matt Naftilan, James Dziura, Aini Jelani, Morgan Soffler and Basmah Safdar. Department of Emergency Medicine, Yale University, School of Medicine, New Haven, CT.

Prior studies suggest a high prevalence of depression in patients with chest pain, but few US studies have examined depression and recurrent chest pain in the emergency room setting. This study sought to compare symptoms of depression, socio-demographic features, and clinical features between low-moderate-risk emergency room (ER) chest pain center (CPC) patients with and without recurrent chest pain at one-month following enrollment.

This study was a prospective cohort study using convenience sample at a tertiary care hospital emergency room in a semi-urban setting. Patients were recruited from the chest pain center (CPC), and completed baseline surveys that assessed depression, anxiety, stress and chest pain. A one-month follow-up assessed the recurrence of chest pain. Univariate and multivariate statistical analyses were conducted.

Between July 30th 2013 to January 31st 2015 a total of 850 patients were invited to participate in our study, 442 (52.0%) agreed to do so, of which 327 (74.0%) were included in the final analysis. An overall 29% had some evidence of depression, be it high symptom scores or current treatment for depression. In addition, using the PHQ-8, we identified forty-one (12.5%) new patients with depressive symptoms. More than two-thirds of enrolled patients had chest pain on at least one occasion following discharge from the hospital (n=115; 35.2%). Patients with recurrent chest pain tended to be slightly younger (51 versus 55 years of age; p= .001), more female (64.3%; p= .023) and less Caucasian (63.5% versus 70.3%; p= .154). In general, women had higher rates of recurrent/persistent chest pain (n=74/184; 40.2%) than men (n=41/143; 28.7%). The overall burden of depression was 37.4% of patients with recurrent/persistent chest pain, compared to 24.5% of patients without (p= .018). Regression analysis revealed that for each single point increase in PHQ-8 score, there is an 7.5% increase in the odds of having recurrent chest pain (model 5: OR=1.075; 95% CI=1.005, 1.149; p= .035). Gender also had a significant effect in the regression model, and the overall burden of depression was highest among women with recurrent/persistent chest pain (43.2%), and differed significantly from women without recurrent/persistent chest pain (26.4%), (p= .023).

The prevalence of depression is high in ER patients with chest pain, and this is particularly relevant for women with baseline depression and recurrent chest pain at one-month follow-up.

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