School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.
Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC, G6V 3Z1, Canada.
Health Qual Life Outcomes. 2022 Jan 10;20(1):7. doi: 10.1186/s12955-021-01912-8.
Patients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life.
A total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points.
Average NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up.
Comorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.
非心因性胸痛（NCCP）患者合并惊恐障碍（PD）时，其症状更为严重，生活质量相关健康状况较差。虽然广泛性焦虑障碍（GAD）是这些患者中第二常见的精神障碍，但它对 NCCP 和生活质量相关健康状况的影响仍研究不足。本研究描述并前瞻性比较了 NCCP 患者中伴有或不伴有 PD 或 GAD 的患者在以下方面的差异：（1）NCCP 严重程度；（2）生活质量相关健康状况的身体和心理成分。
连续纳入两家急诊科的 915 名 NCCP 患者。采用 DSM-IV 焦虑障碍日程表（Anxiety Disorder Schedule for DSM-IV）在基线时评估合并 PD 或 GAD 的情况。在基线和 6 个月随访时通过结构化电话访谈评估 NCCP 严重程度，患者在两个时间点完成 12 项简明健康状况调查问卷 2 版（12-item Short-Form Health Survey Version 2，SF-12v2）以评估生活质量相关健康状况。
NCCP 严重程度在基线和 6 个月随访时均降低（p<0.001），与仅患有 NCCP 的患者相比，合并 PD 或 GAD 的患者在两个时间点均更高（p<0.001）。然而，PD 患者和 GAD 患者的 NCCP 严重程度无差异（p=0.901）。生活质量的身体成分随时间改善（p=0.016），与其他组相比，伴有或不伴有合并 GAD 的 PD 患者的生活质量身体成分显著更低（p<0.001）。生活质量的心理成分存在显著的时间 x 组交互作用（p=0.0499）。伴有或不伴有合并 PD 的 GAD 与较低的心理健康质量相关，这种影响在 6 个月随访时增加。
前瞻性研究显示，NCCP 患者合并 PD 或 GAD 与胸痛严重程度增加和生活质量相关健康状况降低相关。PD 主要与生活质量的身体成分相关，而 GAD 与心理成分的关联更大。了解这些差异可能有助于管理 NCCP 患者及其合并症。
