Anxiety and Depression Linked to Chest Pain in Young Adults

Anxiety, depression, or another mental health disorder may be the underlying explanation for many cases of unexplained chest pain in young adults, according to scientists from King's College London, University College London, and Oxford University.

The researchers studied more than 5,000 individuals from birth in 1946 to young adulthood. Chest pain was more than three times as common among 36-year-olds with a psychiatric disorder or significant psychiatric symptoms than among those with no psychiatric symptoms. Seven years later, those with psychiatric problems were more than twice as likely to have developed chest pains than those who had not exhibited psychiatric symptoms.

"The relationship between chest pain and psychiatric disorder should act as a reminder to clinicians that a high proportion of patients who experience chest pain will have anxiety and depression that may require treatment," said lead author Matthew Hotopf, MB, BS, MRCPsych, MSc, King's College London. "Our finding that new onset chest pain is associated with previous psychiatric disorder implies that anxiety and depression may have a causal role."

Although chest pain was not uncommon among this group of 36-year-old men and women, heart disease was extremely rare, the researchers say. Overall, 17.2 percent of the 3,322 people interviewed reported chest pain. But among the 34 adults who experienced the most severe symptoms – chest pain brought on by physical exercise – there was only one confirmed case of active heart disease. The scientists report their findings in the November/December issue of Psychosomatic Medicine.

The researchers estimate that psychiatric illness or symptoms could explain up to one-quarter of all chest pain cases in the study and up to 60 percent of cases of chest pain brought on by physical exercise.

Researchers also previously examined links between illness experiences in childhood and unexplained chest pain during adulthood. In the current study, individuals with a variety of illnesses in childhood were no more likely to report chest pain in adulthood. But those who had been frequently absent from school or rated as easily fatigued in childhood were more likely to report chest pain. The same was true for people who had one or more family members with poor health, including heart disease.

"Certain previous experiences, which may include having relatives with physical illnesses or suffering fatigue as a child, may lead the individual to react to normal sensations in a different way," said Hotopf. "Individuals from sick families may be more likely to notice and remember minor symptoms such as chest tightness and they may seek medical investigation and reassurance for such symptoms."

The research was funded by the Medical Research Council.

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Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Joel E. Dimsdale, MD, at (619) 543-5468.