Anxiety and depression among patients of non-cardiac chest pain and other medically ill patients


  • Maya . Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
  • Puja Pallavi Department of Psychiatry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
  • Ajay Kumar Bakhla Department of Psychiatry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India



Anxiety, Co morbidity, Depression, Non cardiac chest pain


Background: The current study compared severity of anxiety and depression patients of NCCP and other medical conditions in male adults.

Methods: Sample consisted of consenting male patients from cardiology OPD with symptom of chest pain, whereas control group consisted of patients without symptoms of chest pain, aged between 18 to 60 years. Exclusion criteria for both groups included unstable or life-threatening medical conditions, psychosis, substance use disorders, or any psychiatric illness. Both experimental and control group were evaluated with history, clinical examinations and indicated investigations. The socio demographic data sheet and Hospital Anxiety and Depression Scale (HADS) was applied, patients were asked to read all 14 question and place a tick against the reply representing their feelings, the answers were rated with Likert pattern of scoring. The collected data statistically analyzed.

Results: A total of 51 patients of experimental group with mean age of 44.82±7.63years and 76 control with mean 46.30±8.45 years were participated for this study. The mean HADS anxiety score for NCCP was 13.29±3.42 and for the group of other patients it was 11.06±3.54 (t value=-3.517, df=125 and p value=0.001). Whereas the mean HADS depression score for NCCP was 12.58±2.76 and for the group of other patients it was 10.90±2.26 (t value=-3.743, df=125 and p value=0.000).

Conclusions: NCCP is associated with significantly higher anxiety and depression in comparison to other medically ill patients.


Mikhail M, Crowley G, Haider SH, Veerappan A, Lam R, Talusan A, et al. Non-Cardiac Chest Pain: A Review of Environmental Exposure-Associated Comorbidities and Biomarkers. EMJ. Gastroenterol. 2018 Dec;7(1):103.

Smeijers L, van de Pas H, Nyklicek I, Notten PJ, Pedersen SS, Kop WJ. The independent association of anxiety with non-cardiac chest pain. Psychol health. 2014 Mar 4;29(3):253-63.

Huffman JC, Pollack MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psycho. 2003 May 1;44(3):222-36.

White KS, Craft JM, Gervino EV. Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders. Behav Res thera. 2010 May 1;48(5):394-401.

Mourad G, Strömberg A, Johansson P, Jaarsma T. 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. Patient-Patient-Cent Outcom Res. 2016 Feb 1;9(1):69-77.

Hadlandsmyth K, White KS, Krone RJ. Quality of life in patients with non-CAD chest pain: associations to fear of pain and psychiatric disorder severity. J Clin Psychol Med settings. 2013 Sep 1;20(3):284-93.

Smeijers L, van de Pas H, Nyklicek I, Notten PJ, Pedersen SS, Kop WJ. The independent association of anxiety with non-cardiac chest pain. Psychol Health 2014;29:253-63.

Webster R, Norman P, Goodacre S, Thompson AR, McEachan RR. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department. Psychol health. 2014 Nov 2;29(11):1265-82.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983 Jun;67(6):361-70.

Mayou R. Chest pain, palpitations and panic. J Psych Res. 1998 Jan 1;44(1):53-70.

White KS, Raffa SD, Jakle KR, Stoddard JA, Barlow DH, Brown TA, et al. Morbidity of DSM-IV Axis I disorder in patients with noncardiac chest pain: Psychiatric morbidity linked with increased pain and health care utilization. J Consulting Clin Psychol. 2008 Jun;76(3):422.

O’donovan A, Slavich GM, Epel ES, Neylan TC. Exaggerated neurobiological sensitivity to threat as a mechanism linking anxiety with increased risk for diseases of aging. Neurosci Bio Rev. 2013 Jan 1;37(1):96-108.

Alexander PJ, Prabhu SG, Krishnamoorthy ES, Halkatti PC. Mental disorders in patients with noncardiac chest pain. Acta Psychiatr Scand. 1994;89(5):291-3.

Ho KY, Kang JY, Yeo B, Ng WL. Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors. Gut. 1998 Jul 1;43(1):105-10.

Hocaoglu C, Gulec MY, Durmus I. Psychiatric comorbidity in patients with chest pain without a cardiac etiology. Israel J Psych Related Sci. 2008 Jan 1;45(1):49.

Kushner MG, Beitman BD, Beck NC. Factors predictive of panic disorder in cardiology patients with chest pain and no evidence of coronary artery disease: a cross-validation. J Psych Res. 1989 Jan 1;33(2):207-15.

Basha I, Mukerji V, Langevin P, Kushner M, Alpert M, Beitman BD. Atypical angina in patients with coronary artery disease suggests panic disorder. Int J Psych Med. 1990 Dec;19(4):341-6.

Fleet RP, Dupuis G, Marchand A, Burelle D, Beitman BD. Detecting panic disorder in emergency department chest pain patients: a validated model to improve recognition. Annal Beha Med. 1997 Jun 1;19(2):124-31.

Beitman BD. Panic disorder in patients with angiographically normal coronary arteries. Am J Med. 1992;92(5):33S-40S.

Reis SE, Holubkov R, Smith AC, Kelsey SF, Sharaf BL, Reichek N, et al. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J. 2001 May 1;141(5):735-41.

Jerlock M, Gaston‐Johansson F, Danielson E. Living with unexplained chest pain. J Clini Nurs. 2005 Sep;14(8):956-64.

Eslick GD, Coulshed DS, Talley NJ. the burden of illness of non‐cardiac chest pain. Alimen Pharmacol Thera. 2002 Jul;16(7):1217-23.

Husser D, Bollmann A, Kühne C, Molling J, Klein HU. Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life. Eur J pain. 2006 Jan;10(1):51.

Pitt B. Increased cardiovascular risk associated with non-cardiac chest pain in patients with a prior psychiatric hospitalization: an opportunity and challenge for both the psychiatrist and the cardiologist. Eur Heart J. 2012;33(6):692-4.

Van Handel D, Fass R. The pathophysiology of non-cardiac chest pain. J Gastroenterol Hepatol. 2005;20:S6-13.

Fang J, Bjorkman D. A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment. Ame J Gastroenterol. 2001 Apr 1;96(4):958-68.

Lembo AJ. Visceral hypersensitivity in noncardiac chest pain. Gastroenterol Clin. 2004 Mar 1;33(1):55-60.






Original Research Articles