Psychological Comorbidity in Patients Presenting to the Emergency Department With Low-Risk Chest Pain and Anxiety.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2025-08-08 DOI:10.1111/acem.70113

Linh Dang, Kurt Kroenke, Jill Connors, Timothy E Stump, Patrick O Monahan, Yelena Chernyak, Emily Holmes, Colin Hoffman, Kevin Prather, Paul I Musey

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引用次数: 0

Abstract

Objective: Low-risk chest pain (LRCP) is one of the most common conditions presenting in the emergency department (ED) and is strongly associated with anxiety. The purpose of this study is to determine the prevalence of other psychological comorbidities and clinical factors associated with severe anxiety in LRCP.

Methods: Baseline data is analyzed from the PACER trial comparing the effectiveness of two telehealth interventions for LRCP patients with anxiety. Key eligibility criteria are a HEART score < 7 and either a GAD-7 anxiety score ≥ 8 or a positive PHQ screener for panic disorder. Psychological comorbidity measures included the Patient Health Questionnaire 8-item (PHQ-8) depression scale, the PHQ-14 somatization scale, the Primary Care Posttraumatic Stress Disorder Screen, the Sheehan Disability Scale, and the General Self-Efficacy Scale. Multivariable modeling is used to determine factors associated with severe anxiety.

Results: The 375 patients had a mean age of 39.9; 70.9% were women; 62.9% were White, 32.6% Black, and 4.5% other race. The majority (75%) screened positive for panic disorder, and 42% of participants had severe anxiety (GAD-7 ≥ 15). Non-anxiety psychological comorbidity was very high; the proportion of patients exceeding scale cut points was 58% for depression, 57% for PTSD, 52% for somatization, 59% for high disability, and 31% for low self-efficacy; each was significantly associated with severe anxiety on univariable analysis. Four patient characteristics were independently associated with severe anxiety in multivariable models: odds ratios (95% CI) were 2.7 (1.5-4.9) for depression, 2.3 (1.4-3.9) for low self-efficacy, 2.1 (1.2-3.6) for low education (high school or less), and 1.8 (1.0 to 3.3) for female sex.

Conclusions: LRCP is accompanied not only by anxiety but also by other potentially treatable psychological comorbidities Severe anxiety is more common in individuals with depression, low self-efficacy, lower education, and possibly women.

Trail registration: PACER is registered in clinicaltrials.gov identifier: NCT04811521.

查看原文本刊更多论文

急诊科低危胸痛和焦虑患者的心理合并症

目的：低危性胸痛（LRCP）是急诊科（ED）最常见的症状之一，与焦虑密切相关。本研究的目的是确定LRCP中与严重焦虑相关的其他心理合并症和临床因素的患病率。方法：分析PACER试验的基线数据，比较两种远程医疗干预对LRCP患者焦虑的有效性。结果：375例患者的平均年龄为39.9岁；70.9%为女性；白人占62.9%，黑人占32.6%，其他种族占4.5%。大多数（75%）惊恐障碍筛查呈阳性，42%的参与者有严重焦虑（GAD-7≥15）。非焦虑性心理共病非常高；抑郁症患者超过量表切点的比例为58%，PTSD患者为57%，躯体化患者为52%，高残疾患者为59%，低自我效能患者为31%；单变量分析显示，每一项都与严重焦虑显著相关。在多变量模型中，四种患者特征与严重焦虑独立相关：抑郁症的比值比为2.7(1.5-4.9)，低自我效能的比值比为2.3(1.4-3.9)，低教育程度（高中以下）的比值比为2.1(1.2-3.6)，女性的比值比为1.8（1.0 - 3.3）。结论：LRCP不仅伴有焦虑，还伴有其他潜在的可治疗的心理合并症。严重的焦虑更常见于抑郁症、低自我效能、低教育程度的个体，可能还有女性。试验注册：PACER在clinicaltrials.gov注册，识别码：NCT04811521。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.