Anxiety disorders in children with non-cardiac chest pain: Is routine screening needed in pediatric clinics?

Background: The present study aimed to determine anxiety disorders and other psychopathologies in children and adolescents with non-cardiac chest pain.

Methods: A total of 115 patients (between 8 and 16 years of age), including 61 cases of non-cardiac chest pain referred from the Pediatric Cardiology Outpatient Clinic and 54 healthy volunteers, were included in the study.

Results: The majority of patients with chest pain were girls (82%, p = 0.001). The pain was predominantly localized to the left chest (73.8%), occurred both on exertion and at rest (59%), was not radiating (80.3%), lasted 1-5 min (37.7%), and had been present for more than a year. Psychiatric disorders were found in 39.3% of the chest pain group (p < 0.001). Generalized anxiety disorder (GAD) was the most common diagnosis (19.7%), followed by Attention-deficit/hyperactivity disorder (ADHD) (8.2%). Social anxiety disorder (SAD) (5.6%) and GAD (3.7%) were more common in the control group. The prevalence of GAD was significantly different between groups (p = 0.009). Screen for child anxiety-related disorders (SCARED) (p < 0.001) and Children's Somatization Inventory-24 (CSI-24) (p < 0.001) scores were significantly higher in the chest pain group. The SCARED total score was higher in girls (p = 0.011), and the subscale scores were higher for GAD in adolescents (p = 0.019) and separation anxiety in children (p = 0.043).

Conclusion: We believe that it would be beneficial to perform screenings using scales in outpatient clinics with a high number of patients presenting with chest pain and to refer them for psychiatric evaluation to prevent unnecessary medical diagnostic procedures in children who describe unexplained chest pain and to prevent the potential for mental disorder diagnoses in children.