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Psychosocial and Developmental Antecedents of Chest Pain in Young Adults

Hotopf, Matthew MB, BS, MRCPsych, MSc; Mayou, Richard BM, BCh, MPhil, MSc, MA, FRCP, FRCPsych; Wadsworth, Michael BA, MPhil, PhD, Hon MFPHM; Wessely, Simon MA, MSc, MD, FRCP, MRCPsych

ORIGINAL ARTICLES
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Objective The objective of this study was to assess the relationships among chest pain, psychiatric disorder, and early experience of ill health.

Methods The Medical Research Council National Survey of Health and Development is a population-based birth cohort study established in 1946 (N= 5362). During childhood, several informants (parents, teachers, and school physicians) were interviewed or completed questionnaires. Data were available on the subjects’ health, the health of their parents, and subjects’ personalities. At the age of 36 years, subjects were asked about chest pain using the Rose Angina Questionnaire and completed the Present State Examination, a semistructured psychiatric interview. Subjects were followed for another 7 years (to age 43 years) to determine the outcome of those with chest pain.

Results Chest pain was reported in 17.2% (95% CI = 15.9–18.5%) of respondents at 36 years. The prevalence of exertional chest pain was 1.0% (95% CI = 0.7–1.3%). There was little evidence of coronary heart disease in those with exertional pain at age 36 years when followed for 7 years. However, there was a powerful cross-sectional relationship between psychiatric disorder and chest pain (OR for psychiatric disorder and all chest pain = 3.55, 95% CI = 2.34–5.37; OR for psychiatric disorder and exertional chest pain = 29.08, 95% CI = 6.65–127.15). Childhood risk factors, including poor health reported in parents at age 15 years and fatigue during childhood, were also associated with chest pain.

Conclusions Chest pain (especially exertional chest pain) is strongly associated with psychiatric disorders in young adults. Childhood experiences, including illness in parents, are associated with subsequent chest pain.

From the Guy’s, King’s, and St. Thomas’ School of Medicine and the Institute of Psychiatry (M.H., S.W.), London; Department of Psychiatry (R.M.), Oxford University, Oxford; and Medical Research Council National Survey of Health and Development and Department of Epidemiology and Public Health (M.W.), University College of London Medical School, London, United Kingdom.

Received for publication April 5, 1999;

revision received June 16, 1999.

Address reprint requests to: Dr. Hotopf, Clinical Senior Lecturer, Department of Psychological Medicine, Guy’s, King’s, and St. Thomas’ School of Medicine, and Institute of Psychiatry, 103 Denmark Hill, London SE5 8AZ, United Kingdom. Email: m.hotopf@iop.kcl.ac.uk

Copyright © 1999 by American Psychosomatic Society
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