Essay: Comparison of Depression, Anxiety, and Stress in Non-Coronary Patients with Mild and Severe Chest Pain

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Abstract
Background: With respect to the fact that physical and psychological factors affect each other in patients with non-cardiac chest pain:
Objective: The present study was carried out to compare the depression, anxiety, and stress severity in non-coronary patients with mild and severe chest pain.
Patients and Methods: A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center, Kermanshah city, Iran. Using a matching method, 94 participants were selected and studied in two groups of 47. The instruments of the study comprised comorbidity index, the Brief Pain Index (BPI), and the Depression, Anxiety, and Stress Scale (DASS). The multivariate analysis of variance, chi-squared test, and t-test were used for data analysis.
Results: After adjustment for the effects of age and comorbid conditions, the results showed that there was significant difference among the two groups in terms of depression, anxiety and stress and the severity of these variables was more pronounced in patients with severe chest pain (P < 0.001).
Conclusion: Depression, anxiety, and stress are common psychological occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Therefore, paying attention to psychological factors could help the experts choose solutions to decrease pain and side effects of the diseases. It also may facilitate treatment procedures among patients in severe pain. Further investigation to determine the association between these variables and non-coronary chest pain is necessary.
Keywords: Non-coronary; chest pain; depression; anxiety; stress; patients.

1. Background
Chest pain is a common symptom in general population (1) which is regarded as the second cause for which people visit heart hospitals (2,3). However, only 23% of the visiting patients with chest pain have a real coronary disorder (4) and the rest are due to other causes such as pulmonary problems, musculoskeletal issues, gastritis, and psychological factors (5). Specifically, in 66% of patients, the existence of not one clear cause could be approved (6) and the pain cause in 41% of patients is related to psychological factors (4). Psychological factors and psychiatric disorders play significant role in genesis and development of these pains (7,8) and among these factors, anxiety and depression are considered as the most common existing problems (9). Many studies have dealt with the evaluation of stress, anxiety, and depression in patients with non-cardiac chest pain and have shown the effect of these factors on pain development (10-12). However, few researches have studied the effect of these variables on chest pain exacerbation. Therefore, regarding that the frequent visiting of these patients to the clinics takes a lot of time and money for evaluations and examinations which put a high economic pressure on medical system (13):

2. Objective
The present study was done to investigate and compare depression, anxiety, and stress severity in non-coronary patients with mild and severe chest pain.

3. Patients and Methods
3.1. Study Design
In this cross-sectional causal-comparative study, the depression, anxiety, and stress of patients with chest pain who …

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