Noncardiac chest pain and psychopathology in children and adolescents

Abstract

Objective

We sought to examine the prevalence of DSM-IV psychiatric disorders in children and adolescents with complaints of noncardiac chest pain (NCCP).

Method

We assessed 27 youngsters (ages 8–17 years) referred to a pediatric cardiology practice with complaints of NCCP. Each child and a parent were interviewed using the Anxiety Disorders Interview Schedule for Children.

Results

Sixteen youngsters (59%) were diagnosed with a current DSM-IV disorder. Fifteen (56%) had a current anxiety disorder, nine of whom were diagnosed with panic disorder. One participant was diagnosed with a depressive disorder.

Conclusion

Results of this preliminary study suggest that DSM-IV anxiety disorders may be common in youngsters with NCCP. No evidence was found for high prevalence of depression in this sample. Larger controlled studies are needed to determine the prevalence and impact of psychopathology in youngsters with NCCP.

Introduction

Chest pain is a common complaint among children and adolescents [1]. Annually in the United States, about 600,000 individuals between the ages of 10 and 21 years see a physician for complaints of chest pain [2]. Chest pain is a frequent presentation in pediatric emergency departments [3] and the second most common reason for referral to pediatric cardiologists [4]. In contrast to its presentation in adults, chest pain in children and adolescents is rarely a sign of cardiac disease [5]. Rates of positive cardiac findings range from 0% to 6% in child and adolescent samples [3], [6]. Although noncardiac medical causes (e.g., musculoskeletal, gastrointestinal, asthma) are sometimes identified, the majority of cases (up to 85%) have no clear medical etiology.

Despite a benign medical prognosis, chest pain symptoms persist for many youngsters for months and even years following medical evaluation [3]. Youngsters often worry about the implications of chest pain [7]. A significant proportion of youngsters return for additional medical testing [8]. For some, chest pain symptoms interfere with school and other activities [3].

Systematic diagnostic studies of adults seeking treatment for noncardiac chest pain (NCCP) find that roughly a third have a diagnosis of panic disorder [9]. A population-based study of adult NCCP using self-reported symptoms found that 23% of adults had clinically significant anxiety while 7% reported clinically significant depression [10]. However, some clinical studies find higher rates of depression in adults with NCCP [11]. To date, no study has systematically assessed specific DSM-IV disorders in youngsters with NCCP. Tunaoglu et al. [12] conducted unstructured psychiatric interviews with 74 youngsters with NCCP in a pediatric cardiology service. They found that most of this sample had “psychiatric symptoms,” with “anxiety” as the most commonly reported problem. In the current study, we sought to assess psychopathology in a sample of youngsters referred for cardiology evaluation and found to have NCCP. We used semistructured diagnostic interviews of the youngster and a parent.