Psychological distress in non-cardiac chest pain patients: An application of the common sense model of illness representations

This thesis applied the Common Sense Model of Illness Representations to patients’ experiences of acute non-cardiac chest pain (NCCP). A systematic review indicated high levels of distress and poor quality of life (QoL) in acute NCCP patients, although there were few studies on psychological outcomes in these patients, with very few considering the possible predictors of negative psychological outcomes. Study 1 was a longitudinal questionnaire-based study, assessing illness representations, psychological outcomes and continued chest pain in a sample of acute NCCP patients in an emergency department (N=200) and at one (N=138) and three month (N=110) follow-up. Levels of psychological distress were high, mental QoL was poor, and almost half the participants experienced continued chest pain. An increased belief in psychological causes, perception of a more chronic timeline and weaker perceptions of personal control were associated with poorer psychological outcomes. Continued chest pain was related to increased baseline psychological distress and cardiac worries, a stronger baseline perception of identity and a more chronic timeline, highlighting the role that anxiety and stress may play in causing and maintaining NCCP. The role of psychological factors and the lack of coherence (understanding) in NCCP, was demonstrated in Study 2, a qualitative study (N=7) of patients who experienced continued pain and distress at follow-up. Using the findings from Studies 1 and 2, and previous findings with NCCP patients, a self-help anxiety reduction intervention was developed. This was designed to improve patients’ understanding of NCCP and to provide methods to reduce stress, anxiety and pain. During further qualitative work, the intervention was found to be acceptable, relevant and understandable to both NCCP patients (N=11) and the specialist nurses (N=4). Further research is needed to test the efficacy of the intervention in a randomised controlled trial.