Original contribution
Suicidal ideation in emergency department chest pain patients: Panic disorder a risk factor

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Abstract

Most patients who present to the emergency department (ED) for chest pain do not have a cardiac disorder. Approximately 30% of noncardiac chest pain patients suffer from panic disorder (PD), a disabling, treatable, yet rarely detected psychiatric condition. Although still controversial, PD may be a risk factor for suicidal ideation and attempts. The prevalence of recent suicidal ideation (ie, past week) was studied in 441 consecutive ED chest pain patients who underwent a structured psychiatric interview. To examine the controversial link between panic and suicidal behavior, logistic regression analyses were conducted in which current psychiatric diagnoses (Axis I) as well as pertinent medical and demographic information were assessed as risk factors for suicidal ideation. Participants were interviewed with the Anxiety Disorders Interview Schedule-Revised to establish psychiatric diagnoses. Recent suicidal ideation (ie, past week) was assessed with question 9 of the Beck Depression Inventory. Ten percent of patients had recent suicidal ideation. Sixty percent of patients with suicidal thoughts met criteria for PD. In the patients with PD, suicidal ideation could not be explained by the presence of comorbid psychiatric or medical conditions or medication. In the total sample, only diagnoses of PD (odds ratio [OR] = 4.3; 95% confidence interval [CI], 2.09–8.82; P = .0001) and dysthymia (OR = 9.98; 95% CI, 4.00–24.8; P = .00001) were significant and independent risk factors for suicidal ideation. PD, the most common psychiatric condition in ED chest pain patients, may be an independent risk factor for suicidal ideation, further supporting the need for recognition and treatment of these patients.

References (46)

  • ID Shulman et al.

    Precipitating events, locations and reactions associated with initial unexpected panic attacks

    Behav Res Ther

    (1994)
  • JW Borden

    Panic disorder and suicidality: Prevalence and risk factors

    J Anxiety Disorder

    (1994)
  • BW Karlson et al.

    Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction

    J Intern Med

    (1991)
  • TH Lee et al.

    Acute chest pain in the emergency room

    Identification and examination of low-risk patients

    Arch Intern Med

    (1985)
  • L Goldman et al.

    A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain

    N Engl J Med

    (1982)
  • JS Ockene et al.

    Unexplained chest pain in patients with normal coronary arteriograms

    N Engl J Med

    (1980)
  • KW Yingling et al.

    Estimated prevalences of panic disorder and depression among consecutive patients seen in an emergency department with acute chest pain

    J Gen Intern Med

    (1993)
  • BD Beitman et al.

    Atypical or nonanginal chest pain

    Panic disorder or coronary artery disease?

    Arch Intern Med

    (1987)
  • LR Wulsin et al.

    Axis I disorders in ER patients with atypical chest pain

    Int J Psychiatry Med

    (1991)
  • RP Fleet et al.

    Panic disorder, chest pain and coronary artery disease: literature review

    Can J Cardiol

    (1994)
  • GA Clum et al.

    A meta-analysis of treatments for panic disorder

    J Cons Clin Psychol

    (1993)
  • MM Weissman

    The hidden patient: unrecognized panic disorder

    J Clin Psychiatry

    (1990)
  • BD Beitman et al.

    Follow-up status of patients with angiographically normal coronary arteries and panic disorder

    JAMA

    (1991)
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