Psychosocial and developmental antecedents of chest pain in young adults.

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.