Psychosomatic Medicine, Vol 53, Issue 6 669-683, Copyright © 1991 by American Psychosomatic Society

ORIGINAL ARTICLES

Depression and type A behavior pattern in patients with coronary artery disease: relationships to painful versus silent myocardial ischemia and beta-endorphin responses during exercise

KC Light, MC Herbst, EE Bragdon, AL Hinderliter, GG Koch, MR Davis and DS Sheps
University of North Carolina, Chapel Hill 27599.

A sample of 45 patients with a history of coronary heart disease and documented myocardial ischemia during exercise testing were evaluated in an investigation of the possible relationships between psychological factors (depression and Type A behavior pattern), plasma beta-endorphin response and pain experience during maximal exercise-induced ischemia. Depression was assessed using the MMPI-D subscale, while Type A was evaluated using the Structured Interview. All patients developed ischemia during exercise as defined by ST-segment depression; however, only 18 patients reported anginal pain. Patients with high depression scores (MMPI-D greater than or equal to 70; n = 13) showed lesser increases in plasma beta-endorphin levels, tended more often to report anginal pain and rated pain as more severe during exercise than patients with low depression scores (MMPI-D less than 60; n = 18). Hemodynamic responses and severity of ischemia (assessed by ejection fraction changes and wall-motion abnormalities) did not differ between depression groups. Even after adjustment for group differences in exercise duration, depression was significantly associated with a lesser beta-endorphin response in the sample as a whole and, among patients reporting angina, with earlier pain onset and greater pain duration and severity. In contrast, when Type A versus B/X subgroups were compared, no differences in pain experience, beta-endorphin response or measures of ischemia were obtained. These findings suggest that in patients with ischemic heart disease, there may be a relationship between depression and anginal pain which may in part involve a blunted or absent beta-endorphin response.

This article has been cited by other articles:

				M. W. Ketterer, W. Knysz, S.J. Keteyian, J. Schairer, S. Jafri, M. Alam, A.J. Farha, and S. Deveshwar Cardiovascular Symptoms in Coronary-Artery Disease Patients Are Strongly Correlated With Emotional Distress Psychosomatics, May 1, 2008; 49(3): 230 - 234. [Abstract] [Full Text] [PDF]

				S. E. Hofkamp, C. A. Henrikson, and S. T. Wegener An Interactive Model of Pain and Myocardial Ischemia Psychosom Med, September 1, 2007; 69(7): 632 - 639. [Abstract] [Full Text] [PDF]

				F. N. Jacka, J. A. Pasco, S. McConnell, L. J. Williams, M. A. Kotowicz, G. C. Nicholson, and M. Berk Self-Reported Depression and Cardiovascular Risk Factors in a Community Sample of Women Psychosomatics, February 1, 2007; 48(1): 54 - 59. [Abstract] [Full Text] [PDF]

				D. S. Sheps, F. Creed, and R. E. Clouse Chest Pain in Patients With Cardiac and Noncardiac Disease Psychosom Med, November 1, 2004; 66(6): 861 - 867. [Abstract] [Full Text] [PDF]

				M. W. Ketterer, G. Mahr, J. J. Cao, M. Hudson, S. Smith, and W. Knysz What's "Unstable" in Unstable Angina? Psychosomatics, June 1, 2004; 45(3): 185 - 196. [Abstract] [Full Text] [PDF]

				J. M. C. Ramsay, M. R. McDermott, and C. Bray Components of the Anger-Hostility Complex and Symptom Reporting in Patients with Coronary Artery Disease: A Multi-Measure Study J Health Psychol, December 1, 2001; 6(6): 713 - 729. [Abstract] [PDF]

				D. Sheffield, P. L. Biles, H. Orom, W. Maixner, and D. S. Sheps Race and Sex Differences in Cutaneous Pain Perception Psychosom Med, July 1, 2000; 62(4): 517 - 523. [Abstract] [Full Text] [PDF]

				M. Sullivan, A. LaCroix, J. Russo, E. Swords, M. Sornson, and W. Katon Depression in Coronary Heart Disease: What Is the Appropriate Diagnostic Threshold? Psychosomatics, August 1, 1999; 40(4): 286 - 292. [Abstract] [Full Text]