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Social Problem Solving and Noncardiac Chest Pain

From the Department of Psychology (A.M.N., C.M.N., T.A.C., J.F., M.L.), Drexel University, Philadelphia, Pennsylvania; Department of Medicine (A.M.N., C.M.N., D.J.), Drexel University College of Medicine, Philadelphia, Pennsylvania; Healthy Weight Program (M.S.X.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Arthur M. Nezu, Department of Psychology, MS 515, Drexel University, 245 N. 15^th Street, Philadelphia, PA 19102-1192. E-mail: amn23{at}drexel.edu

Objective:To investigate differences in social problem solving (SPS) between individuals with noncardiac chest pain (NCCP) and persons with chest pain who tested positive for underlying cardiac disease. Methods: The major design involved a matched case-control methodology and compared a group of patients with NCCP (n = 53) with a group of patients with cardiac disease-related chest pain (n = 53) with regard to a battery of psychological distress, stress, and pain measures as well as a multidimensional measure of SPS. Results: Initial analyses found no differences between the groups regarding reported levels of chest pain intensity or frequency. However, patients with NCCP, as compared with their matched counterparts, reported significantly higher levels of depression, anxiety, perceived stress, and anger. In the analysis that addressed SPS differences between groups, general negative affectivity and prior history of cardiac disease served as covariates and revealed that individuals with NCCP were characterized by less effective problem solving on three of five dimensions assessed as compared with their matched counterparts. Moreover, the relationship between SPS and pain among patients with NCCP was found to be above and beyond that related to general negative affectivity. Conclusions: These findings both support and add to the literature regarding psychosocial correlates of NCCP and identify SPS as a potentially important factor in its pathogenesis.

Key Words: noncardiac chest pain • social problem solving • stress • coping

Abbreviations: CVD = cardiovascular disease; FAS = Framingham Anger Scales; HADS = Hospital Anxiety and Depression Scale; MANOVA = multivariate analysis of variance; MPI = myocardial perfusion imaging; NCCP = noncardiac chest pain; PSS = Perceived Stress Scale; PST = problem-solving therapy; RA = research assistant; SPS = social problem solving; SPSI-R = Social Problem-Solving Inventory—Revised.