Psychiatric disorders in youth with medically unexplained chest pain versus innocent heart murmur

Objective: To examine the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders in youth with chest pain compared with a control sample with innocent heart murmur. Study design: We assessed youth ages 8 to 17 years who were examined in cardiology settings for medically unexplained chest pain (n = 100) or innocent heart murmur (n = 80). We conducted semi-structured interviews and assessed medical history, quality of life, and disability. Results: Youth with chest pain had a higher prevalence of psychiatric disorders compared with youth with murmur (74% versus 47%, χ ² = 13.3; P <.001). Anxiety disorders predominated, although major depression was also more common in the chest pain group (9% versus 0%; Fisher exact tests; P <.01). Onset of psychiatric disorders generally preceded chest pain. Patterns were similar for boys and girls and for children and adolescents. Chest pain was associated with poorer quality of life and with pain-related disability for youth with co-morbid psychiatric disorder. Conclusions: In childhood and adolescence, medically unexplained chest pain is associated with a high prevalence of psychiatric disorders. Systematic mental health screening may improve detection and enhance treatment of these patients.