# Internalizing Characteristics in Adolescents with Non-Cardiac Chest Pain: A Cross-Sectional Study from Turkey

## TL;DR

Adolescents with non-cardiac chest pain often have anxiety and depression, and factors like gender and psychosocial history influence their symptoms.

## Contribution

The study identifies internalizing characteristics and sociodemographic factors associated with non-cardiac chest pain in Turkish adolescents.

## Key findings

- Adolescents with non-cardiac chest pain show higher anxiety, depression, and psychological distress.
- Female adolescents and those with prior psychosocial symptoms have higher symptom burdens.
- Higher maternal age is linked to lower perceived stress in adolescents with non-cardiac chest pain.

## Abstract

What are the main findings?
Adolescents with non-cardiac chest pain show significantly elevated internalizing symptoms, particularly anxiety, depression, and overall psychological distress.Female gender and a prior history of psychosocial symptoms are associated with higher anxiety and symptom burden, while higher maternal age is linked to lower perceived stress.

Adolescents with non-cardiac chest pain show significantly elevated internalizing symptoms, particularly anxiety, depression, and overall psychological distress.

Female gender and a prior history of psychosocial symptoms are associated with higher anxiety and symptom burden, while higher maternal age is linked to lower perceived stress.

What are the implications of the main findings?
Non-cardiac chest pain in adolescents should be considered a potential somatic marker of underlying psychological distress rather than a purely benign physical complaint.Routine psychological screening may improve early identification and management of at-risk adolescents, reducing unnecessary medical investigations and healthcare utilization.

Non-cardiac chest pain in adolescents should be considered a potential somatic marker of underlying psychological distress rather than a purely benign physical complaint.

Routine psychological screening may improve early identification and management of at-risk adolescents, reducing unnecessary medical investigations and healthcare utilization.

Background/Objectives: This study aimed to investigate the internalizing characteristics, including anxiety and depressive symptoms, in adolescents presenting with non-cardiac chest pain (NCCP), and to explore the effects of sociodemographic variables and prior psychosocial experiences on psychological distress. Methods: This cross-sectional study was conducted in Turkey and included 128 adolescents aged 10–18 years (57.0% female, 43.0% male) who presented to pediatric cardiology or general pediatric outpatient clinics. The Children’s Depression Inventory (CDI), State–Trait Anxiety Inventory for Children (STAI-C), Screen for Child Anxiety Related Emotional Disorders (SCARED), Brief Symptom Inventory (BSI), and the Social Support Appraisals Scale for Children (SSAS-C). Sociodemographic variables and prior psychosocial symptom history were also recorded. Results: Adolescents with non-cardiac chest pain exhibited elevated anxiety and psychological distress compared to controls. Female participants demonstrated higher levels of stress, anxiety, and overall psychological symptom burden than males. Higher maternal age was associated with lower perceived stress, while a prior history of psychosocial symptoms was linked to increased anxiety and global psychological distress. Participants with a history of psychosocial symptoms had higher anxiety (p = 0.027) and BSI (p = 0.004) scores. Significant positive correlations were found between anxiety, depression, obsessive–compulsive symptoms, and the BSI total score (r values ranging from 0.718 to 0.892). Conclusions: Adolescents with NCCP exhibit significant internalizing symptoms, particularly anxiety and depression. Female gender and prior psychosocial stressors were associated with elevated symptom scores. Maternal age may have a buffering effect on adolescent stress levels. These findings underscore the importance of integrating psychological screening into the evaluation of chest pain in adolescents to enable early identification and intervention.