Background: Psychological distress, hostility, and low social support increase risk for morbidity and mortality in individuals with coronary artery disease (CAD), with inconsistent evidence for other chronic illnesses. Their influence on emergency department (ED) visits has received little attention.


Objectives: To assess 1) the association of psychological risk factors with all-cause ED utilisation over a period of up to 8 years in men and women with stable CAD or other non-cardiovascular (NCV) chronic disease, and 2) whether results differ by sex and CAD.


Methods: Men and women (N=1267; 60.38% men; 60.85±7.01 years) with CAD or NCV disease completed validated questionnaires on depression, anxiety, stress, hostility, and social support. The primary outcome was a composite defined by at least one ED (all-cause) visit, using Quebec administrative databases. Analyses included multivariable Cox proportional hazard models and controlled for sociodemographic and health parameters.


Results: Over a median follow-up of 6.06 years, there was a total of 760 cases of ED visits. Symptoms of anxiety and chronic stress increased the risk for ED utilisation by 10% (95%CI, 1.02-1.19) and 15% (95%CI, 1.06-1.25) respectively, for each standard deviation (SD) increase in score. Depression symptoms (HR=1.21 per 1SD, 95%CI, 1.11-1.31) significantly increased risk only among those with CAD.


Conclusion: Psychological distress and chronic stress predicted increased risk of adverse outcomes in patients with chronic disease, with CAD individuals showing a particular vulnerability. In light of increasing health care costs, addressing patients' psychological well-being appears essential in the management of chronic disease.