Abstract
Anxiety is prevalent among hospital inpatients and it has harmful effects on patient well-being and clinical outcomes. We aimed to characterize the sources of hospital distress and their relationship to anxiety. We conducted a cross-sectional study of inpatients (n = 271) throughout two Southeastern U.S. metropolitan hospitals. Participants completed a survey to identify which of 38 stressors they were experiencing. They also completed the State Trait Anxiety Inventory six-item scale. We evaluated the prevalence of stressors, their distribution, and crude association with anxiety. We then used multivariate logistic regression to estimate the association between stressors and clinically relevant anxiety, with and without adjusting for demographic variables. We used factor analysis to describe the interrelationships among stressors and to examine whether groups of stressors tend to be endorsed together. The following stressors were highly endorsed across all unit types: pain, being unable to sleep, feelings of frustration, being overwhelmed, and fear of the unknown. Stressors relating to isolation/meaninglessness and fear/frustration tend to be endorsed together. Stressors were more frequently endorsed by younger, female, and uninsured or Medicaid-insured patients and being female and uninsured was associated with anxiety in bivariate analysis. After controlling for the sources of distress in multivariate linear analysis, gender and insurance status no longer predicted anxiety. Feelings of isolation, lack of meaning, frustration, fear, or a loss of control were predictive. Study results suggest that multiple stressors are prevalent among hospital inpatients and relatively consistent across hospital unit and disease type. Interventions for anxiety or emotional/spiritual burden may be best targeted to stressors that are frequently endorsed or associated with anxiety, especially among young and female patients.
Highlights
Hospital inpatients experience high levels of stress and anxiety, which can increase symptom severity and disability and lead to longer, more costly hospital stays and more likely readmission [1,2,3,4]
Anxiety has been found to be associated with specific stressors in hospitalized patients, for example insufficient sleep, pain, inadequate explanation of the treatment, separation from family, uncertainty, loss of control, fear, and impaired body image among pre- and post-surgical patients [5, 7,8,9, 14] and physical symptoms, financial instability, social support or isolation, shame, and stress among cancer patients [15, 16]
Based on t-test comparison of mean State-Trait Anxiety Inventory (STAI) scores between those who did and did not endorse each stressor, we found that each of the 38 stressors was significantly associated with anxiety: p < .0001 for 29 stressors, p < .001 for five stressors, p < .01 for three, p = .043 for a single stressor (S3 Table)
Summary
Hospital inpatients experience high levels of stress and anxiety, which can increase symptom severity and disability and lead to longer, more costly hospital stays and more likely readmission [1,2,3,4]. Hospital-based approaches have been impeded by the fact that few studies have examined variables associated with anxiety within and across a more inclusive and heterogenous inpatient population. Hospital-wide interventions have been shown effective in screening for and addressing domestic violence and nutritional needs, issues that are present in patient populations across the hospital [18, 19]. Interventions such as music therapy [20, 21] and mindfulness [17] have been effectively deployed hospital-wide to reduce anxiety and distress across multiple units and disease types. To improve the hospital experience for all patients, it is necessary to gain an understanding of the factors that increase anxiety as well as the prevalence and distribution of these sources of distress
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