Stressor Prevalence, Grouping, Distribution, and Association with Anxiety among Hospitalized Patients: A Precursor Study for Developing Targeted Chaplain Interventions Open Access

Palmer, Patricia (Spring 2018)

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OBJECTIVE: To lay the groundwork for the development of targeted chaplain interventions by exploring hospital inpatients’ stressors, how they are distributed (singly and in groups), and how these exposures, along with other factors, are associated with the outcome of anxiety.

METHODS: We conducted a cross-sectional study of inpatients (n = 271) at two Southeastern U.S. metropolitan hospitals using data collected from August 2017 to January 2018. Participants recruited randomly from rooms within each medical and intensive care unit completed a survey to identify which of 41 stressors they were experiencing. We grouped related items through factor analysis and improved factor reliability and validity by separating out stressors that did not load strongly or cleanly on a single factor. We evaluated the prevalence of grouped and single stressors, their distribution, and their crude association with anxiety, measured with the State Trait Anxiety Index six-item scale (STAI-6). We used linear regression to estimate the association between stressors and anxiety, and adjusted for demographic, illness, and religion in sequential models.

RESULTS: Study participants were older, more educated, and more likely to be Protestant or African American than the U.S. population. Although stressors differed across unit type, pain, being unable to sleep, and feelings of frustration, being overwhelmed, and sadness were common across all or most unit types. Factor analysis produced two thematic multi-item factors: isolation and fear. Bivariate analysis shows that patients requesting a chaplain or reporting lower importance of religion in their day-to-day life had significantly higher levels of clinically-relevant anxiety. Significance was marginal for those who were younger, female, or on Medicaid. In all regression models, isolation and fear factors, inability to sleep, worries about quality of life (QOL), treatment on a cardiology or hematology/oncology unit, and having requested a chaplain were significantly associated with anxiety. 

CONCLUSION: Study results suggest that multiple stressors are prevalent among hospital inpatients. Interventions for anxiety or emotional/spiritual burden may be best targeted to isolation, fear, and other significant or frequency-endorsed stressors, especially among young and female patients on units with elevated anxiety. Study results provide rich context in which to develop and deploy interventions. 

Table of Contents


   Anxiety in the Hospital               1

   The Association of Anxiety with Spiritual Distress            2

   Stressors          3

   Interventions for Anxiety           4

   Chaplain Interventions                5

   Efficacy of Chaplain Interventions          7

   Study Aims       11

METHODS           12

   Study Design and Recruitment 12

   Measures         13

   Statistical Analysis        16

RESULTS              20

   Recruitment    20

   Description of Study Participants            20

   Frequency and Distribution of Stressors              22

   Factor Analysis               23

   Patient Characteristics and Stressors     26

   Patient Characteristics and Anxiety        28

   Multivariate Regression Modeling             29


   Strengths and Limitations             39

   Future Directions             40



FIGURES              64

APPENDIX I         67

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