Stressor Prevalence, Grouping, Distribution, and Association with Anxiety among Hospitalized Patients: A Precursor Study for Developing Targeted Chaplain Interventions Public
Palmer, Patricia (Spring 2018)
Published
Abstract
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
BACKGROUND 1
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
DISCUSSION 32
Strengths and Limitations 39
Future Directions 40
REFERENCES 42
TABLES 51
FIGURES 64
APPENDIX I 67
About this Master's Thesis
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