Influence of Healthcare Delivery Type on Patients’ Mental Health: Is Hospitalization Always a Stressful Factor? Can Allostatic Load Help Assess a Patient’s Psychological Disorders?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Materials and Measurements
- Cut-off points:
- TENSION/ANXIETY. Normal 39–59
- DEPRESSION. Normal <45
- ANGER. Normal <53
- VIGOR. Normal >57
- FATIGUE. Normal <50
- CONFUSION. Normal <50
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Outpatients vs. Hospitalized | |||
---|---|---|---|
Adjusted β-Coefficients * | 95%CI | p-Value | |
Tension-Anxiety | 8.16 | (5.03 to 11.29) | <0.001 |
Depression-Melancholy | −0.340 | (−2.17 to 1.49) | 0.714 |
Anger-Hostility | 3.69 | (2.9 to 5.18) | <0.001 |
Vigor | −0.915 | (−3.46 to 1.63) | 0.479 |
Fatigue | 2.35 | (0.06 to 4.64) | 0.044 |
Confusion | −0.506 | (−1.17 to 0.153) | 0.132 |
Overall (n = 156) | Hospitalized Group (n = 110) | Outpatient Group (n = 46) | p | ||
---|---|---|---|---|---|
Median age ± SD (range) | 56.1 ± 16.2 (20–98) | 60.5 ± 16.2 (20–98) | 52.5 ± 15.1 (25–82) | 0.004 | |
Gender | Male | 61 (39.1%) | 39 (35.5%) | 22 (47.8%) | 0.149 |
Female | 95 (60.9%) | 71 (64.5%) | 24 (52.2%) | ||
Civil status | Single | 20 (12.8%) | 11 (10%) | 9 (19.6%) | 0.092 |
Married | 90 (57.7%) | 61 (55.5%) | 29 (63%) | ||
Widower | 21 (13.5%) | 19 (17.3%) | 2 (4.3%) | ||
Separated | 12 (7.7%) | 8 (7.3%) | 4 (8.7%) | ||
Divorced | 13 (8.3%) | 11 (10%) | 2 (4.3%) | ||
Educational level | Primary studies. | 1 (0.6%) | 1 (0.9%) | 0 | 0.444 |
Elementary Baccalaureate, School Graduate, primary education completed or equivalent | 11 (7.1%) | 6 (5.5%) | 5 (10.9%) | ||
First or second degree vocational training. | 19 (12.2%) | 16 (14.9%) | 3 (6.5%) | ||
Bachelor’s degree, Secondary Education studies. | 26 (16.7%) | 20 (18.2%) | 6 (13%) | ||
Diploma from university schools, technical architect, technical engineer. | 27 (17.3%) | 17 (15.5%) | 10 (21.7%) | ||
University master’s degree/other higher university studies | 72 (46.2%) | 50 (45.5%) | 22 (47.8%) | ||
Employment status | Salaried public sector employee | 13 (8.4%) | 9 (8.3%) | 4 (8.7%) | 0.495 |
Salaried private sector | 76 (49.4%) | 51 (47.2%) | 25 (54.3%) | ||
Entrepreneur | 4 (2.6%) | 2 (1.9%) | 2 (4.3%) | ||
Unemployed | 6 (3.9%) | 3 (2.8%) | 3 (6.5%) | ||
Retired | 42 (27.3%) | 34 (31.5%) | 8 (17.4%) | ||
Student | 2 (1.3%) | 2 (1.9%) | 0 | ||
Dedicated to housework. | 10 (6.5%) | 6 (5.6%) | 4 (8.7%) | ||
With permanent work Disability | 1 (0.6%) | 1 (0.9%) | 0 | ||
Monthly income | Less than 1000 euros | 4 (2.6%) | 3 (2.7%) | 1 (2.2%) | 0.995 |
1000–1999 euros | 44 (28.2%) | 32 (29.1%) | 12 (26.1%) | ||
2000–2999 euros | 64 (41%) | 45 (40.9%) | 19 (41.3%) | ||
3000–3999 euros | 30 (19.2%) | 20 (18.2%) | 10 (21.7%) | ||
4000–4999 euros | 11 (7.1%) | 8 (7.3%) | 3 (6.5%) | ||
More than 5000 | 3 (1.9%) | 2 (1.8%) | 1 (2.2%) | ||
Changes in the employment situation | Unemployed | 63 (40.4%) | 48 (43.6%) | 15 (32.6%) | 0.241 |
I lost my job temporarily | 1 (0.6%) | 0 | 1 (2.2%) | ||
I lost my job permanently | 41 (26.3%) | 29 (26.4%) | 12 (26.1%) | ||
I kept the job | 51 (32.7%) | 33 (30%) | 18 (39.1%) | ||
Kept their job | Worse conditions than before | 2 (4%) | 2 (6.1%) | 0 | 0.431 |
Same conditions | 48 (96%) | 31 (93.9%) | 17 (100%) | ||
Children | 112 (71.8%) | 82 (74.5%) | 30 (65.2%) | 0.238 | |
Nº cohabitants | 0 | 32 (20.5%) | 25 (22.7%) | 5 (10.9%) | 0.592 |
1 | 77 (49.4%) | 52 (47.3%) | 25 (54.3%) | ||
2 | 27 (17.3%) | 19 (17.3%) | 8 (17.4%) | ||
3 | 15 (9.6%) | 11 (10%) | 4 (8.7%) | ||
4 | 4 (2.6%) | 3 (2.7%) | 1 (2.2%) | ||
5 | 1 (2.2%) | 0 | 1 (2.2%) | ||
No response | 2 | 0 | 2 (4.3%) |
Overall (n = 156) | Hospitalized Group (n = 110) | Outpatient Group (n = 46) | p | ||
---|---|---|---|---|---|
Psychological help during confinement | No | 133 (85.3%) | 97 (88.2%) | 36 (78.3%) | 0.059 |
Yes | 20 (12.8%) | 10 (9.1%) | 10 (21.7%) | ||
I prefer not to answer | 3 (1.9%) | 3 (2.7%) | 0 |
1 Visit (n = 18) | 2 Visits (n = 15) | 3–4 Visits (n = 13) | p | |
---|---|---|---|---|
Tension-Anxiety (median ± IQR) | 39 ± 16.5 | 52 ± 10 | 60 ± 6 | <0.001 |
Depression-Melancholy (median ± IQR) | 40 ± 2.3 | 43 ± 5 | 44 ± 5.5 | 0.009 |
Anger-Hostility (median ± IQR) | 36.5 ± 6.3 | 40 ± 10 | 43 ± 10 | 0.014 |
Vigor (median ± IQR) | 54 ± 6.3 | 49 ± 7 | 49 ± 9 | 0.008 |
Fatigue (median ± IQR) | 46 ± 10 | 48 ± 9 | 48 ± 8.5 | 0.419 |
Confusion (median ± IQR) | 33 ± 2.3 | 33 ± 2 | 32 ± 2 | 0.624 |
Overall (n =156) | Hospitalized Group (n = 110) | Outpatient Group (n = 46) | p | ||
---|---|---|---|---|---|
Systolic Blood Pressure (median ± IQR) | 127 ± 31.3 | 128.5 ± 33.3 | 125.5 ± 22.3 | 0.257 | |
Normal (140 or less) | 117 (75%) | 79 (71.8%) | 38 (82.6%) | 0.156 | |
Elevated (more than 140) | 39 (25%) | 31 (28.2%) | 8 (17.4%) | ||
Diastolic Blood Pressure (median ± IQR) | 73.5 ± 18 | 76 ± 19.3 | 69 ± 14.5 | 0.008 | |
Normal (less than 90) | 131 (84%) | 89 (80.9%) | 42 (91.3%) | 0.107 | |
Elevated (90 or more) | 25 (16%) | 21 (19.1%) | 4 (8.7%) | ||
Heart Rate (median ± IQR) | 84.5 ± 19 | 86 ± 17.3 | 79 ± 19.8 | 0.003 | |
Normal (less than 100) | 133 (85.3%) | 91 (82.7%) | 42 (91.3%) | 0.168 | |
Elevated (100 oo more) | 23 (14.7%) | 19 (17.3%) | 4 (8.7%) | ||
Leukocytes (median ± IQR) | 5435 ± 2493 | 5385 ± 2632 | 5618 ± 2118 | 0.607 | |
Normal (4400–11,000) | 119 (76.3%) | 81 (73.6%) | 38 (82.6%) | 0.230 | |
Altered (>11,000 or < 4400) | 37 (23.7%) | 29 (26.4%) | 8 (17.4%) | ||
Lymphocites (median ± IQR) | 1049 ± 469 | 1010 ± 400 | 1100 ± 478 | 0.020 | |
Normal (1200–3400) | 49 (31.4%) | 28 (25.5%) | 21 (45.7%) | 0.013 | |
Altered (>3400 or <1200) | 107 (68.6%) | 82 (74.5%) | 25 (54.3%) | ||
D dimer (median ± IQR) | 596 ± 622 | 810 ± 907 | 429.5 ± 216 | <0.001 | |
Normal (<500) | 63 (40.6%) | 30 (27.5%) | 33 (71.7%) | <0.001 | |
Elevated (>500) | 92 (59.4%) | 79 (72.5%) | 13 (28.3%) | ||
C–reactive protein (median ± IQR) | 38.9 ± 68.7 | 54 ± 80.9 | 19.6 ± 30.3 | <0.001 | |
Normal (<5) | 12 (7.7%) | 5 (4.5%) | 7 (15.2%) | 0.042 | |
Elevated (>5) | 144 (92.3%) | 105 (95.5%) | 39 (84.8%) | ||
Fibrinogen (median ± IQR) | 468 ± 301 | 556.5 ± 290 | 287 ± 147 | <0.001 | |
Normal (<450) | 76 (48.7%) | 35 (31.8%) | 41 (89.1%) | <0.001 | |
Elevated (>450) | 80 (51.3%) | 75 (68.2%) | 5 (10.9%) | ||
Ferritin (median ± IQR) | 532 ± 280 | 645 ± 968 | 385.5 ± 244 | <0.001 | |
Normal (<150) | 1 (0.6%) | 1 (0.9%) | 0 | >0.999 | |
Elevated (>150) | 154 (99.4%) | 108 (99.1%) | 46 (100%) | ||
Lactate dehydrogenase (median ± IQR) | 402.2 ± 246 | 484 ± 290 | 288 ± 124 | <0.001 | |
Normal (<480) | 96 (61.9%) | 51 (46.8%) | 45 (97.8%) | <0.001 | |
Elevated (>480) | 59 (38.1%) | 58 (53.2%) | 1 (2.2%) | ||
Lactate (median ± IQR) | 1.2 ± 0.5 | 1.3 ± 0.7 | 1.1 ± 0.4 | 0.058 | |
Normal (<2) | 143 (92.9%) | 97 (89.8%) | 46 (100%) | 0.034 | |
Elevated (>2) | 11 (7.1%) | 11(10.2%) | 0 |
Overall (n = 156) | Hospitalized Group (n = 110) | Outpatient Group (n = 46) | p | ||
---|---|---|---|---|---|
Score Allostatic Load (median ± IQR) | 5 ± 2 | 6 ± 2 | 3 ± 2 | <0.001 | |
1 | 3 (1.9%) | 1 (0.9%) | 2 (4.3%) | <0.001 | |
2 | 18 (11.5%) | 6 (5.5%) | 12 (26.1%) | ||
3 | 17 (10.9%) | 6 (5.5%) | 11 (23.9%) | ||
4 | 28 (17.9%) | 13 (11.8%) | 15 (32.6%) | ||
5 | 27 (17.3%) | 25 (22.7%) | 2 (4.3%) | ||
6 | 30 (19.2%) | 26 (23.6%) | 4 (8.7%) | ||
7 | 16 (10.3%) | 16 (14.5%) | 0 | ||
8 | 13 (8.3%) | 13 (11.8%) | 0 | ||
9 | 2 (1.3%) | 2 (1.8%) | 0 | ||
10 | 2 (1.3%) | 2 (1.8%) | 0 |
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Gómez García, A.M.; García-Rico, E. Influence of Healthcare Delivery Type on Patients’ Mental Health: Is Hospitalization Always a Stressful Factor? Can Allostatic Load Help Assess a Patient’s Psychological Disorders? Clin. Pract. 2024, 14, 995-1009. https://doi.org/10.3390/clinpract14030079
Gómez García AM, García-Rico E. Influence of Healthcare Delivery Type on Patients’ Mental Health: Is Hospitalization Always a Stressful Factor? Can Allostatic Load Help Assess a Patient’s Psychological Disorders? Clinics and Practice. 2024; 14(3):995-1009. https://doi.org/10.3390/clinpract14030079
Chicago/Turabian StyleGómez García, Ana María, and Eduardo García-Rico. 2024. "Influence of Healthcare Delivery Type on Patients’ Mental Health: Is Hospitalization Always a Stressful Factor? Can Allostatic Load Help Assess a Patient’s Psychological Disorders?" Clinics and Practice 14, no. 3: 995-1009. https://doi.org/10.3390/clinpract14030079
APA StyleGómez García, A. M., & García-Rico, E. (2024). Influence of Healthcare Delivery Type on Patients’ Mental Health: Is Hospitalization Always a Stressful Factor? Can Allostatic Load Help Assess a Patient’s Psychological Disorders? Clinics and Practice, 14(3), 995-1009. https://doi.org/10.3390/clinpract14030079