Depression, anxiety, and moods of hospitalized patients under contact precautions

Abstract

Objective: To determine the association between contact precautions and depression or anxiety as well as feelings of anger, sadness, worry, happiness, or confusion.

Design: Prospective frequency-matched cohort study.

Setting: The University of Maryland Medical Center, a 662-bed tertiary care hospital in Baltimore, Maryland.

Participants: A total of 1,876 medical and surgical patients over the age of 18 years were approached; 528 patients were enrolled from January through November 2010, and 296 patients, frequency matched by hospital unit, completed follow-up on hospital day 3.

Results: The primary outcome was Hospital Anxiety and Depression Scale (HADS) scores on hospital day 3, controlling for baseline HADS scores. Secondary moods were measured with visual analog mood scale diaries. Patients under contact precautions had baseline symptoms of depression 1.3 points higher (P<.01) and anxiety 0.8 points higher (P=.08) at hospital admission using HADS. Exposure to contact precautions was not associated with increased depression (P=.42) or anxiety (P=.25) on hospital day 3. On hospital day 3, patients under contact precautions were no more likely than unexposed patients to be angry (20% vs 20%; P=.99), sad (33% vs 38%; P=.45), worried (51% vs 46%; P=.41), happy (58% vs 67%; P=.14), or confused (23% vs 24%; P=.95).

Conclusions: Patients under contact precautions have more symptoms of depression and anxiety at hospital admission but do not appear to be more likely to develop depression, anxiety, or negative moods while under contact precautions. The use of contact precautions should not be restricted by the belief that contact precautions will produce more depression or anxiety.

FIGURE 1.

Flowchart demonstrating enrollment and inclusion of patients in the final matched cohort.

FIGURE 2.

Mean unadjusted Hospital Anxiety and Depression Scale depression subscale scores on hospital days 1, 3, and 7. Vertical lines represent 95% confidence intervals around the mean.

FIGURE 3.

Mean unadjusted Hospital Anxiety and Depression Scale anxiety subscale scores on hospital days 1, 3, and 7. Vertical lines represent 95% confidence intervals around the mean.

FIGURE 4.

Frequency that patients identified themselves as angry, confused, worried, happy, or sad on visual analog mood scales at the time of hospital admission (A) and on hospital day 3 (B).