Impact of anxiety and depression on treatment adherence and nursing workload in hospitalized patients with gastrointestinal diseases

Table 1 Comparison of baseline patient characteristics, mean ± SD/n (%)/median (P25, P75)

Characteristic	Group A (n = 93)	Group B (n = 67)	Statistic	P value
Demographics
Age (years)	50.89 ± 13.41	44.62 ± 13.18	t = 2.939	0.004
Sex (male)	47 (50.54)	31 (46.27)	χ2 = 0.284	0.594
Education, college and above	57 (61.29)	39 (58.21)	χ2 = 0.154	0.695
Marital status, married	80 (86.02)	56 (83.58)	χ2 = 0.182	0.670
Clinical features
Disease type, functional	27 (29.03)	40 (59.70)	χ2 = 15.050	< 0.001
Disease severity score	3 (2, 5)	5 (4, 7)	U = 3562.500	< 0.001
Number of extra-gastrointestinal comorbidities	1 (0, 2)	1 (0, 2)	U = 5235.500	0.664
Underwent surgery, yes	12 (12.90)	13 (19.40)	χ2 = 1.248	0.264
Laboratory indicators
Admission CRP (mg/L)	3.90 (1.80, 9.40)	8.15 (3.20, 18.33)	U = 3820.000	0.003
Admission albumin (g/L)	38.92 ± 5.01	37.71 ± 5.33	t = 1.467	0.144
Psychological scores
HADS-A total score	4.89 ± 2.41	11.23 ± 4.52	t = -11.462	< 0.001
HADS-D total score	4.61 ± 2.35	10.31 ± 4.38	t = -10.615	< 0.001

CRP: C-reactive protein; HADS-A: Hospital Anxiety and Depression Scale-anxiety subscale; HADS-D: Hospital Anxiety and Depression Scale-depression subscale.

Table 2 Univariate analysis of observation indicators between groups, mean ± SD/n (%)/median (P25, P75)

Observation indicator	Group A (n = 93)	Group B (n = 67)	Statistic	P value
Primary outcomes
MARS score	4 (3, 5)	3 (2, 4)	U = 3280.000	< 0.001
Mean daily NAS score (%)	52.34 ± 18.27	66.89 ± 21.45	t = -4.618	< 0.001
Secondary outcomes
Total length of stay (days)	7 (5, 10)	9 (7, 13)	U = 3547.000	< 0.001
Total hospitalization cost (10000 CNY)	2.15 (1.42, 3.58)	2.84 (1.78, 4.65)	U = 3695.500	0.001
30-day unplanned readmission, yes	8 (8.60)	14 (20.90)	χ2 = 4.963	0.026
GSRS total score	38.72 ± 12.46	55.41 ± 14.83	t = -7.715	< 0.001
GIQLI total score	98.56 ± 23.18	76.34 ± 25.67	t = 5.718	< 0.001

MARS: Medication Adherence Report Scale; NAS: Nursing Activities Score; GSRS: Gastrointestinal Symptom Rating Scale; GIQLI: Gastrointestinal Quality of Life Index; CNY: Chinese yuan.

Table 3 Multivariate linear regression analysis of the impact of anxiety/depression status on primary outcome indicators

Dependent variable	Independent variable	β (95%CI)	t value	P value
MARS score	Group B (vs group A)	-1.36 (-1.82, -0.90)	-4.962	< 0.001
	Age	0.01 (-0.01, 0.03)	1.267	0.267
	Disease type (functional vs organic)	-0.12 (-0.58, 0.34)	-0.617	0.583
	Disease severity score	-0.15 (-0.23, -0.07)	-3.582	< 0.001
	Admission CRP (log-transformed)	-0.18 (-0.45, 0.09)	-1.253	0.184
Mean daily NAS score	Group B (vs group A)	8.42 (5.21, 11.63)	5.072	< 0.001
	Age	-0.16 (-0.35, 0.03)	-1.634	0.089
	Disease type (functional vs organic)	4.12 (0.78, 7.46)	2.317	0.012
	Disease severity score	1.85 (1.08, 2.62)	4.621	< 0.001
	Admission CRP (log-transformed)	2.56 (0.67, 4.45)	2.523	0.006

CI: Confidence interval; CRP: C-reactive protein; MARS: Medication Adherence Report Scale; NAS: Nursing Activities Score.

Table 4 Logistic regression analysis of the impact of anxiety/depression status on 30-day unplanned readmission

Variable	Univariate analysis OR (95%CI)	P value	Multivariate analysis aOR (95%CI)	P value
Group B (vs group A)	3.07 (1.38, 5.92)	0.004	2.63 (1.09, 5.92)	0.026
Age (per 10-year increase)	0.78 (0.49, 1.08)	0.240	0.81 (0.52, 1.11)	0.187
Disease type (functional vs organic)	1.49 (0.73, 3.34)	0.275	1.19 (0.56, 2.82)	0.652
Disease severity score	1.26 (1.08, 1.52)	0.010	1.21 (0.98, 1.43)	0.062
Total length of stay	1.10 (1.08, 1.14)	0.008	1.03 (1.01, 1.06)	0.048

The multivariate model adjusted for all variables listed in the table. OR: Odds ratio; aOR: Adjusted odds ratio; CI: Confidence interval.

Table 5 Dose-response relationship analysis of anxiety (Hospital Anxiety and Depression Scale-anxiety subscale) and depression (Hospital Anxiety and Depression Scale-depression subscale) symptom scores on primary outcomes

Independent variable	Dependent: MARS score β (95%CI)	P value	Dependent: Mean daily NAS score β (95%CI)	P value
HADS-A total score	-0.10 (-0.16, -0.08)	< 0.001	0.62 (0.40, 0.85)	< 0.001
HADS-D total score	-0.11 (-0.13, -0.07)	< 0.001	0.72 (0.49, 0.93)	< 0.001

Both models were adjusted for age, disease type, disease severity score, and admission C-reactive protein level. HADS-A: Hospital Anxiety and Depression Scale-anxiety subscale; HADS-D: Hospital Anxiety and Depression Scale-depression subscale; MARS: Medication Adherence Report Scale; NAS: Nursing Activities Score; CI: Confidence interval.