Longitudinal associations of chronic health stress and COVID-19-related anxiety among outpatients with anxiety and mood disorders.

BACKGROUND: The 2019 coronavirus (COVID-19) pandemic led to elevated levels of psychological distress on a global scale. Given that individuals with pre-existing physical conditions are at risk for worse COVID-19 outcomes, those dealing with the stress of physical health problems (including knowing someone with health problems) may experience more severe distress during the pandemic. METHODS: Patients with emotional disorders who completed a diagnostic assessment in the 6 months prior to COVID-19 were surveyed in May-June 2020 on their emotional reactions to COVID-19 (N = 77). RESULTS: Multiple linear regression was used to test the hypothesis that chronic stress due to having and knowing others with physical health problems would predict COVID-related worries and behaviours, holding pre-COVID levels of depression, anxiety and worry about health constant. Chronic stress surrounding the health of others was significantly associated with experiencing more severe COVID-related worry and behaviours. In comparison, chronic stress due to one's own health problems had weak and non-significant associations with COVID-related worries and behaviours. CONCLUSIONS: Results indicate that outpatients who report stress about surrounding loved one's health are at risk for experiencing more severe distress during a health pandemic and thus, may benefit from targeted outreach, assessment and intervention.

Delirium and Healthcare Utilization in Patients Undergoing Hematopoietic Stem Cell Transplantation.

Delirium, a common neuropsychiatric syndrome among hospitalized patients, has been associated with significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Although delirium is often reversible with prompt diagnosis and appropriate management, timely screening of hospitalized patients, including HSCT recipients at risk for delirium, is lacking. The association between delirium symptoms and healthcare utilization among HSCT recipients is also limited. We conducted a retrospective analysis of 502 hospitalized patients admitted for allogeneic or autologous HSCT at 2 tertiary care hospitals between April 2016 and April 2021. We used Natural Language Processing (NLP) to identify patients with delirium symptoms, as defined by an NLP-assisted chart review of the electronic health record (EHR). We used multivariable regression models to examine the associations between delirium symptoms, clinical outcomes, and healthcare utilization, adjusting for patient-, disease-, and transplantation-related factors. Overall, 44.4% (124 of 279) of patients undergoing allogeneic HSCT and 39.0% (87 of 223) of those undergoing autologous HSCT were identified as having delirium symptoms during their index hospitalization. Two-thirds (139 of 211) of the patients with delirium symptoms were prescribed treatment with antipsychotic medications. Among allogeneic HSCT recipients, delirium symptoms were associated with longer hospital length of stay (ß = 7.960; P < .001), fewer days alive and out of the hospital (ß = -23.669; P < .001), and more intensive care unit admissions (odds ratio, 2.854; P = .002). In autologous HSCT recipients, delirium symptoms were associated with longer hospital length of stay (ß = 2.204; P < .001). NLP-assisted EHR review is a feasible approach to identifying hospitalized patients, including HSCT recipients at risk for delirium. Because delirium symptoms are negatively associated with health care utilization during and after HSCT, our findings underscore the need to efficiently identify patients hospitalized for HSCT who are at risk of delirium to improve their outcomes. © 2023 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.