State trait anxiety in the emergency department: an analysis of anticipatory and life stressors.
OBJECTIVE
To determine the relationship between stress indicators and state anxiety among pediatric emergency department (ED) patients, as a background to develop appropriate psychoeducational and behavioral interventions.


METHODS
Patients with nonchronic conditions aged 10 to 18 years completed questionnaires assessing demographics; (8) life stressors (LSs), such as death in family and marital separation/divorce; (10) anticipatory stressors (ASs) such as fear of needles, blood, or undressing; and the State Trait Anxiety Inventory for Children (a 20-item validated tool).


RESULTS
One hundred patients completed the study: the mean age was 13.3 years; 56% were female; and 90% were Latino patients. Notable life stressors (mean, 1.83) included: change in school location (24%), change in school performance (29%), death in family (33%), and marital separation/divorce (48%). Common AS (mean, 4.76) included worry about shots (33%), strangers (41%), talking about personal problems (44%), separation from parents (51%), undressing (56%), hospitalization (57%), and pain (73%). Significant correlations were found between age and state anxiety (r, -0.21; P < 0.05), age and AS (r, -0.38; P < 0.001), and AS and state anxiety (r, 0.20; P < 0.05). Patients with clinical state anxiety (36%) were more likely to be in the ED with a complaint of pain and/or trauma, had significantly more AS (t, 2.1; P < 0.05), and worry about parental separation (χ, 5.5; P < 0.05) and blood tests (χ, 4.9; P < 0.05) than patients with subclinical state anxiety.


CONCLUSIONS
The ED experience produces fear/anxiety, particularly in younger patients with a chief complaint of pain and/or trauma. Findings may lead to the development of psychoeducational and behavioral interventions that focus on anxiety reduction.
Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. nager@chla.usc.edu
Alan L
AL
Nager
Nicole E
NE
Mahrer
Jeffrey I
JI
Gold
D000293:Adolescent; D059031:Anticipation, Psychological; D001007:Anxiety / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D002648:Child; D004630:Emergencies / Q000523:psychology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005239:Fear / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006785:Hospitals, University / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008016:Life Change Events; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D026441:Mind-Body Therapies; D010146:Pain / Q000523:psychology; D010555:Personality Inventory; D011446:Prospective Studies; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology; D014947:Wounds and Injuries / Q000523:psychology