title: Perception of a hectic hospital environment at admission relates to acute stress disorder symptoms in myocardial infarction patients.
abstract: OBJECTIVE
  Hospital crowding is a public health problem that may impact on the quality of medical treatment and increase the risk of developing traumatic stress, e.g., after myocardial infarction (MI). This study examines whether subjective appraisal of crowding at hospital admission due to MI is associated with acute stress disorder (ASD) symptoms.
  
  
  METHODS
  We investigated 102 consecutive patients with acute MI within 48h after having reached stable circulatory conditions. The appraisal of crowding was measured by the retrospective assessment of the perception of a hectic hospital environment at admission. Furthermore, patients completed the Acute Stress Disorder Scale to rate the psychological stress reaction.
  
  
  RESULTS
  The perception of a hectic hospital environment was associated with the development of ASD symptoms (r=0.254, P=.013) independently of demographic, peritraumatic and medical factors. Post hoc analysis revealed associations with dissociative (r=0.211, P=.041), reexperiencing (r=0.184, P=.074) and arousal (r=0.179, P=.083) symptoms.
  
  
  CONCLUSIONS
  The findings suggest that, besides objective circumstances, the way hospital admission due to MI is perceived by the patient may influence the development of MI-triggered ASD symptoms. The psychological and physiological long-term outcomes of the perception of a hectic hospital environment and the role of preventive interventions need further examination.
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of Bern, Switzerland; Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Bern, Switzerland. Electronic address: rebecca.meister@insel.ch.
authors.forename: Rebecca Elisabeth
authors.initials: RE
authors.lastname: Meister
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors.forename: Tania
authors.initials: T
authors.lastname: Weber
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of Bern, Switzerland; Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
authors.forename: Mary
authors.initials: M
authors.lastname: Princip
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schnyder
authors.affiliation: Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Barth
authors.affiliation: Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Znoj
authors.affiliation: Department of Cardiology, Bern University Hospital and Spital Netz Bern, Spital Tiefenau, Bern, Switzerland.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of Bern, Switzerland; Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
mesh_terms: D000368:Aged; D003441:Crowding / Q000523:psychology*; D004777:Environment; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D010343:Patient Admission; D040701:Stress Disorders, Traumatic, Acute / Q000523:psychology*
keywords: Acute myocardial infarction; Acute stress disorder; Cardiology; Crowding; Hectic hospital environment