School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom.
PLoS One. 2023 Mar 9;18(3):e0282789. doi: 10.1371/journal.pone.0282789. eCollection 2023.
Hospital inpatients are exposed to high levels of stress during hospitalisation that may increase susceptibility to major adverse health events post-hospitalisation (known as post-hospital syndrome). However, the existing evidence base has not been reviewed and the magnitude of this relationship remains unknown. Therefore, the aim of the current systematic review and meta-analysis was to: 1) synthesise existing evidence and to determine the strength of the relationship between in-hospital stress and patient outcomes, and 2) determine if this relationship differs between (i) in-hospital vs post-hospital outcomes, and (ii) subjective vs objective outcome measures.
A systematic search of MEDLINE, EMBASE, PsychINFO, CINAHL, and Web of Science from inception to February 2023 was conducted. Included studies reported a measure of perceived and appraised stress while in hospital, and at least one patient outcome. A random-effects model was generated to pool correlations (Pearson's r), followed by sub-group and sensitivity analyses. The study protocol was preregistered on PROSPERO (CRD42021237017).
A total of 10 studies, comprising 16 effects and 1,832 patients, satisfied the eligibility criteria and were included. A small-to-medium association was found: as in-hospital stress increased, patient outcomes deteriorated (r = 0.19; 95% CI: 0.12-0.26; I2 = 63.6; p < 0.001). This association was significantly stronger for (i) in-hospital versus post-hospital outcomes, and (ii) subjective versus objective outcome measures. Sensitivity analyses indicated that our findings were robust.
Higher levels of psychological stress experienced by hospital inpatients are associated with poorer patient outcomes. However, more high-quality, larger scale studies are required to better understand the association between in-hospital stressors and adverse outcomes.
住院患者在住院期间会承受较高水平的压力，这可能会增加他们在出院后发生重大不良健康事件的易感性（称为出院后综合征）。然而，现有的证据基础尚未得到审查，这种关系的程度仍不清楚。因此，本系统评价和荟萃分析的目的是：1）综合现有证据，确定住院期间压力与患者结局之间的关系强度，2）确定这种关系是否在（i）住院期间与出院后结局之间以及（ii）主观与客观结局测量之间存在差异。
从开始到 2023 年 2 月，对 MEDLINE、EMBASE、PsychINFO、CINAHL 和 Web of Science 进行了系统搜索。纳入的研究报告了在医院期间感知和评估的压力以及至少一项患者结局的测量值。使用随机效应模型生成相关系数（Pearson's r）的汇总，然后进行亚组和敏感性分析。研究方案已在 PROSPERO（CRD42021237017）上预先注册。
共有 10 项研究，包括 16 项效应和 1832 名患者，符合入选标准并被纳入。发现存在小到中等程度的关联：随着住院期间压力的增加，患者结局恶化（r = 0.19；95%CI：0.12-0.26；I² = 63.6；p < 0.001）。这种关联在（i）住院期间与出院后结局以及（ii）主观与客观结局测量之间更为显著。敏感性分析表明，我们的研究结果是稳健的。
住院患者经历的心理压力水平较高与患者结局较差相关。然而，需要更多高质量、大规模的研究来更好地理解住院压力源与不良结局之间的关系。
