Correlation between crowdedness in emergency departments and anxiety in Chinese patients

Table 1 Baseline characteristics of subjects

	Inpatients (n = 173)	Outpatients (n = 216)	Nurses (n = 43)	P value between inpatients and outpatients
Number (n, %)	173 (40.05)	216 (50.00)	43 (9.95)
Age (mean ± average)	66.9 ± 19.4	70.2 ± 17.0	30.1 ± 8.6	0.075
Gender (n, %)				0.309
Male	86 (49.71)	96 (44.44)	3 (6.98)
Female	87 (50.29)	120 (55.56)	40 (93.02)
Education level (n, %)				0.184
Primary school	39 (22.54)	49 (22.7)
Middle school	70 (40.46)	105 (48.61)
College or university	52 (30.06)	55 (25.46)
Master’s degree	12 (6.94)	7 (3.24)
Marriage (n, %)				0.057
Not married	9 (5.20)	7 (3.24)
Married	111 (64.16)	122 (56.48)
Divorced	5 (2.89)	2 (0.93)
Widowed	43 (24.86)	81 (37.50)
Had a partner	5 (2.89)	4 (1.85)
Alcohol drinking (n, %)				< 0.001
Abstaining	106 (61.27)	58 (26.85)
Social drinking	14 (8.09)	9 (4.17)
Heavy drinking	16 (9.25)	34 (15.74)
Occasional drinking	31 (17.92)	115 (53.24)
Alcoholism	6 (3.47)	0 (0.00)
Smoking (n, %)				< 0.001
Never smoked	102 (58.96)	64 (29.63)
Current smoker	46 (26.59)	29 (13.43)
Stopped smoking	25 (14.45)	123 (56.94)

Table 2 Comparison of crowdedness, state anxiety, and trait anxiety in inpatients and outpatients as well as nurses

	Inpatients (n = 173)	Outpatients (n = 216)	Nurses (n = 43)	P value between inpatients and outpatients	P value among three groups
Crowdedness (mean ± SD)	210.70 ± 155.30a	172.20 ± 48.70c	131.60 ± 17.30c	0.006	< 0.001
State anxiety (mean ± SD)	49.50 ± 6.00a	50.80 ± 2.80c	44.70 ± 5.80e	0.005	< 0.001
Trait anxiety (mean ± SD)	45.40 ± 5.70a	46.80 ± 2.70c	45.80 ± 6.20ac	0.002	< 0.001

^a,c,eDifferent upper-case letters denote a significant difference at P < 0.05 between different groups. SD: Standard deviation.

Table 3 Factors influencing state anxiety of inpatients and outpatients in emergency departments analyzed by generalized linear regression method

	State anxiety
	Inpatients (n = 173)		Outpatients (n = 216)
	Estimate (SE)	P value	Estimate (SE)	P value
Age	-0.005 (0.024)	0.827	0.015 (0.011)	0.190
Gender
Male	-1.151 (0.907)	0.204	0.071 (0.379)	0.852
Female (ref.)
Education level
Primary school	-2.385 (1.956)	0.223	1.735 (1.109)	0.118
Middle school	-3.071 (1.852)	0.097	1.171 (1.071)	0.274
College or university	-2.373 (1.901)	0.212	0.938 (1.101)	0.394
Master’s degree (ref.)
Marriage
Not married	3.067 (3.304)	0.353	-1.214 (1.684)	0.471
Married	-0.291 (2.708)	0.915	-1.213 (1.366)	0.374
Divorced	-1.600 (3.746)	0.669	-3.000 (2.327)	0.197
Widowed	-0.088 (2.799)	0.975	0.068 (1.376)	0.961
Had a partner (ref.)
Alcohol drinking
Abstaining	-5.072 (2.456)	0.039	0.573 (0.444)	0.197
Social drinking	-4.381 (2.856)	0.125	-0.360 (0.953)	0.706
Heavy drinking	-7.167 (2.802)	0.011	0.329 (0.538)	0.540
Occasional drinking	-5.800 (2.618)	0.027	(ref.)
Alcoholism (ref.)
Smoking
Never smoked	0.036 (1.334)	0.978	0.852 (0.421)	0.053
Current smoker	0.466 (1.484)	0.753	0.912 (0.564)	0.106
Stopped smoking (ref.)
Time of admission to ED	-0.038 (0.014)	0.006	-0.011 (0.002)	< 0.001
Waiting time in ED	0.116 (0.028)	< 0.001	-0.049 (0.013)	< 0.001
Number of patients	0.010 (0.003)	0.002	-0.008 (0.004)	0.050
Number of nurses	0.002 (0.001)	0.004	-0.005 (0.002)	< 0.001
Hospitalization time	0.007 (0.002)	0.002	-0.010 (0.007)	0.134
Hospitalization cost
≤ 1000	-4.421 (1.405)	0.002	0.376 (0.649)	0.562
1001-3000	-5.321 (1.236)	< 0.0001	0.382 (0.617)	0.536
3001-20000	-2.508 (1.037)	0.0156	-0.743 (0.700)	0.289
≥ 20000 (ref.)
Hypertension control
0	-1.177 (2.862)	0.681	-0.833 (1.084)	0.442
1	-0.767 (2.955)	0.795	-1.641 (1.085)	0.131
2 (ref.)
Diabetes
No	-1.881 (1.074)	0.080	-0.693 (0.348)	0.046
Yes (ref.)
Stroke
No	2.551 (1.390)	0.067	-1.157 (0.621)	0.062
Yes (ref.)
Coronary heart disease
No	-0.046 (0.945)	0.961	-0.898 (0.280)	0.001
Yes (ref.)
Thyroid disease
No	1.652 (5.645)	0.770	-0.603 (1.436)	0.674
Yes (ref.)
Malignant tumor
No	0.110 (5.723)	0.985	1.174 (0.684)	0.086
Yes (ref.)
Arrhythmia
No	-1.196 (1.309)	0.361	-1.034 (0.440)	0.019
Yes (ref.)
Severity grade
0	11.950 (3.917)	0.002	-1.943 (0.905)	0.032
1	10.060 (3.946)	0.011	(ref.)
2	11.136 (4.041)	0.006
3 (ref.)
Location
Emergency room	3.315 (5.678)	0.559	-1.943 (0.905)	0.032
Observing area	2.103 (5.752)	0.715	(ref.)
Infusion area (ref.)
Disease
Headache
No	-0.001 (1.316)	0.100	-0.621 (0.727)	0.393
Yes (ref.)
Chest pain
No	-0.718 (1.042)	0.491	0.411 (0.347)	0.236
Yes (ref.)
Abdominal pain
No	1.449 (1.224)	0.237	0.125 (0.559)	0.823
Yes (ref.)
Dyspnea
No	-2.715 (0.927)	0.003	-0.506 (0.346)	0.144
Yes (ref.)
Gastrointestinal bleeding
No	5.286 (1.918)	0.006	1.080 (0.774)	0.163
Yes (ref.)
Palpitation
No	0.493 (0.993)	0.619	-0.515 (0.354)	0.145
Yes (ref.)
Syncope
No	-1.029 (1.431)	0.472	-0.390 (0.625)	0.532
Yes (ref.)
Hemoptysis
No	2.472 (3.328)	0.458	0.911 (1.435)	0.526
Yes (ref.)
Cough and sputum
No	-0.833 (1.209)	0.491	0.470 (0.485)	0.332
Yes (ref.)
Trauma
No	1.052 (5.728)	0.854	0.000 (0.000)	NA
Yes (ref.)
Cardiovascular disease
No	-0.959 (2.075)	0.644	0.414 (1.025)	0.686
Yes (ref.)
Degree of crowdedness	0.006 (0.003)	0.049	-0.004 (0.004)	0.259
Trait anxiety	0.367 (0.076)	< 0. 001	0.632 (0.054)	< 0. 001

ED: Emergency department.

Table 4 Factors associated with trait anxiety of inpatients and outpatients in emergency departments analyzed using a generalized linear regression model

	Trait anxiety
	Inpatients (n = 173)		Outpatients (n = 216)
	Estimate (SE)	P value	Estimate (SE)	P value
Age	0.034 (0.022)	0.120	0.010 (0.011)	0.351
Gender
Male	-1.988 (0.848)	0.019	-0.077 (0.374)	0.837
Female (ref.)
Education level
Primary school	2.942 (1.840)	0.110	1.225 (1.091)	0.262
Middle school	1.074 (1.742)	0.538	0.210 (1.054)	0.842
College or university	0.721 (1.789)	0.687	0.460 (1.083)	0.671
Master’s degree (ref.)
Marriage
Not married	1.867 (3.106)	0.548	-0.393 (1.681)	0.815
Married	-0.882 (2.546)	0.729	-0.783 (1.363)	0.566
Divorced	-3.200 (3.522)	0.364	-3.750 (2.323)	0.106
Widowed	0.642 (2.631)	0.807	0.059 (1.374)	0.966
Had a partner (ref.)
Alcohol drinking
Abstaining	-0.560 (2.356)	0.812	1.308 (0.430)	0.002
Social drinking	-0.762 (2.740)	0.781	1.114 (0.924)	0.228
Heavy drinking	-1.833 (2.688)	0.495	0.346 (0.521)	0.507
Occasional drinking	-2.033 (2.511)	0.418	(ref.)
Alcoholism (ref.)
Smoking
Never smoked	1.538 (1.245)	0.217	1.174 (0.413)	0.005
Current smoker	-0.531 (1.384)	0.701	0.573 (0.553)	0.300
Stopped smoking (ref.)
Time of admission to ED	-0.027 (0.013)	0.041	-0.016 (0.003)	< 0.001
Waiting time in ED	0.046 (0.027)	0.050	-0.072 (0.012)	< 0.001
Number of patients	-0.007 (0.003)	0.031	-0.014 (0.005)	0.004
Number of nurses	-0.001 (0.001)	0.042	-0.005 (0.002)	0.002
Hospitalization time	0.001 (0.002)	0.677	-0.005 (0.008)	0.566
Hospitalization cost
≤ 1000	-0.551 (1.414)	0.697	0.973 (0.640)	0.128
1001-3000	-0.386 (1.244)	0.756	0.727 (0.608)	0.232
3001-20000	0.649 (1.043)	0.534	-0.214 (0.690)	0.756
≥ 20000 (ref.)
Hypertension control
0	0.660 (2.497)	0.791	-0.033 (1.309)	0.980
1	0.767 (2.578)	0.766	0.026 (1.310)	0.984
2 (ref.)
Diabetes
No	-0.536 (1.043)	0.607	-0.752 (0.403)	0.062
Yes (ref.)
Stroke
No	0.011 (1.350)	0.994	-1.852 (0.713)	0.009
Yes (ref.)
Coronary heart disease
No	-0.896 (0.907)	0.323	-0.733 (0.328)	0.026
Yes (ref.)
Thyroid disease
No	-3.606 (5.297)	0.496	-0.122 (1.662)	0.942
Yes (ref.)
Malignant tumor
No	1.290 (5.509)	0.815	1.729 (0.788)	0.028
Yes (ref.)
Arrhythmia
No	-2.265 (1.250)	0.070	-1.158 (0.510)	0.023
Yes (ref.)
Severity grade
0	13.388 (3.756)	< 0.001	-1.967 (1.050)	0.061
1	11.160 (3.783)	0.003	(ref.)
2	11.864 (3.875)	0.002
3 (ref.)
Location
Emergency room	-1.419 (5.508)	0.797	-2.786 (1.042)	0.008
Observing area	-3.103 (5.580)	0.578	(ref.)
Infusion area (ref.)
Disease
Headache
No	2.102 (1.255)	0.094	-0.905 (0.841)	0.282
Yes (ref.)
Chest pain
No	0.908 (1.003)	0.365	0.175 (0.402)	0.663
Yes (ref.)
Abdominal pain
No	0.411 (1.183)	0.729	0.940 (0.644)	0.144
Yes (ref.)
Dyspnea
No	0.480 (0.916)	0.601	-0.801 (0.399)	0.045
Yes (ref.)
Gastrointestinal bleeding
No	-1.448 (1.887)	0.443	1.056 (0.896)	0.239
Yes (ref.)
Palpitation
No	0.107 (0.956)	0.911	-0.370 (0.410)	0.367
Yes (ref.)
Syncope
No	0.783 (1.378)	0.570	-0.223 (0.724)	0.758
Yes (ref.)
Hemoptysis
No	0.309 (3.209)	0.923	1.897 (1.657)	0.252
Yes (ref.)
Cough and sputum
No	0.771 (1.164)	0.508	-0.017 (0.562)	0.976
Yes (ref.)
Trauma
No	1.301 (5.537)	0.814	0.000 (0.000)	NA
Yes (ref.)
Cardiovascular disease
No	0.979 (1.997)	0.624	-0.124 (1.185)	0.916
Yes (ref.)
Degree of crowdedness	-0.006 (0.003)	0.026	-0.009 (0.004)	0.013
State anxiety	0.328 (0.068)	< 0.001	0.615 (0.053)	< 0.001

ED: Emergency department.

Table 5 Factors influencing state and trait anxiety of nurses in emergency departments

	State anxiety			Trait anxiety
	Estimate value	SD	P value	Estimate value	SD	P value
Crowdedness	0.021	0.044	0.627	-0.015	0.050	0.766
Trait anxiety	0.501	0.122	< 0.001
State anxiety				0.636	0.155	< 0.0001

SD: Standard deviation.

Table 6 Factors influencing state and trait anxiety of inpatients and outpatients in emergency departments analyzed by multivariable regression method

Variable	State anxiety			Trait anxiety
	Estimate value	SD	P value	Estimate value	SD	P value
Inpatients
Trait anxiety	0.403	0.066	< 0.001
State anxiety				0.401	0.073	< 0.001
Time of onset and admission	-0.040	0.013	0.003
Waiting time after admission	0.098	0.025	0.0001
Number of patients during that day	0.011	0.003	0.001	-0.011	0.003	0.001
Hospitalization time	0.005	0.002	0.003
Gastrointestinal bleeding
No	4.305	1.509	0.004
Yes (ref.)
Hospitalization cost
≤ 1000	-2.316	1.405	0.099
1001-3000	-1.643	1.210	0.175
3001-20000	-1.824	0.895	0.042
≥ 20000 (ref.)
Illness severity grade
0				8.995	3.493	0.010
1				8.548	3.490	0.014
2				8.749	3.584	0.015
3 (ref.)
Outpatients
Trait anxiety	0.307	0.054	< 0.001
State anxiety				0.558	0.052	< 0.001
Number of nurses	-0.004	0.001	0.007
Waiting time after entering the ED				-0.045	0.010	< 0.001
Coronary heart disease
No	-0.640	0.254	0.012
Yes (ref.)

ED: Emergency department; SD: Standard deviation.