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State Trait Anxiety in the Emergency Department: An Analysis of Anticipatory and Life Stressors

Nager, Alan L. MD, MHA*†; Mahrer, Nicole E. BA; Gold, Jeffrey I. PhD†‡§

doi: 10.1097/PEC.0b013e3181fe90eb
Original Articles

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 2, 5.5; P < 0.05) and blood tests (χ 2, 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.

From the *Department of Pediatrics, Division of Emergency and Transport Medicine; †Keck School of Medicine, University of Southern California; and ‡Department of Anesthesiology Critical Care Medicine, and §USC University Center of Excellence in Developmental Disabilities Children's Hospital Los Angeles, Los Angeles, CA.

Reprints: Alan L. Nager, MD, MHA, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop no. 113, Los Angeles, CA 90027 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.