Understanding and measuring the impact of in-hospital stress on post-hospital outcomes

Inpatients are exposed to high levels of psychological stress during hospitalisation that may increase susceptibility to major adverse health events post-hospitalisation (a phenomenon known as post-hospital syndrome). Despite a large body of literature linking stress to negative health outcomes, little is known of this relationship within a hospital context. To further our understanding, we ought to identify and measure the hospital-related stressors inpatients experience. Therefore, the aim of this thesis was to develop and validate a tool to assess in-hospital stress.
To begin, a systematic review was conducted (Chapter 2) to synthesise existing evidence and determine the strength of the relationship between in-hospital stress and patient outcomes. Meta-analysis of 10 studies revealed a small-to-medium correlation between the two variables. Next, a patient-reported outcome measure was developed to assess the hospital-related stress perceived by inpatients (Chapter 3). The Hospital Stress Questionnaire (HSQ) lists 67 hospital-related stressors, identified from previous literature and qualitative interviews with recent patients. The HSQ was administered to 200 recent patients to provide initial validation, this yielded excellent internal consistency and construct validity. This was bolstered by a full validation of 670 recent patients (Chapter 4), which informed item reduction to produce long, medium, and short versions of the HSQ, each with excellent psychometric properties. The final study (Chapter 5), provides evidence that the HSQ is capable of predicting a range of post-hospital health outcomes. The thesis concludes with a protocol for a future study (Chapter 6).
Findings support the theory of post-hospital syndrome, and offer a valid and reliable measure of in-hospital stress. The HSQ may be used in interventions to reduce in-hospital stress, or to identify patients most at risk of post-hospital syndrome. However, the measure is yet to be tested on current inpatients, and further research is required to support the tool’s predictive ability.