High prevalence of anxiety and depression among patients hospitalized with acute febrile illness in Sri Lanka

Introduction: Acute febrile illnesses (AFI) such as dengue, leptospirosis, and influenza result in large numbers of hospitalization in the tropics. These illnesses may negatively impact patients’ mental health. We evaluated the prevalence of anxiety and depression and risk factors associated with these conditions in patients hospitalized with AFI. Methodology: From July- October 2017, we conducted a cross-sectional study of consecutive patients ≥12 years admitted with AFI to a tertiary care hospital in Sri Lanka. We administered the Hospital Anxiety and Depression Scale (HADS) validated in the local language of Sinhala to identify the presence and severity of anxiety and depression. We identified the prevalence of anxiety and depression and determined the association with sociodemographic and clinical characteristics using Chi square and t-tests and multivariabele logistic regression. Results: Of 193 enrolled, 44.6% were male. AFI included dengue (62.7%), viral fever (10.4%), urinary tract infection (6.2%), leptospirosis (4.7%), pneumonia (3.1%) and typhus (0.5%). Overall, 41.4% patients had anxiety and 42.5% had depression. On multivariable analysis, anxiety was associated with awareness of diagnosis (OR=4.3, CI 1.3-13.76, p=.03), lower satisfaction score (OR=0.73, CI 0.58-0.92, p=.008) and lower income (OR=1.92, CI 1.03-3.57, p=.03). Depression was associated with anorexia (OR=2.8, CI 1.33-5.87, p=.006) and diarrhea (OR=2.29, CI 1.17-4.47, p=.01). Conclusions: Patients hospitalized with AFI had a high prevalence of anxiety and depression. Gastrointestinal symptoms, lower socioeconomic status, and awareness of illness diagnosis were all associated with anxiety. Our findings may be helpful in developing interventions to counteract anxiety and depression among patients hospitalized with AFI. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Name of the Institutional Review Board or Ethics Committee: Ethical Review Committee of the Faculty of Medicine, University of Ruhuna, Sri Lanka. Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethical Review Committee of the Faculty of Medicine, University of Ruhuna, Sri Lanka. ERC approval No: 14.06.2017:3.10 Written informed consent was obtained from the patients or from parents for their participation. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data cannot be shared publicly because approval to do so was not originally obtained from the local ethics board. Data may be made available by contacting the Faculty of Medicine, University of Ruhuna Ethical Review Committee, who may grant access on a case-by-base basis for researchers who meet the criteria for access to confidential data.