Prevalence of Anxiety Levels Among Hospitalized Patients with Chronic Diseases in Aden, Yemen: A Cross-Sectional Study

The Invisible Backpack

Imagine you are carrying a heavy backpack. Inside, you have a chronic disease—something like diabetes, high blood pressure, or kidney trouble. This backpack is heavy enough on its own; it requires daily medicine, strict diets, and constant check-ups. But now, imagine someone secretly fills that same backpack with a second, invisible weight: anxiety. This isn't just "feeling a little worried"; it's a constant, buzzing fear that something awful might happen, making it hard to relax or sleep.

In the world of medicine, scientists have long known that physical sickness and mental worry often travel together. It's like a bad habit that spreads: when your body is fighting a long-term illness, your mind often starts fighting too. This is especially true in places where life is already hard, like countries facing war or economic trouble. When the environment is stressful, that invisible backpack gets even heavier. The question researchers have been asking is: just how heavy is this invisible weight for people who are already sick? And who carries the heaviest load?

The Heavy Load in Aden

This study is like a giant, careful weigh-in for a group of patients in Aden, Yemen. The researchers wanted to see how much anxiety was hiding inside the backpacks of people living with chronic diseases in a city that has been through a long and difficult conflict. They didn't just guess; they went to four major hospitals and asked 196 adult patients to fill out a simple, seven-question checklist called the GAD-7. Think of this checklist as a "worry-o-meter" that asks things like, "Have you felt nervous?" or "Have you been unable to stop worrying?" over the last two weeks.

The results were startling. The researchers found that anxiety wasn't just a visitor; it was practically living in the room with almost everyone. A massive 83.7% of the patients (that's 164 out of 196 people) had some level of anxiety. To break that down: 35.2% had mild anxiety, 26.5% had moderate anxiety, and a worrying 21.9% were dealing with severe anxiety. Only about one in six people (16.3%) had no anxiety symptoms at all. In a world where anxiety usually affects about one in five people, finding it in more than four out of five sick patients is like finding a storm cloud over almost every house in a neighborhood.

Who Carries the Heaviest Load?

The study didn't just count the anxiety; it tried to figure out who was carrying the heaviest invisible backpacks. The researchers discovered a few clear patterns:

• The Gender Gap: Being female was a huge factor. Women in the study were 3.43 times more likely to have moderate-to-severe anxiety than men. On average, women's worry scores were nearly 2 points higher than men's. The researchers suggest this might be because women in this region often carry the double burden of managing their own health while also caring for their families and facing more economic insecurity.
• The "Stacking" Effect: The more diseases a person had, the heavier the anxiety. If a patient had multiple chronic conditions (like having both diabetes and kidney trouble), their anxiety risk jumped by 3.43 times for each extra disease. It's like adding another heavy brick to the backpack; the more bricks, the harder it is to walk.
• The Kidney Connection: Among all the different types of sickness, patients with kidney disease had the highest anxiety scores. Their average worry score was 11.50, compared to 9.00 for those without kidney issues. The researchers noted that kidney disease is particularly demanding, often requiring frequent hospital visits for dialysis and strict lifestyle changes, which adds a lot of stress.
• The Age Surprise: You might think older people would be the most worried, but the study found that people aged 31 to 50 had the highest rates of severe anxiety (32.8%). This is the age group that is usually trying to support families and work, but in a conflict zone with a broken economy, that pressure is immense. Interestingly, people over 60 had the lowest rates of severe anxiety, perhaps because they had learned to cope better over time or had stronger family support.

What the Study Says (and Doesn't Say)

The researchers were very careful about what they could conclude. They found that female sex and the number of chronic diseases were the strongest predictors of severe anxiety. They also found that kidney disease and other chronic conditions (like asthma or cancer) were linked to higher anxiety, but surprisingly, diabetes and high blood pressure did not show a strong link to higher anxiety in this specific group. The authors suggest this might be because diabetes and high blood pressure are so common in Yemen that people have adapted to them, or because their treatments are more stable.

However, the study also points out what it didn't prove. Because this was a "snapshot" taken at one moment in time (a cross-sectional study), they cannot say for sure that the sickness caused the anxiety, or that the anxiety made the sickness worse. It's like seeing a car with a flat tire and a broken engine; you know they are both broken, but you don't know which one broke first. They also noted that they didn't directly measure how much violence or trauma each person had seen, which could be a hidden factor making the backpack even heavier.

The Takeaway

The main message from this paper is that in Aden, Yemen, the mental burden of chronic illness is enormous and often ignored. The researchers suggest that doctors shouldn't just treat the physical disease; they need to check the "worry-o-meter" too. They recommend that hospitals start screening every patient for anxiety, especially women, those with kidney disease, and those juggling multiple illnesses. They argue that without helping people put down their invisible backpacks, it will be very hard for them to manage their physical health. The study doesn't offer a magic cure, but it shines a bright light on a problem that needs to be fixed, suggesting that in a place where life is already hard, mental health support is not a luxury—it's a necessity.