BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Objective:To investigate the mechanism of overexpression of miR-320e in inhibiting inflammatory response of re-spiratory syncytial virus(RSV)infected bronchial epithelial cells.Methods:Human bronchial epithelial cells 16HBE were cultured in vitro and infected with RSV,and cells were divided into Con group,RSV group,RSV+miR-NC group,RSV+miR-320e group,RSV+miR-320e+vector group,RSV+miR-320e+TLR4 group.RT-qPCR was used to detect expression levels of miR-320e and TLR4 mRNA;MTT to detect cell proliferation changes;flow cytometry to detect cell apoptosis;Western blot was used to detect Bcl-2,Bax,TLR4,IκBα,p-IκBα,NF-κB and p-NF-κB protein expressions;ELISA to detect TNF-α,IL-6,IL-1β and IFN-α,IFN-β expres-sions;dual luciferase experiment to verify the tageting relationship between miR-320e and TLR4.Results:Compared with Con group,miR-320e expression level,survival rate,Bcl-2 and IκBα protein expressions were significantly reduced,apoptosis rate,Bax protein expression,TNF-α,IL-6,IL-1β and IFN-α,IFN-β expressions,TLR4 mRNA and protein expression,and p-IκBα protein expres-sion and p-NF-κB/NF-κB were increased significantly in RSV group.Compared with RSV+miR-NC group,miR-320e expression level,survival rate,IFN-α,IFN-β expressions,Bcl-2 and IκBα protein expressions were significantly increased,apoptosis rate,Bax pro-tein expression,TNF-α,IL-6,IL-1β expressions,TLR4 mRNA and protein expression,and p-IκBα protein expression and p-NF-κB/NF-κB in RSV+miR-320e group were significantly reduced.miR-320e targets and negatively regulates the expression of TLR4.Up-regulation of TLR4 can partially restore the effect of overexpression of miR-320e on apoptosis and inflammatory response of RSV-infected bronchial epithelial cells 16HBE.Conclusion:miR-320e inhibits 16HBE apoptosis and inflammation in RSV-infected bronchial epi-thelial cells by targeting and negatively regulating TLR4 expression.