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Open Access Full Text Article                                                          Research Article

Assessment of Anxiety and Depression among Inpatients at a Healthcare Facility in Aligarh: A Cross-Sectional Pilot Study

Nazia Sadaf *¹, Ammar Ibne Anwar ², Abdul Aziz Khan ², Zarin Fatima ³, Heena Khan ³

¹ MD Scholar, Department of Tahaffuzi wa Samaji Tib (Preventive and Social Medicine), Faculty of Unani Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India-202002

² Associate Professor, Department of Tahaffuzi wa Samaji Tib (Preventive and Social Medicine), Faculty of Unani Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India- 202002

³ MD Scholar, Department of Ilmul Saidla (Unani Pharmacy), Faculty of Unani Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India- 202002

 

 

INTRODUCTION

Mental, physical, and social well-being are essential and intricately connected aspects of life for everyone. Unfortunately, across much of the world, mental health and mental illnesses continue to be overlooked and inadequately addressed ¹.

Depression is a prevalent, debilitating, and potentially life-threatening condition that arises from various risk factors, including biological aspects (genetics, chronic illnesses, and terminal conditions), psychological influences, social elements (family dynamics, relationships, violence, and disasters), cultural factors (religion, caste, beliefs, and attitudes), and economic conditions. Globally, over 300 million people suffer from depression, and nearly as many experience clinically significant anxiety [WHO, 2023] and recognised as the leading cause of disability worldwide ².

In India, the National Mental Health Survey 2015-16 found that approximately 15% of Indian adults require active intervention for one or more mental health conditions, with depression and anxiety being the most common ³. Depression occurs approximately 50% more frequently in women than in men, and globally, over 10% of pregnant women and new mothers suffer from depression ⁴. Suicide, often linked to untreated depression and anxiety, remains the fourth leading cause of death among people aged 15–29 ⁵. During the COVID-19 pandemic, there has also been a sharp rise; many studies reported increases of 25% or more in the combined prevalence of anxiety and depression across many countries ⁶.

Modern Perspective

Depression is a mental health condition characterised by intense feelings of hopelessness and inadequacy, often accompanied by significant loss of energy and interest in daily life. It is increasingly recognised as a global issue and frequently referred to as a modern-day epidemic ⁷.

There are three main types of mood disorders: major depression, dysthymia, and bipolar disorder. Major depression involves persistent sadness or irritability for at least two weeks, accompanied by difficulties in sleeping, eating, or enjoying activities. Dysthymia is a milder but longer-lasting form of depression that hinders a person's ability to feel good and can include episodes of major depression. Bipolar disorder, formerly known as manic disorder, is characterised by extreme mood swings between highs (mania) and lows (depression) ⁸. Depression can be classified as mild, moderate, or severe based on the range and intensity of symptoms ⁹.

It can arise from a combination of genetic, biological, social, and sociocultural factors. Biological causes involve imbalances in neurotransmitters like serotonin, norepinephrine, dopamine, and GABA. Social influences include family conflicts, traumatic events, stress, addiction, and unhealthy lifestyle choices such as poor sleep patterns. Additionally, sociocultural factors like education, religious beliefs, value systems, and significant life changes (moving or switching schools) can contribute, along with feelings of hopelessness and lack of purpose in life ¹⁰.

It is diagnosed when five or more DSM-IV-TR symptoms persist over two weeks, accompanied by noticeable changes in functioning of pleasure. Depression and anxiety are classified in DSM-5 and ICD-11 as mood and anxiety disorders, respectively. Diagnosis requires a combination of persistent symptoms such as low mood, excessive worry, fatigue, sleep disturbances, and suicidal ideation. At least one symptom must be either depressed mood or anhedonia (loss of interest or pleasure). 

Unani Perspective

From a Unani perspective, the roots of mental health disturbances have been explored for centuries under the concept of Quwwat-e-Nafsaniya (psychic faculty). The foundations of psychiatry can be traced back to Hippocrates (430 B.C.), who attributed mental disturbances, including melancholia, to an excess of black bile ¹¹. Galen further elaborated that disorders of the mind could arise from a lessening of phlegm in the brain, leading to reduced humidity ¹² and emphasised sadness (Leading to social aversion and constant worry) and fear (Linked to external darkness) as central features of melancholia ¹³. Rhazes (850–925 A.D.) provided concise insights into conditions such as delirium (Karabit), melancholia, and hysteria, while Avicenna (980–1037 A.D.) presented a comprehensive account of psychiatric disorders in his Canon of Medicine. He highlighted the roles of imagination, reasoning, and memory as critical faculties ¹⁴ and described diverse forms of melancholia, including sanguine and choleric variants ¹⁵. 

Al Jurjani, the renowned Unani scholar, stated that prolonged sadness causes the body's innate heat to return to the heart, leading to congestion, which can result in sudden death ¹⁶.

These classical insights highlight the holistic orientation of Unani medicine, which considers mental health inseparable from physical, emotional, and spiritual well-being. 

Understanding anxiety and depression in hospitalised patients is critical for improving recovery outcomes. While modern psychiatry provides structured diagnostic frameworks, the Unani system emphasises temperamental balance and a holistic approach to care.

Objectives

1. To assess anxiety and depression among inpatients admitted to a healthcare facility in Aligarh using the Hospital Anxiety and Depression Scale (HADS).
2. To assess the correlation between anxiety and depression scores among admitted patients.

METHODOLOGY

It was a hospital-based cross-sectional study conducted to find out the level of anxiety and depression among admitted patients in the hospital. 

Place of Study: Ajmal Khan Tibbiya College & Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

B) Sampling Method: Stratified systematic random sampling 

The study population consisted of patients who were admitted to the wards (Surgery, Obstetrics and Gynaecology, and Medicine) and gave informed consent.

The study was conducted from October to December 2024

5. Inclusion Criteria:
6. Patients of either sex between the ages of 20 to 65 years.
7. Patients were admitted to the indoor ward of AKTCH.
8. Patients who gave consent for participation in the study.
9. Exclusion Criteria:
10. Patients below the age of 20 years and above 65 years.
11. The patient is attending the OPD only.
12.  Patients who have not given consent for participation in the study.

 

7. Sample size: 20 (purposive sampling, calculated based on feasibility for pilot study)
8. Method of Study and Research Instrument:

To accomplish the study, a validated HADS (Hospital Anxiety and Depression Scale) ¹⁷        (Beekman, E. et al., 2018) questionnaire was used.

A semi-structured, questionnaire-based proforma, which consisted of 2 sections. 

Section A consists of Personal Information, which includes socio-demographic information regarding the subject’s age, gender, profession, address, religion, marital status, and reason for admission (diagnosis) and consent form.

Section B consists of the HADS questionnaire. 

A validated tool for hospital patients, used as a screening instrument (not diagnostic). Cut-off scores followed standard guidelines (0–7 normal, 8–10 borderline, 11–21 probable case).

 

 

RESULT

Table 1: Distribution of patients according to sociodemographic variables

 

 

 

 

Table 1 provides an overview of the patients' socio-demographic characteristics. The highest proportion (40%) belonged to the 25-35 age group, while 25% were in the 46-55 and 56-65 age categories. Additionally, 10% of the patients fell within the 36-45 age range. Gender distribution was equal, with males and females each accounting for 50% of the sample.

Regarding marital status, out of the 20 patients surveyed, 18 (90%) were married, whereas 2 (10%) were unmarried. Regarding occupation, homemakers constituted the largest group, i.e, 10 (50%), followed by businessmen, 4 (20%). Dependents accounted for 2 (10%), while the remaining 1 (5%) were retired policemen, farmers, carpenters, and tailors, respectively.

Furthermore, the majority of patients, 18 (90%), identified as Muslim, while the remaining 2 (10%) belonged to non-Muslim religious groups.

 

 

Table 2: Distribution of patients according to medical history

Medical History                                                         Disease		Frequency (n%)
Past history	Hypothyroidism	3 (15)
	Hypertension	2 (10)
	T2DM	1 (05)
	Blood transfusion	1 (05)
	Tuberculosis	1 (05)
	Miscarriage	1 (05)
	No past history	11 (55)
	Total	20 (100)
OPD	Surgery	10 (50)
	Gynaecology	6 (30)
	Skin	1 (05)
	IBT	2 (10)
	Medicine	1 (05)
	Total	20 (100)

  

                    

Figure 1: Distribution of patients according to OPD

Table 3: Distribution of patients according to diagnosis

		Frequency (n %)
Diagnosis	Cholelithiasis	2 (10)
	Inguinal Hernia	3 (15)
	Fistula in Ano	2 (10)
	DUB	2 (10)
	Haemorrhoid	1 (05)
	Urinary Bladder Poly	1 (05)
	Urinary tract infection	1 (05)
	Psoriasis	1 (05)
	Hypertension	1 (05)
	Polyarthralgia	1 (05)
	Leucorrhoea	1 (05)
	Anaemia	1 (05)
	2° infertility	1 (05)
	Hypothyroidism	1 (05)
	Cystitis	1 (05)
	Total	20 (100)

 

Table 4: Overall frequency distribution of depression and anxiety using HADS

	Depression	Anxiety
Score	Frequency (n %)	Frequency (n %)
0-7= Normal	7 (35)	9 (45)
8-10= Borderline/ Abnormal	11 (55)	8 (40)
11-21= Case of Anxiety/Depression	2 (10)	3 (15)
Total	20 (100)	20 (100)

 

 

 

  

Figure 2: Distribution according to Anxiety score

Figure 3: Distribution according to Depression

 

 

 

Table 4 presents the distribution of depression and anxiety levels among inpatient individuals, based on the Hospital Anxiety and Depression Scale (HADS) scoring. The data indicate that 35% of patients exhibited normal mood levels, while 55% fell into the borderline depression category. A confirmed diagnosis of depression was observed in 10% of cases.

Similarly, regarding anxiety levels, 45% of patients demonstrated normal anxiety levels, while 40% were classified as borderline anxiety cases. Confirmed anxiety was present in 15% of the studied population. The study indicates that anxiety was more prevalent among females (66.67%) than males (33.33%).

The findings indicate a positive relationship between anxiety and depression among admitted patients. Participants with elevated anxiety scores were more likely to exhibit depressive symptoms.

DISCUSSION:

Mental health disorders, particularly anxiety and depression, remain significant challenges among hospitalised patients, affecting their overall well-being and recovery process. This study assessed the prevalence and severity of anxiety and depression among admitted patients in the hospital of AMU, providing critical insights into their mental health status.

The findings indicate that depression is not solely an individual struggle but a broader societal concern, shaped by a complex interplay of biological, psychological, social, cultural, and economic factors. Its widespread impact extends beyond the affected individuals, influencing families, communities, and healthcare systems. While modern medicine provides advanced diagnostic tools and therapeutic interventions, a more holistic approach incorporating traditional perspectives, such as those offered by Unani medicine, could enhance mental health care strategies and promote more comprehensive patient management.

The demographic analysis revealed significant variations in anxiety and depression levels among different age groups, gender distributions, and medical histories. The highest representation of admitted patients belonged to the 25–35 age group (40%), whereas older age groups showed relatively lower percentages. Gender distribution was equal among male and female patients, and the majority (90%) were married. This study also reveals that a higher percentage of females (66.67%) experienced anxiety compared to males (33.33%).

Kulkarni et al. (2014) ¹⁸ reported that depression was more prevalent among females in Southern India. Their study highlights regional and gender disparities in mental health concerns.

 A notable proportion of patients exhibited borderline or elevated levels of anxiety and depression, highlighting the necessity for proactive mental health interventions within hospital settings. Based on the HADS questionnaire, 40% of patients were borderline in anxiety scores, and 15% were classified as suffering from anxiety. Similarly, 55% of patients were borderline for depression, and 10% were diagnosed with clinical depression. This study found that hospitalized patients showed symptoms of anxiety and depression. Similar findings were reported by Gammon J. (1998) ¹⁹, whose research on the psychological effects of hospitalization showed increased levels of both conditions in patients.

These findings emphasize the importance of incorporating routine psychological assessments into hospital care to ensure the timely identification and management of mental health disorders. 

A previous study by Kar, N. et al (2022) ²⁰ emphasizes the complex interplay of clinical and socio-cultural factors affecting mental health in hospitalized patients and their families. Their findings highlighted that non-clinical factors like unemployment significantly influence mental health and stress outcomes across all groups. Another study by Vadakkiniath, I. J. (2023) ²¹    highlights a high prevalence of stress, anxiety, and depression among patients with chronic diseases, especially cardiovascular conditions, influenced by various sociodemographic and psychosocial factors. It emphasizes the need for integrating mental health support into chronic disease management to improve overall outcomes.

Further, Ranjan, R., et al (2020) ²² in their study found that anxiety and depression are present in patients with chronic non-communicable diseases like hypertension and diabetes. Women showed higher depression scores, and both anxiety and depression negatively impacted quality of life. The authors emphasize the importance of psychiatric assessment to improve patient outcomes.

One more study by Kulkarni et al (2021) ²³ found that hospitalised patients showed symptoms of anxiety and depression, with evidence suggesting a correlation between the two. It emphasised that the importance of routine psychological assessment in hospitals is critical as untreated anxiety and depression may prolong recovery, worsen prognosis, morbidity, and increase healthcare costs. Although this study also noted limitations, such as a small sample size.

Unani system emphasises mizaj balance, dietary regulation, lifestyle modification (Asbab-e-Sitta Zarooriya), counselling, and herbal remedies (e.g., Brahmi, Asgandh, Ustukhuddus). Integrating these with modern psychiatric care may enhance patient-centred, culturally sensitive, and holistic management of depression and anxiety.

Beyond clinical interventions, addressing anxiety and depression requires societal shifts in attitudes toward mental health. Reducing stigma, promoting awareness, and promoting comprehensive care strategies can improve patient outcomes and create a more supportive environment for those struggling with psychological distress. Integrating interdisciplinary approaches and enhancing accessibility to mental health services can lead to more effective treatment and long-term recovery.

CONCLUSION

The findings of this study highlight the significant burden of anxiety and depression among ward patients, highlighting the urgent need for early detection and comprehensive management. While modern medicine provides effective diagnostic (DSM-5, ICD-11) and therapeutic strategies, integrating Unani principles of temperament correction, lifestyle regulation, and holistic healing with evidence-based psychiatry can enrich treatment outcomes and support recovery. Moreover, addressing mental health concerns requires not just medical advancements but also societal transformations, reducing stigma, fostering awareness, and ensuring equitable access to mental health resources.

By prioritising early identification and timely psychological assessment and intervention, incorporating evidence-based treatments, and promoting an inclusive approach to patient care, healthcare providers can create a more supportive environment for individuals battling anxiety and depression. Strengthening awareness and intervention strategies can pave the way for a future where mental health is universally recognised, valued, and protected, ultimately improving overall patient quality of life, well-being and recovery outcomes.

Acknowledgements: The authors express their sincere gratitude to their respective institution and department for providing the necessary academic support and facilities to conduct this study. The authors also acknowledge all the participants who voluntarily participated in the study and contributed valuable information to the research.

Funding Statement: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of Interest: The authors declare no conflicts of interest related to the publication of this research paper.

Ethical Considerations: Written informed consent was obtained from all study participants prior to data collection. Confidentiality and privacy of participants were strictly maintained. The study was observational and questionnaire-based in nature, with no therapeutic intervention involved. 

Author Contribution:

1. Nazia Sadaf: Literature search, Data collection, Manuscript writing. 
2. Ammar Ibne Anwar: Conceptualisation, Manuscript review and editing.
3. Abdul Aziz Khan: Concept, data analysis.
4. Zarin Fatima: Manuscript formatting, data collection.
5. Heena Khan: Literature search.

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