The Impact of Monophobia on Anxiety, Quality of Sleep, Communication Patterns, and healthcare Outcomes among hospitalized Patients

The Impact of Monophobia on Anxiety, Quality of Sleep, Communication Patterns, and healthcare Outcomes among hospitalized Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Monophobia on Anxiety, Quality of Sleep, Communication Patterns, and healthcare Outcomes among hospitalized Patients Ayman Hamdan-Mansour, Nour J. Amleh, Samir Jabaiti, Huda M. Al Nabulsi, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9367328/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract despite its potential influence on hospitalized patients’ psychological and behavioral outcomes. This study aimed to examine the association between monophobia and hospitalization-related anxiety, sleep disturbance, communication patterns, and selected clinical factors among hospitalized patients in Jordan. Methods: A cross-sectional descriptive study was conducted among 306 patients recruited from three referral hospitals in Jordan between January and June 2025. Data were collected using a structured questionnaire including sociodemographic variables, the Hospital Anxiety and Depression Scale (HADS-A), the Patient Communication Pattern Scale (PCPS), the PROMIS Sleep Disturbance Short Form, and a monophobia scale developed based on DSM-5-TR criteria. Multiple regression analysis was performed to identify predictors of monophobia. Results: The mean monophobia score indicated mild severity (M = 2.7, SD = 3.0). Approximately 39.2% of participants reported borderline to severe anxiety. Monophobia was significantly correlated with anxiety (r = .59, p < .001) but not with communication patterns or sleep disturbance. Regression analysis showed that anxiety (B = .36, p < .001), sleep disturbance (B = − .05, p = .021), room preference (B = .34, p < .001), and having a companion (B = .56, p = .047) were significant predictors, explaining 40% of the variance. Conclusions: Monophobia among hospitalized patients is primarily associated with anxiety and contextual hospitalization factors. Incorporating psychological screening and supportive interventions may improve patient outcomes. Monophobia hospitalization anxiety sleep quality communication patterns inpatients Introduction Phobias are common mental disorders that significantly affect individuals’ functioning and social life. Types of phobias are defined within the sociocultural context and are affected by social norms and interpersonal dynamics (1). A particular type of phobia that seems to be cryptic within other types of psychological disturbances is monophobia. Monophobia is used interchangeably with autophobia, isophobia, and eremophobia. Previous reports indicated that the prevalence of specific phobias seems to be remarkable compared to other forms of anxiety-related disorders (2). However, the prevalence of monophobia is not reported and addressed adequately in the literature despite its significant interference in the progression of the health status of those who might have an undetected monophobia (3). This may draw attention to psychological and sociodemographic factors that indicate the presence of monophobia. The notion that being hospitalized would produce fear is common. Previous reports showed that patients normally feel anxious about being hospitalized due to medical or social concerns (4). Hospitalization was found to increase the sense of feeling lonely, being away from family, and feeling isolated for medical reasons (Rodríguez-Prat et al., 2024). Once such fear becomes excessive and irrational, it interferes directly with treatment plans (5). Patients with anxiety-related disorders, relative to healthy others, exhibit stronger fear expression that leads to mismanagement and delay in achieving treatment outcomes (6). Monophobia is found to be associated with sleep disturbances, leading to increased perception of threat and anxiety among hospitalized patients (7). The literature provided robust evidence that connects various forms of phobias to social and occupational impairment; however, monophobia has received little attention. In particular, there is a need to connect monophobia symptoms to inpatients’ experiences during hospitalization. Among hospitalized patients, poorer sleep quality and impaired communication with healthcare providers are among the most noted concerns (8,9,10). Nevertheless, less emphasis is placed on the underlying reasons for such hospitalization issues, in which monophobia could be the undetected and defined cause. Previous reports indicated anxiety has been associated with longer lengths of hospital stay and higher readmission rates, highlighting the clinical relevance of identifying monophobia as a potential contributing factor. Monophobia may interfere with patients’ engagement in care and compromise the achievement of treatment goals within the planned hospitalization period ( 11, 12). The purpose of this study was to determine the impact of the severity of monophobia symptoms on hospitalization-related anxiety, quality of sleep, communication patterns, and hospitalization-related factors among patients admitted to general healthcare settings in Jordan. The specific aims were: What is the prediction power of hospitalization anxiety, quality of sleep, communication patterns, and hospitalization-related factors on monophobia symptoms among patients admitted to general healthcare settings in Jordan? What are the differences in severity of monophobia symptoms in relation to sociodemographic and health-related factors among patients admitted to general healthcare settings in Jordan? Materials and Methods Design : This study uses a cross-sectional, descriptive-correlational design. Data was collected using a structured self-reported questionnaire. Data collected from Jan. to June 2025. Setting : Data were collected from three major referral hospitals in Jordan: one university-affiliated hospital, one major governmental hospital, and one private hospital. These hospitals are considered the main ones in the country with the highest capacity and occupancy rates. Sample and sampling : A convenience sampling technique used to recruit patients from the general units at hospitals. Inclusion criteria included: 1) Being 18 years or older, 2) Admitted to a general care unit during the past three days at the time of data collection, and 3) Ability to read, write, and understand the Arabic language, as it is the language used in the survey. Those who have any physical or cognitive disability, according to their medical records, and who have a companion with them in the same room or have a permanent caregiver all the time were excluded from the study, as such elements may influence the response to the questions that addressed the variables of the study. Data Collection : Ethical approval obtained before data collection (Approval: JUH10-2025/6105, 5-3-2025). The research team targeted the general unit in coordination with the healthcare teams, who acted as facilitators to introduce the study to the patients and invite them if interested. Those interested were approached by the research team, who introduced the study and provided information regarding the purpose, significance, and voluntary participation. Patients were assured of confidentiality and that their accepting or refusing participation would not affect their status as patients and the quality of care provided. All patients were asked to sign the consent form in the presence of one healthcare provider before being provided with the survey package. The survey required 10 minutes to be filled out. All data is saved to a password-protected computer file. Measurements : The following tools were used in this study, all of which were administered in the Arabic language. For instruments not originally available in Arabic, translation and cultural adaptation were conducted in accordance with the World Health Organization (WHO) guidelines, using the standard forward–backward translation protocol. Monophobia has been assessed using the author’s developed questions, adapted from the criteria of DSM-5-TR of specific phobias (13). Patients were asked about being afraid to stay alone in a separate room, addressing the following three issues: Avoidance or endurance with distress, being out of proportion, and persistent fear. The patients were asked to rate their fear from 0 (not at all) to 10 (extremely and enduringly) for each of the items. This is a scale of three items; I managed to score each of the three categories out of 10 on average. The higher the score, the more increased the severity of monophobia. Hospitalization Anxiety , assessed using the anxiety domain of the Hospital Anxiety and Depression Scale (HADS-A) (14), is commonly used in hospital settings. The scale consists of 7 questions; the original tool is divided into two scales: HADS-A (anxiety) and HADS-D (depression). In this study, we have used the HADS-A (anxiety). Participants rate their feelings over the past week (reminding them to address the feeling related to their hospitalization period only) on a scale from 0 (no anxiety) to 3 (severe anxiety), with higher scores indicating greater severity of symptoms (14). The total score of the scale can be organized in levels as follows: 0–7: Normal (no clinically significant anxiety), 8–10: Borderline/possible anxiety, and 11–21: Clinically significant anxiety. The scale has good reliability, with Cronbach’s alpha values typically ranging from 0.78 to 0.86. In this study, the internal consistency was good with a Cronbach's alpha of .81. 2. Patient’s communication pattern was assessed using the Patient Communication Pattern Scale (PCPS) (15). It consists of 14 items, each rated from 0 (strongly disagree) to 6 (strongly agree). Higher scores represent a more open and collaborative communication pattern (15). The scale encompasses five different facets of communication: (1) relaying clear information about the illness and symptoms, (2) questioning and requesting clarifications, (3) initiating requests for information from the physician, (4) guiding the physician according to one’s own preferences, and (5) reporting one’s feelings. The scale has good reliability with Cronbach’s alpha coefficients exceeding 0.70 across its subscales. In this study, the Internal consistency was good with a Cronbach's alpha of .83. 3. Sleep disturbances were assessed using the DSM-5 Level 1 Cross-Cutting Symptom Measure: Adult measure and the 8-item PROMIS Sleep Disturbance Short Form (16). The Arabic version of the scale used in this study (17). This scale is used to measure the domain of sleep disturbance in individuals aged 18 and older. The Arabic version of the scale was used in this study. Each item asks the patient to rate the severity of his/her sleep disturbance during the past 7 days (reminding them to address the feeling related to their hospitalization period only). Each item on the measure is rated on a 5-point scale from 1 (never) to 5 (always), with a range in score from 8 to 40. A score of less than 55 = None to slight, 55.0 – 59.9 = Mild, 60.0 – 69.9 = Moderate, and 70 and over = Severe sleep disturbances. The Arabic version of the scale has a Cronbach’s alpha of 0.85 (17). Data Analysis The data were analyzed using IBM SPSS Statistics version 28 for Windows. Descriptive statistics of mean and standard deviation are used to describe the sample characteristics and the psychological variables. Pearson correlation is used to test the relationship between the study variables. ANCOVA and t-tests for independent samples were used to test differences in monophobia in relation to sociodemographic characteristics and health-related factors. Preliminary analyses were carried out to ensure no violations of the assumptions of normality, linearity, multicollinearity, and homoscedasticity. Standardized regression analysis was used to test the predictive power of the variables of the study on monophobia. A p-value less than 0.05 is considered statistically significant. Results Descriptive characteristics Demographic characteristics A total of 306 hospitalized patients participated in the study. The analysis (see Table 1) showed that most of the patients were females (61.1%, n = 187). The mean age of the patients was 43.6 years (SD = 15.7), and most patients were married (71.2, n = 218). Of the patients, 48.0% (n = 147) readmitted at least once in the past year for the same medical problem, and the mean number of days of admission (length of stay) was 4.1 days (SD = 4.1). Insert Table 1 here Health-related factors The analysis showed that 19.3% (n = 59) suffer from other forms of phobias. Most reported medical problems were bone and joint diseases (20.6%, n = 63) and respiratory diseases (15.0%, n = 46). Only a small percentage of them had mental illnesses (2%, n = 6). In addition, 4.2% (n = 13) use psychiatric medications. (See table 2). Insert Table 3 here Variables of the study Phobia : The mean score of the monophobia was 2.7 (SD = 3.0), with 50% (n = 153) of the sample having a score of 0 to 2.0, indicating mild severity of monophobia symptoms. Anxiety : The mean score of the anxiety was 7.2 (SD = 4.8). Those who have normal levels of anxiety (no anxiety) represented 60.8% (n = 186), while 39.2% (n = 120) have borderline abnormal and severe levels of anxiety. Patient communication pattern : The mean score of PCPS was 57.8 (SD = 14.4), with 50% (n = 153) of them having a score of 57.0 or less, indicating a moderate to high level of effectiveness of practicing communication skills. Sleep disturbances : The mean score for sleep disturbance was 25.3 (SD = 7.1), with 50% (n =153) of them had a score of 25.0 or more, indicating a moderate level of sleep disturbance. Insert Table 3 here Bivariate analysis To assess the correlation between monophobia and anxiety, patients’ communication patterns, and sleep disturbances using the Pearson coefficient, the analysis showed that a significant correlation was detected between anxiety and monophobia (r = .59, p 0.05) nor sleep disturbances (r = -.06, p > 0.05). Differences in monophobia in relation to selected sociodemographic The analysis using the Pearson correlation coefficient showed that there’s a significant positive correlation (weak) between monophobia and the number of admissions in the past year (r = 0.16, p 0.05; r = 0.05, p > 0.05, respectively). Also, there was a significant difference between monophobia and cardiovascular disease (t = -3.0, p = 0.003), burns (t = -2.6, p = .010), and general surgery/ENT (t = 2.1, p = .047). The patients who were known to have mental illnesses had the highest mean score of monophobia (M = 7.3, SD = 1.21, t = -9.0, p = .001). The analysis also showed that there is no significant difference in relation to marital status and length of stay (p > .05), while a significant difference was found in monophobia in relation to preferred room to stay (F (2,302) = 7.70, p < 0.001) Regression analysis Using the standardized multiple regression analysis, the analysis (see table 4) showed that the model that contains patient communication pattern, sleep disturbances, anxiety, age, having a companion, admission type, room preference, sex, and whether taking psychotropic medications was significant (F 9, 304 = 21.76, p < .001). The model was able to explain 40.0% (R 2 = .40, adjusted R 2 = .38) of the variation in monophobia. A Durbin-Watson value of 1.86 indicates that no autocorrelation was detected. The analysis showed that the significant predictors were hospitalization anxiety (B = .36, p < .001), sleep disturbances (B = - .05, p = .021), type of room preference (B = .34, p < .001), and having a companion (B = .56, p = .047). Insert Table 4 here Discussion We found that monophobia is linked and can be predicted by patients’ psychosomatic problems, hospitalization anxiety, sleep disturbances, communication patterns, and several healthcare outcomes. Patients with higher scores of monophobia could also be identified from their behaviors upon admission, where the type of room preference of not being alone and preferring having a companion predicted a higher score of monophobia among those patients. The strong correlation between hospitalization anxiety, number of admissions, and intensity of monophobia symptoms suggests that fear of being alone is a broader reflection of anxiety processes rather than an isolated experience. Patients who experience recurrent hospitalization may link emotional distress to hospital environments, which reinforce fear responses through anticipation of being alone. Emotional distress persists beyond acute illness and is strongly associated with the hospitalization experience (9). This may increase vulnerability to fear of solitude and fear of rehospitalization. Such an experience has been translated to a higher vulnerability to fear of solitude and fear of being hospitalized again. While our study showed a strong link between monophobia and hospitalization anxiety, the effect of solitude was more subtle on other dimensions, like sleep quality and communication. Nevertheless, hospital-related sleep disturbances may have multifactorial causes, such as medical conditions, environmental noise, or medication effects (18), rather than being connected solely to monophobia. This may also explain why monophobia appears to manifest primarily as a situational emotional response rather than as a generalized impairment across sleep and communication domains. Likewise, communication remained relatively intact. Patient’s communication pattern appeared to be moderate to high, indicating that most patients were able to communicate with their healthcare providers despite anxiety symptoms. Such findings can be understood within the cultural context of the study setting. Jordanian society is characterized by strong collectivist values that emphasize family cohesion and social responsibility. These values encourage frequent and supportive family visits during hospitalization, as visiting sick individuals is a deeply rooted social norm and religious beliefs that mandate visiting sick persons. This has also been observed in other cultures, where family presence induces a sense of obligation in patients to communicate openly with healthcare providers (19). Unlike other specific phobias, our study showed that monophobia has little to no connection to sociodemographic factors such as age, sex, or marital status. This suggests that monophobia is more of a situational response rather than a personality-bound reaction. However, monophobia was associated with environmental factors. Patients who shared rooms showed higher levels of monophobia symptoms, which can be explained by a “dependency effect"; constant company reinforces avoidance of solitude, which ultimately limits the patient's own capacity to self-soothe and tolerate solitude (Coelho et al., 2020(1). Similarly, patients who stay in private rooms show high monophobia levels, indicating that loneliness can intensify emotional vulnerability, sustaining partial meeting of the diagnostic criteria of monophobia. One limitation is related to self-reported surveys; due to cultural or personal reasons, some individuals may have overstated or understated their emotional distress. Conclusion The present study highlights that monophobia among hospitalized patients is associated with anxiety and is strongly shaped by environmental and social factors rather than personal characteristics. Anxiety, sleep disturbances, and dysfunctional communication patterns did connect to monophobia. The results imply that healthcare professionals and mental health specialists do. There is a need to integrate culturally sensitive companionship and supportive policies in hospitals for patients who express their general fear and insist on not being in a separate room alone. HCPs need to be educated and encouraged to be alert to monophobia signs that might interfere with the success of treatment plans. There is a need for further investigations to test the effective use of the therapeutic environment and increase awareness among healthcare professionals of the early warning signs of monophobia. Declarations Ethics approval and consent to participate: This study was conducted by the ethical standards of the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of the University of Jordan and the Ministry of Education. Written informed consent was obtained from all participants and, where applicable, from their parents or legal guardians before participation. Consent for publication: Not applicable, as no person’s data in any form (including individual details, images, or videos) is included in the manuscript. Availability of data and materials : The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests : The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions AHM and LH conceptualized and designed the study. AHM supervised the study and contributed to the methodological framework. NJA, SJ, HMN, DML, MHAZ, MSE, HKAS, FTA, WJY, and MIA contributed to data collection and coordination of the fieldwork. AHM and LH performed data analysis and interpretation. NJA and LH drafted the manuscript. AHM critically revised the manuscript for important intellectual content. All authors contributed to reviewing and editing the manuscript, reading, and approving the final version. References Coelho CM, Gonçalves-Bradley D, Zsido AN. Who worries about specific phobias? A population-based study of risk factors. J Psychiatr Res. 2020;126:67–72. doi:10.1016/j.jpsychires.2020.05.001. Ekici F, Karaoğlan G, Kandeğer A, Demir LS, Güler Ö. Exploring overlooked anxiety disorders: prevalence of adult separation anxiety disorder and specific phobia in the general population. Genel Tip Derg. 2023;33(6):796–805. Rodriguez-Prat A, Pergolizzi D, Crespo I, Monforte-Royo C. Experiences of isolation among patients hospitalized during an infectious disease outbreak: a systematic review and meta-ethnography. Behav Med. 2024;50(3):195–210. doi:10.1080/08964289.2023.2214717. Alhurani AS, Hamdan-Mansour A, Ahmad M, McKee G, O’Donnell S, O’Brien F, et al. The association of persistent symptoms of depression and anxiety with recurrent acute coronary syndrome events: a prospective observational study. Healthcare (Basel). 2022;10(2):383. doi:10.3390/healthcare10020383. Ju N, Yang X, Ma X, Wang B, Fu L, Hu Y, et al. Hospitalization, interpersonal and personal factors of social anxiety among COVID-19 survivors at six-month follow-up: the minority stress model. Eur J Psychotraumatol. 2022;13(1):2019980. Ahmed S, Jafri H, Ahmed WN, Khanam A, Rashid Y, Ahmed M. Pakistani healthcare professionals’ perceptions of communication about hereditary breast cancer: a qualitative study in a LMIC. J Community Genet. 2023;14(3):287–294. Zenses AK, Lenaert B, Peigneux P, Beckers T, Boddez Y. Sleep deprivation increases threat beliefs in human fear conditioning. J Sleep Res. 2020;29(3):e12873. doi:10.1111/jsr.12873. Gulluni S, De Panfilis C, Marchesi C. Anxiety disorders in medical settings: implications for patient outcomes. Curr Psychiatry Rep. 2021;23(3):15. Hamaideh SH, Abu Khait A, Al-Modallal H, Masa’deh R, Hamdan-Mansour A, AlBashtawy M. Perceived stress and resilience among psychiatric nurses working in inpatient units. Hosp Top. 2024:1–9. doi:10.1080/00185868.2024.2383912. Wu Y, Zhang C, Liu H. Hospital anxiety and its impact on sleep and patient–provider communication. J Adv Nurs. 2022;78(9):2840–2850. Lee S, Jeong H. Psychological distress, length of hospital stay, and readmission risk: a systematic review. Int J Qual Health Care. 2023;35(2):mzad012. Zaben F, Ibdah R, Hamdan-Mansour A. Status and correlates of pediatric oncology nurses' therapeutic communication skills. Open Nurs J. 2025;19:e18744346438769. American Psychological Association. Publication manual of the American Psychological Association. 7th ed. Washington (DC): American Psychological Association; 2022. Soares-Filho BF, Nobrega ACL, Laskowski M, Miltenburg S, Cruz AMF, Mansur AJ. Anxiety and depression in patients with recurrent chest pain. Rev Psiquiatr Clin. 2009;36(3):89–93. Ilan S, Carmel S. Patient communication pattern scale: psychometric characteristics. Health Expect. 2016;19(4):842–853. Yu L, Buysse DJ, Germain A, Moul DE, Stover A, Dodds NE, et al. Development of short forms from the PROMIS sleep disturbance and impairment item banks. Behav Sleep Med. 2012;10(1):6–24. Hamdan-Mansour A, Thultheen I, Alduraidi H, Hamaideh S, BaniHani M, Hamdan-Mansour R. Relationship among depression, psychological distress, and sleep disturbances among older persons with chronic illness. Aging Med Health. 2022;13(3):125–131. Adams C, Harrison R, Schembri A, Junge M, Walpola R. The silent threat: sleep disturbances in hospitalized patients. Int J Qual Health Care. 2024;36(2):mzae042. doi:10.1093/intqhc/mzae042. McCauley C, Thompson S, O'Connor M, Smith J. Family presence and perceived obligation: patient-caregiver communication in palliative care. Palliat Med. 2023;37(9):1230–1242. doi:10.1177/02692163231205130. Tables Table 1: Descriptive statistics of the demographic factors (N = 306) Variable n % Sex Female 187 61.1 Male 119 38.9 Marital status Single 48 15.7 Widow 18 5.9 Married 218 71.2 Divorced 22 7.2 Re-admission No 159 52.0 Yes 147 48.0 Type of insurance Public 250 81.7 Private 16 5.2 No insurance 22 7.2 Charity organizations 18 5.9 Table 2: Descriptive statistics of the health-related factors (N = 306) Variable n % Cardiovascular diseases Yes 56 18.3 Bone and joint diseases Yes 63 20.6 Chest diseases Yes 46 15.0 Cancer disease Yes 28 9.2 Gynecological diseases Yes 52 17.0 Blood diseases Yes 39 12.7 General Surgery/ENT Yes 43 14.1 GI Yes 28 9.2 Burn diseases Yes 4 1.3 All others Yes 66 18.3 Length of stay Less than expected 43 14.1 More than expected 108 35.3 As expected, 92 30.1 do not know 63 20.6 Preferred room Single room 178 58.2 Room with 2 beds 81 26.5 Room with > 3 beds 47 15.4 Type of room Single room 78 25.5 Room with 2 beds 82 26.8 Room with > 3 beds 146 47.7 Do you prefer to have a companion Yes 225 73.5 Do you have a companion Yes 174 56.9 Do you suffer from any type of phobia Yes 59 19.3 Any psychiatric medication Yes 13 4.2 Do you have any relative with mental illness Yes 15 4.9 Table 3: Descriptive statistics of the variables of the study (N = 306) Variables M SD Min Max Q1 Q2 (Md) Q3 Monophobia 2.7 3.0 0 8.0 0 2.0 5.0 Anxiety 7.2 4.8 0 21.0 3.8 6.5 10.0 PCP 57.8 14.4 19.0 82.0 49.0 57.0 68.0 Sleep disturbance 25.3 7.1 8.0 40.0 21.0 25.0 30.0 PCP: Patient communication pattern Table 4: Regressing hospitalization anxiety, sleep disturbances, communication patterns, sociodemographic factors and health-related factors on monophobia among hospitalized patients (N=306) B SE t-test p-value 95.0% CI for B Lower Bound Upper Bound Anxiety .358 .030 12.09 <.001 .300 .416 Patient communication pattern -.004 .010 -.42 .677 -.023 .015 Sleep disturbances -.045 .020 -2.32 . 021 -.084 -.007 Age -.008 .009 -.85 .395 -.025 .010 Sex -.067 .288 -.23 .816 -.633 .499 type of room preference .639 .189 3.39 .001 .268 1.010 Having companion .558 .279 2.00 .047 .008 1.108 On psychotropic medications .751 .745 1.00 .314 -.715 2.216 Family history of mental illness .161 .661 .24 .808 -1.139 1.462 Model summary F = 21.76 R 2 .40 Durbin-Watson 1.86 p value < .001 Adj R 2 .3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers invited by journal 06 May, 2026 Editor invited by journal 13 Apr, 2026 Editor assigned by journal 09 Apr, 2026 Submission checks completed at journal 09 Apr, 2026 First submitted to journal 09 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9367328","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":638002565,"identity":"67346efa-0817-416d-ba77-4eed6f0c6509","order_by":0,"name":"Ayman Hamdan-Mansour","email":"","orcid":"","institution":"University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Ayman","middleName":"","lastName":"Hamdan-Mansour","suffix":""},{"id":638002566,"identity":"0c3e79f8-1ba6-45ff-b576-92ef776fedaa","order_by":1,"name":"Nour J. Amleh","email":"","orcid":"","institution":"King Hussein Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Nour","middleName":"J.","lastName":"Amleh","suffix":""},{"id":638002567,"identity":"1617e794-5c4b-483f-b03a-bd53973b7752","order_by":2,"name":"Samir Jabaiti","email":"","orcid":"","institution":"University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Samir","middleName":"","lastName":"Jabaiti","suffix":""},{"id":638002568,"identity":"a4027de5-a5c7-4149-8b56-6ee863dbfa06","order_by":3,"name":"Huda M. Al Nabulsi","email":"","orcid":"","institution":"zarqa hospital,Jordan","correspondingAuthor":false,"prefix":"","firstName":"Huda","middleName":"M. Al","lastName":"Nabulsi","suffix":""},{"id":638002569,"identity":"07d2a4ad-548c-47c6-8e1d-71d031a2f4c9","order_by":4,"name":"Dana M. AL-laham","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Dana","middleName":"M.","lastName":"AL-laham","suffix":""},{"id":638002570,"identity":"6296415e-9a0c-45af-8a0f-b4522091dd49","order_by":5,"name":"Lobna Harazneh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACAwYeEHUYwkuogArzEK/lDMlaGNuI0cLee+zBD4bD8ubtx589eDjPTt7gdgPjg7dteLTwnEs37GH4bzjnTEK6QeK2ZMMNdw4wG87Fp0Uix0yCh+Ew4wyGhGMSiduYGTfcSGCT5iWgRfIPw2H7GfwP2yQS59TbA7Ww/yakRRpoS+IMiWQ2icSGw4kgW5jxauE5lyYtY3A4eYbEMzaJhGPHk2feOdgsOeccbi327b3HJN9UHLadwZ/+TPJHTbVt3+3mgx/elOHWArULmSPB2EBIPTqQIFXDKBgFo2AUDHcAAN4KUZuts0FZAAAAAElFTkSuQmCC","orcid":"","institution":"Arab American University","correspondingAuthor":true,"prefix":"","firstName":"Lobna","middleName":"","lastName":"Harazneh","suffix":""},{"id":638002571,"identity":"15441802-8e2b-477e-92b9-e1e3e32d2e71","order_by":6,"name":"Marah H. Abu Zahra","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Marah","middleName":"H. Abu","lastName":"Zahra","suffix":""},{"id":638002572,"identity":"811696fa-3e1d-4b3e-9580-d17c94348a0b","order_by":7,"name":"Malak S. Elhaj","email":"","orcid":"","institution":"zarqa hospital,Jordan","correspondingAuthor":false,"prefix":"","firstName":"Malak","middleName":"S.","lastName":"Elhaj","suffix":""},{"id":638002573,"identity":"51e6ea59-3679-40b5-91cb-493cb95cf3d9","order_by":8,"name":"Haneen K. Abu Siris","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Haneen","middleName":"K. Abu","lastName":"Siris","suffix":""},{"id":638002574,"identity":"bcf18fdd-3527-430e-9b7e-1f7c116bc5d2","order_by":9,"name":"Farah T. Alma’aitah","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Farah","middleName":"T.","lastName":"Alma’aitah","suffix":""},{"id":638002575,"identity":"e8df85af-f198-45e1-b005-0318686a3def","order_by":10,"name":"Wafa’ J. Yacoub","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Wafa’","middleName":"J.","lastName":"Yacoub","suffix":""},{"id":638002576,"identity":"08cae0ba-c695-448e-a7da-e1510f321621","order_by":11,"name":"Mirna I. Alhijazeen","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Mirna","middleName":"I.","lastName":"Alhijazeen","suffix":""}],"badges":[],"createdAt":"2026-04-09 10:40:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9367328/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9367328/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109296342,"identity":"bf7ded0f-ba2b-4a3b-abd1-7aae9a9b2d79","added_by":"auto","created_at":"2026-05-15 08:46:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":285789,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9367328/v1/083d571d-05e6-4505-b38b-90529e65a2cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Monophobia on Anxiety, Quality of Sleep, Communication Patterns, and healthcare Outcomes among hospitalized Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhobias are common mental disorders that significantly affect individuals\u0026rsquo; functioning and social life. Types of phobias are defined within the sociocultural context and are affected by social norms and interpersonal dynamics (1). A particular type of phobia that seems to be cryptic within other types of psychological disturbances is monophobia. Monophobia is used interchangeably with autophobia, isophobia, and eremophobia. Previous reports indicated that the prevalence of specific phobias seems to be remarkable compared to other forms of anxiety-related disorders (2). However, the prevalence of monophobia is not reported and addressed adequately in the literature despite its significant interference in the progression of the health status of those who might have an undetected monophobia (3). This may draw attention to psychological and sociodemographic factors that indicate the presence of monophobia.\u003c/p\u003e \u003cp\u003eThe notion that being hospitalized would produce fear is common. Previous reports showed that patients normally feel anxious about being hospitalized due to medical or social concerns (4). Hospitalization was found to increase the sense of feeling lonely, being away from family, and feeling isolated for medical reasons (Rodr\u0026iacute;guez-Prat et al., 2024). Once such fear becomes excessive and irrational, it interferes directly with treatment plans (5). Patients with anxiety-related disorders, relative to healthy others, exhibit stronger fear expression that leads to mismanagement and delay in achieving treatment outcomes (6). Monophobia is found to be associated with sleep disturbances, leading to increased perception of threat and anxiety among hospitalized patients (7). The literature provided robust evidence that connects various forms of phobias to social and occupational impairment; however, monophobia has received little attention. In particular, there is a need to connect monophobia symptoms to inpatients\u0026rsquo; experiences during hospitalization. Among hospitalized patients, poorer sleep quality and impaired communication with healthcare providers are among the most noted concerns (8,9,10). Nevertheless, less emphasis is placed on the underlying reasons for such hospitalization issues, in which monophobia could be the undetected and defined cause. Previous reports indicated anxiety has been associated with longer lengths of hospital stay and higher readmission rates, highlighting the clinical relevance of identifying monophobia as a potential contributing factor. Monophobia may interfere with patients\u0026rsquo; engagement in care and compromise the achievement of treatment goals within the planned hospitalization period ( 11, 12). The \u003cem\u003epurpose\u003c/em\u003e of this study was to determine the impact of the severity of monophobia symptoms on hospitalization-related anxiety, quality of sleep, communication patterns, and hospitalization-related factors among patients admitted to general healthcare settings in Jordan.\u003c/p\u003e \u003cp\u003eThe specific aims were:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eWhat is the prediction power of hospitalization anxiety, quality of sleep, communication\u003c/span\u003e patterns, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand hospitalization-related factors on monophobia symptoms among patients admitted to general healthcare settings in Jordan?\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eWhat are the differences in severity of monophobia symptoms in relation to sociodemographic and health-related factors among patients admitted to general healthcare settings in Jordan?\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e: This study uses a cross-sectional, descriptive-correlational design. Data was collected using a structured self-reported questionnaire. Data collected from Jan. to June 2025.\u003cbr\u003e\u003cstrong\u003eSetting\u003c/strong\u003e: Data were collected from three major referral hospitals in Jordan: one university-affiliated hospital, one major governmental hospital, and one private hospital. These hospitals are considered the main ones in the country with the highest capacity and occupancy rates. \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eSample and sampling\u003c/strong\u003e: A convenience sampling technique used to recruit patients from the general units at hospitals. Inclusion criteria included: 1) Being 18 years or older, 2) Admitted to a general care unit during the past three days at the time of data collection, and 3) Ability to read, write, and understand the Arabic language, as it is the language used in the survey. Those who have any physical or cognitive disability, according to their medical records, and who have a companion with them in the same room or have a permanent caregiver all the time were excluded from the study, as such elements may influence the response to the questions that addressed the variables of the study.\u003cbr\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e: Ethical approval obtained before data collection (Approval: JUH10-2025/6105, 5-3-2025). The research team targeted the general unit in coordination with the healthcare teams, who acted as facilitators to introduce the study to the patients and invite them if interested. Those interested were approached by the research team, who introduced the study and provided information regarding the purpose, significance, and voluntary participation. Patients were assured of confidentiality and that their accepting or refusing participation would not affect their status as patients and the quality of care provided. All patients were asked to sign the consent form in the presence of one healthcare provider before being provided with the survey package. The survey required 10 minutes to be filled out. All data is saved to a password-protected computer file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurements\u003c/strong\u003e: The following tools were used in this study, all of which were administered in the Arabic language. For instruments not originally available in Arabic, translation and cultural adaptation were conducted in accordance with the World Health Organization (WHO) guidelines, using the standard forward\u0026ndash;backward translation protocol.\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cem\u003eMonophobia\u0026nbsp;\u003c/em\u003ehas been assessed using\u0026nbsp;the\u0026nbsp;author\u0026rsquo;s developed questions,\u0026nbsp;adapted from the criteria of\u0026nbsp;DSM-5-TR\u0026nbsp;of specific\u0026nbsp;phobias (13).\u0026nbsp;Patients were asked about being afraid to stay alone in a separate room,\u0026nbsp;addressing the following three issues: Avoidance or endurance with distress, being out of proportion, and persistent fear. The patients were asked to rate their fear from 0 (not at all) to 10 (extremely and\u0026nbsp;enduringly)\u0026nbsp;for each of the items. This is a scale of three\u0026nbsp;items;\u0026nbsp;I\u0026nbsp;managed to score each of the three categories out of 10\u0026nbsp;on\u0026nbsp;average. The higher the score,\u0026nbsp;the more\u0026nbsp;increased\u0026nbsp;the severity\u0026nbsp;of monophobia. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eHospitalization Anxiety\u003c/em\u003e\u003cem\u003e,\u0026nbsp;\u003c/em\u003eassessed using the anxiety domain of the Hospital Anxiety and Depression Scale\u0026nbsp;(HADS-A) (14),\u0026nbsp;is\u0026nbsp;commonly used in hospital settings. The scale consists of 7 questions;\u0026nbsp;the original tool\u0026nbsp;is\u0026nbsp;divided into two scales: HADS-A (anxiety) and HADS-D (depression). In\u0026nbsp;this study,\u0026nbsp;we have used the HADS-A (anxiety). Participants rate their feelings over the past week (reminding them to address the feeling related to their hospitalization period only) on a scale from 0 (no anxiety) to 3 (severe anxiety), with higher scores indicating greater severity of\u0026nbsp;symptoms (14).\u0026nbsp;The total score of the scale can be organized in levels as follows: 0\u0026ndash;7:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNormal (no clinically significant anxiety),\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e8\u0026ndash;10:\u0026nbsp;Borderline/possible\u0026nbsp;anxiety, and 11\u0026ndash;21: Clinically significant anxiety. The scale has good reliability,\u0026nbsp;with Cronbach\u0026rsquo;s alpha values typically\u0026nbsp;ranging\u0026nbsp;from 0.78 to 0.86. In this study,\u0026nbsp;the internal consistency was good with\u0026nbsp;a Cronbach\u0026apos;s\u0026nbsp;alpha of .81.\u0026nbsp;\u003cbr\u003e2.\u0026nbsp;\u003cem\u003ePatient\u0026rsquo;s communication pattern\u003c/em\u003e was assessed using the Patient Communication Pattern Scale (PCPS)\u0026nbsp;(15).\u0026nbsp;It consists of 14 items, each rated from 0 (strongly disagree) to 6 (strongly agree). Higher scores represent a more open and collaborative communication\u0026nbsp;pattern (15).\u0026nbsp;The scale encompasses five different facets of communication: (1) relaying clear information about the illness and symptoms, (2) questioning and requesting clarifications, (3) initiating requests for information from the physician, (4) guiding the physician according to one\u0026rsquo;s own preferences, and (5) reporting one\u0026rsquo;s feelings. The scale has good reliability with Cronbach\u0026rsquo;s alpha coefficients exceeding 0.70 across its subscales. In this study,\u0026nbsp;the\u0026nbsp;Internal\u0026nbsp;consistency was good with\u0026nbsp;a Cronbach\u0026apos;s\u0026nbsp;alpha of .83.\u003cbr\u003e3.\u0026nbsp;\u003cem\u003eSleep disturbances\u003c/em\u003e were assessed using\u0026nbsp;the\u0026nbsp;DSM-5 Level 1 Cross-Cutting Symptom Measure:\u0026nbsp;Adult\u0026nbsp;measure and\u0026nbsp;the 8-item PROMIS Sleep Disturbance Short Form\u0026nbsp;(16).\u0026nbsp;The\u0026nbsp;Arabic version of the scale used in this study\u0026nbsp;(17). This scale is used to measure the domain of sleep disturbance in individuals aged 18 and older. The Arabic version of the scale was used in this study. Each item asks the patient to rate the severity of his/her sleep disturbance during the past 7 days (reminding them to address the feeling related to their hospitalization period only). Each item on the measure is rated on a 5-point scale from 1 (never) to 5 (always),\u0026nbsp;with a range in score from 8 to 40.\u0026nbsp;A score\u0026nbsp;of less than 55 = None to slight, 55.0 \u0026ndash; 59.9 = Mild, 60.0 \u0026ndash; 69.9 = Moderate, and 70 and over = Severe sleep disturbances. The Arabic version of the scale has a Cronbach\u0026rsquo;s\u0026nbsp;alpha\u0026nbsp;of 0.85\u0026nbsp;(17).\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eData Analysis\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThe data were analyzed using IBM SPSS Statistics version 28 for Windows. Descriptive statistics of mean and standard deviation are used to describe the sample characteristics and the psychological variables. Pearson correlation is used to test the relationship between the study variables. ANCOVA and t-tests for independent samples were used to test differences in monophobia in relation to sociodemographic characteristics and health-related factors. Preliminary analyses were carried out to ensure no violations of the assumptions of normality, linearity, multicollinearity, and homoscedasticity. Standardized regression analysis was used to test the predictive power of the variables of the study on monophobia. A p-value less than 0.05 is considered statistically significant.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDescriptive characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDemographic characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 306 hospitalized patients participated in the study. The analysis (see\u0026nbsp;Table 1) showed that most of the patients were females (61.1%, n = 187). The mean age of the patients was 43.6 years (SD = 15.7), and most patients were married (71.2, n = 218). Of the patients, 48.0% (n = 147) readmitted at least once in the past year for the same medical problem, and the mean number of days of admission (length of stay) was 4.1 days (SD = 4.1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 1 here\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth-related factors\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis showed that 19.3% (n = 59) suffer from other forms of phobias. Most reported medical problems were bone and joint diseases (20.6%, n = 63) and respiratory diseases (15.0%, n =\u0026nbsp;46). Only a small percentage of them had mental illnesses (2%, n = 6). In addition, 4.2% (n = 13) use psychiatric medications. (See table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInsert Table 3 here\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePhobia\u003c/u\u003e: The mean score of the monophobia was 2.7 (SD = 3.0), with 50% (n = 153) of the sample\u0026nbsp;having a score of 0 to 2.0, indicating mild severity of monophobia symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAnxiety\u003c/u\u003e: The mean score of the anxiety was 7.2 (SD = 4.8). Those who have normal levels of anxiety (no anxiety) represented 60.8% (n = 186), while 39.2%\u0026nbsp;(n = 120) have borderline abnormal and severe levels of anxiety.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePatient communication pattern\u003c/u\u003e: The mean score of PCPS was 57.8 (SD = 14.4), with 50% (n = 153) of them\u0026nbsp;having a score of 57.0 or less, indicating a moderate to high level of effectiveness of practicing communication skills.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eSleep disturbances\u003c/u\u003e: The mean score for sleep disturbance was 25.3 (SD = 7.1), with 50% (n =153) of them had a score of 25.0 or more, indicating a moderate level of sleep disturbance.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 3 here\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the correlation between monophobia\u0026nbsp;and anxiety, patients’ communication patterns, and sleep disturbances using the Pearson coefficient, the analysis showed that a significant correlation was detected between anxiety and monophobia (r = .59, p \u0026lt; .001), while no significant correlation was observed between monophobia and patients' communication patterns (r = -.06, p\u0026gt; 0.05) nor sleep disturbances (r = -.06, p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferences in monophobia in relation to selected sociodemographic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis using the Pearson correlation coefficient showed that there’s a significant positive correlation (weak) between monophobia and the number of admissions in the past year (r = 0.16, p \u0026lt; 0.05), while no significant correlation was detected between monophobia and age and the average number of days stayed in the hospital in the past admission (r = 0.04, p \u0026gt; 0.05; r = 0.05, p \u0026gt; 0.05, respectively). Also, there was a significant difference between monophobia and cardiovascular disease (t = -3.0, p = 0.003), burns (t = -2.6, p = .010), and general surgery/ENT (t = 2.1, p = .047). The patients who were known to have mental illnesses had the highest mean score of monophobia (M = 7.3, SD = 1.21, t = -9.0, p = .001). The analysis also showed that there is no significant difference in relation to marital status and length of stay (p \u0026gt; .05), while a significant difference was found in monophobia in relation to preferred room to stay (F \u003csub\u003e(2,302)\u003c/sub\u003e = 7.70, p \u0026lt; 0.001)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegression analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing the standardized multiple regression analysis, the analysis (see table 4) showed that the model that contains patient communication pattern, sleep disturbances, anxiety, age, having a companion, admission type, room preference, sex, and whether taking psychotropic medications was significant (F \u003csub\u003e9, 304\u003c/sub\u003e = 21.76, p \u0026lt; .001). The model was able to explain 40.0% (R\u003csup\u003e2\u003c/sup\u003e = .40, adjusted R\u003csup\u003e2\u003c/sup\u003e = .38) of the variation in monophobia. A Durbin-Watson value of 1.86 indicates that no autocorrelation was detected. The analysis showed that the significant predictors were hospitalization anxiety (B = .36, p \u0026lt; .001), sleep disturbances (B = - .05, p = .021), type of room preference (B = .34, p \u0026lt; .001), and having a companion (B = .56, p = .047).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Table 4 here \u0026nbsp;\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe found that monophobia is linked and can be predicted by patients\u0026rsquo; psychosomatic problems, hospitalization anxiety, sleep disturbances, communication patterns, and several healthcare outcomes. Patients with higher scores of monophobia could also be identified from their behaviors upon admission, where the type of room preference of not being alone and preferring having a companion predicted a higher score of monophobia among those patients. The strong correlation between hospitalization anxiety, number of admissions, and intensity of monophobia symptoms suggests that fear of being alone is a broader reflection of anxiety processes rather than an isolated experience. Patients who experience recurrent hospitalization may link emotional distress to hospital environments, which reinforce fear responses through anticipation of being alone. Emotional distress persists beyond acute illness and is strongly associated with the hospitalization experience (9). This may increase vulnerability to fear of solitude and fear of rehospitalization. Such an experience has been translated to a higher vulnerability to fear of solitude and fear of being hospitalized again.\u003c/p\u003e \u003cp\u003eWhile our study showed a strong link between monophobia and hospitalization anxiety, the effect of solitude was more subtle on other dimensions, like sleep quality and communication. Nevertheless, hospital-related sleep disturbances may have multifactorial causes, such as medical conditions, environmental noise, or medication effects (18), rather than being connected solely to monophobia. This may also explain why monophobia appears to manifest primarily as a situational emotional response rather than as a generalized impairment across sleep and communication domains. Likewise, communication remained relatively intact. Patient\u0026rsquo;s communication pattern appeared to be moderate to high, indicating that most patients were able to communicate with their healthcare providers despite anxiety symptoms. Such findings can be understood within the cultural context of the study setting. Jordanian society is characterized by strong collectivist values that emphasize family cohesion and social responsibility. These values encourage frequent and supportive family visits during hospitalization, as visiting sick individuals is a deeply rooted social norm and religious beliefs that mandate visiting sick persons. This has also been observed in other cultures, where family presence induces a sense of obligation in patients to communicate openly with healthcare providers (19).\u003c/p\u003e \u003cp\u003eUnlike other specific phobias, our study showed that monophobia has little to no connection to sociodemographic factors such as age, sex, or marital status. This suggests that monophobia is more of a situational response rather than a personality-bound reaction. However, monophobia was associated with environmental factors. Patients who shared rooms showed higher levels of monophobia symptoms, which can be explained by a \u0026ldquo;dependency effect\"; constant company reinforces avoidance of solitude, which ultimately limits the patient's own capacity to self-soothe and tolerate solitude (Coelho et al., 2020(1). Similarly, patients who stay in private rooms show high monophobia levels, indicating that loneliness can intensify emotional vulnerability, sustaining partial meeting of the diagnostic criteria of monophobia.\u003c/p\u003e \u003cp\u003eOne limitation is related to self-reported surveys; due to cultural or personal reasons, some individuals may have overstated or understated their emotional distress.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study highlights that monophobia among hospitalized patients is associated with anxiety and is strongly shaped by environmental and social factors rather than personal characteristics. Anxiety, sleep disturbances, and dysfunctional communication patterns did connect to monophobia. The results imply that healthcare professionals and mental health specialists do. There is a need to integrate culturally sensitive companionship and supportive policies in hospitals for patients who express their general fear and insist on not being in a separate room alone. HCPs need to be educated and encouraged to be alert to monophobia signs that might interfere with the success of treatment plans. There is a need for further investigations to test the effective use of the therapeutic environment and increase awareness among healthcare professionals of the early warning signs of monophobia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics\u003cstrong\u003e\u0026nbsp;approval and consent to participate:\u003c/strong\u003e This study was conducted by the ethical standards of the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of the University of Jordan and the Ministry of Education. Written informed consent was obtained from all participants and, where applicable, from their parents or legal guardians before participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: Not\u003c/strong\u003e applicable, as no person’s data in any form (including individual details, images, or videos) is included in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: The data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch3\u003eAuthors’ contributions\u003c/h3\u003e\n\u003cp\u003eAHM and LH conceptualized and designed the study. AHM supervised the study and contributed to the methodological framework.\u003c/p\u003e\n\u003cp\u003eNJA, SJ, HMN, DML, MHAZ, MSE, HKAS, FTA, WJY, and MIA contributed to data collection and coordination of the fieldwork.\u003c/p\u003e\n\u003cp\u003eAHM and LH performed data analysis and interpretation.\u003c/p\u003e\n\u003cp\u003eNJA and LH drafted the manuscript. AHM critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003eAll authors contributed to reviewing and editing the manuscript, reading, and approving the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCoelho CM, Gon\u0026ccedil;alves-Bradley D, Zsido AN. Who worries about specific phobias? A population-based study of risk factors. \u003cstrong\u003eJ Psychiatr Res.\u003c/strong\u003e 2020;126:67\u0026ndash;72. doi:10.1016/j.jpsychires.2020.05.001.\u003c/li\u003e\n\u003cli\u003eEkici F, Karaoğlan G, Kandeğer A, Demir LS, G\u0026uuml;ler \u0026Ouml;. Exploring overlooked anxiety disorders: prevalence of adult separation anxiety disorder and specific phobia in the general population. \u003cstrong\u003eGenel Tip Derg.\u003c/strong\u003e 2023;33(6):796\u0026ndash;805.\u003c/li\u003e\n\u003cli\u003eRodriguez-Prat A, Pergolizzi D, Crespo I, Monforte-Royo C. Experiences of isolation among patients hospitalized during an infectious disease outbreak: a systematic review and meta-ethnography. \u003cstrong\u003eBehav Med.\u003c/strong\u003e 2024;50(3):195\u0026ndash;210. doi:10.1080/08964289.2023.2214717.\u003c/li\u003e\n\u003cli\u003eAlhurani AS, Hamdan-Mansour A, Ahmad M, McKee G, O\u0026rsquo;Donnell S, O\u0026rsquo;Brien F, et al. The association of persistent symptoms of depression and anxiety with recurrent acute coronary syndrome events: a prospective observational study. \u003cstrong\u003eHealthcare (Basel).\u003c/strong\u003e 2022;10(2):383. doi:10.3390/healthcare10020383.\u003c/li\u003e\n\u003cli\u003eJu N, Yang X, Ma X, Wang B, Fu L, Hu Y, et al. Hospitalization, interpersonal and personal factors of social anxiety among COVID-19 survivors at six-month follow-up: the minority stress model. \u003cstrong\u003eEur J Psychotraumatol.\u003c/strong\u003e 2022;13(1):2019980.\u003c/li\u003e\n\u003cli\u003eAhmed S, Jafri H, Ahmed WN, Khanam A, Rashid Y, Ahmed M. Pakistani healthcare professionals\u0026rsquo; perceptions of communication about hereditary breast cancer: a qualitative study in a LMIC. \u003cstrong\u003eJ Community Genet.\u003c/strong\u003e 2023;14(3):287\u0026ndash;294.\u003c/li\u003e\n\u003cli\u003eZenses AK, Lenaert B, Peigneux P, Beckers T, Boddez Y. Sleep deprivation increases threat beliefs in human fear conditioning. \u003cstrong\u003eJ Sleep Res.\u003c/strong\u003e 2020;29(3):e12873. doi:10.1111/jsr.12873.\u003c/li\u003e\n\u003cli\u003eGulluni S, De Panfilis C, Marchesi C. Anxiety disorders in medical settings: implications for patient outcomes. \u003cstrong\u003eCurr Psychiatry Rep.\u003c/strong\u003e 2021;23(3):15.\u003c/li\u003e\n\u003cli\u003eHamaideh SH, Abu Khait A, Al-Modallal H, Masa\u0026rsquo;deh R, Hamdan-Mansour A, AlBashtawy M. Perceived stress and resilience among psychiatric nurses working in inpatient units. \u003cstrong\u003eHosp Top.\u003c/strong\u003e 2024:1\u0026ndash;9. doi:10.1080/00185868.2024.2383912.\u003c/li\u003e\n\u003cli\u003eWu Y, Zhang C, Liu H. Hospital anxiety and its impact on sleep and patient\u0026ndash;provider communication. \u003cstrong\u003eJ Adv Nurs.\u003c/strong\u003e 2022;78(9):2840\u0026ndash;2850.\u003c/li\u003e\n\u003cli\u003eLee S, Jeong H. Psychological distress, length of hospital stay, and readmission risk: a systematic review. \u003cstrong\u003eInt J Qual Health Care.\u003c/strong\u003e 2023;35(2):mzad012.\u003c/li\u003e\n\u003cli\u003eZaben F, Ibdah R, Hamdan-Mansour A. Status and correlates of pediatric oncology nurses\u0026apos; therapeutic communication skills. \u003cstrong\u003eOpen Nurs J.\u003c/strong\u003e 2025;19:e18744346438769.\u003c/li\u003e\n\u003cli\u003eAmerican Psychological Association. \u003cstrong\u003ePublication manual of the American Psychological Association.\u003c/strong\u003e 7th ed. Washington (DC): American Psychological Association; 2022.\u003c/li\u003e\n\u003cli\u003eSoares-Filho BF, Nobrega ACL, Laskowski M, Miltenburg S, Cruz AMF, Mansur AJ. Anxiety and depression in patients with recurrent chest pain. \u003cstrong\u003eRev Psiquiatr Clin.\u003c/strong\u003e 2009;36(3):89\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003eIlan S, Carmel S. Patient communication pattern scale: psychometric characteristics. \u003cstrong\u003eHealth Expect.\u003c/strong\u003e 2016;19(4):842\u0026ndash;853.\u003c/li\u003e\n\u003cli\u003eYu L, Buysse DJ, Germain A, Moul DE, Stover A, Dodds NE, et al. Development of short forms from the PROMIS sleep disturbance and impairment item banks. \u003cstrong\u003eBehav Sleep Med.\u003c/strong\u003e 2012;10(1):6\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eHamdan-Mansour A, Thultheen I, Alduraidi H, Hamaideh S, BaniHani M, Hamdan-Mansour R. Relationship among depression, psychological distress, and sleep disturbances among older persons with chronic illness. \u003cstrong\u003eAging Med Health.\u003c/strong\u003e 2022;13(3):125\u0026ndash;131.\u003c/li\u003e\n\u003cli\u003eAdams C, Harrison R, Schembri A, Junge M, Walpola R. The silent threat: sleep disturbances in hospitalized patients. \u003cstrong\u003eInt J Qual Health Care.\u003c/strong\u003e 2024;36(2):mzae042. doi:10.1093/intqhc/mzae042.\u003c/li\u003e\n\u003cli\u003eMcCauley C, Thompson S, O\u0026apos;Connor M, Smith J. Family presence and perceived obligation: patient-caregiver communication in palliative care. \u003cstrong\u003ePalliat Med.\u003c/strong\u003e 2023;37(9):1230\u0026ndash;1242. doi:10.1177/02692163231205130. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Descriptive statistics of the demographic factors (N = 306)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"569\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e61.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMarital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp; 48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e71.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp; 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp; 7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eRe-admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e52.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eType of insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;Public\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e81.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePrivate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp; 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp; 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp; 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp; 7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCharity organizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Descriptive statistics of the health-related factors (N = 306)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 462px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eCardiovascular diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eBone and joint diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eChest diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eCancer disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp; 9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eGynecological diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eBlood diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eGeneral Surgery/ENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eGI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp; 9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eBurn diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eAll others\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eLength of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLess than expected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMore than expected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAs expected,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003edo not know \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003ePreferred room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eSingle room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e58.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRoom with 2 beds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRoom with \u003cu\u003e\u0026gt;\u003c/u\u003e 3 beds\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eType of room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eSingle room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRoom with 2 beds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRoom with \u003cu\u003e\u0026gt;\u003c/u\u003e 3 beds\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eDo you prefer to have a companion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eDo you have a companion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e56.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eDo you suffer from any type of phobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e19.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eAny psychiatric medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp; 4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 306px;\"\u003e\n \u003cp\u003eDo you have any relative with mental illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp; 4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Descriptive statistics of the variables of the study (N = 306)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQ1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQ2 (Md)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQ3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eMonophobia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; 8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp; 5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eAnxiety\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; 7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003ePCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e57.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e82.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e49.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e57.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e68.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eSleep disturbance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; 7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp; 8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePCP: Patient communication pattern\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Regressing hospitalization anxiety, sleep disturbances, communication patterns, sociodemographic factors and health-related factors on monophobia among hospitalized patients (N=306)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et-test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.0% CI for B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower Bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper Bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e12.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.416\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient communication pattern\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep disturbances\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.\u003cstrong\u003e021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.816\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.499\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003etype of room preference\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving companion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOn psychotropic medications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of mental illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e-1.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel summary\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eF =\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e21.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eDurbin-Watson\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.86\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003ep value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eAdj R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Monophobia, hospitalization anxiety, sleep quality, communication patterns, inpatients","lastPublishedDoi":"10.21203/rs.3.rs-9367328/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9367328/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003edespite its potential influence on hospitalized patients\u0026rsquo; psychological and behavioral outcomes. This study aimed to examine the association between monophobia and hospitalization-related anxiety, sleep disturbance, communication patterns, and selected clinical factors among hospitalized patients in Jordan.\u003c/p\u003e \u003cp\u003eMethods: A cross-sectional descriptive study was conducted among 306 patients recruited from three referral hospitals in Jordan between January and June 2025. Data were collected using a structured questionnaire including sociodemographic variables, the Hospital Anxiety and Depression Scale (HADS-A), the Patient Communication Pattern Scale (PCPS), the PROMIS Sleep Disturbance Short Form, and a monophobia scale developed based on DSM-5-TR criteria. Multiple regression analysis was performed to identify predictors of monophobia.\u003c/p\u003e \u003cp\u003eResults: The mean monophobia score indicated mild severity (M\u0026thinsp;=\u0026thinsp;2.7, SD\u0026thinsp;=\u0026thinsp;3.0). Approximately 39.2% of participants reported borderline to severe anxiety. Monophobia was significantly correlated with anxiety (r = .59, p \u0026lt; .001) but not with communication patterns or sleep disturbance. Regression analysis showed that anxiety (B = .36, p \u0026lt; .001), sleep disturbance (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.05, p = .021), room preference (B = .34, p \u0026lt; .001), and having a companion (B = .56, p = .047) were significant predictors, explaining 40% of the variance.\u003c/p\u003e \u003cp\u003eConclusions: Monophobia among hospitalized patients is primarily associated with anxiety and contextual hospitalization factors. Incorporating psychological screening and supportive interventions may improve patient outcomes.\u003c/p\u003e","manuscriptTitle":"The Impact of Monophobia on Anxiety, Quality of Sleep, Communication Patterns, and healthcare Outcomes among hospitalized Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-14 17:27:49","doi":"10.21203/rs.3.rs-9367328/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"153072533511337184889074248170911011026","date":"2026-05-16T12:13:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96575924597318344029443221711338555700","date":"2026-05-06T07:14:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-06T05:44:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-13T07:06:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-10T01:28:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-10T01:27:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2026-04-09T10:26:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"428062d0-506d-44a7-846d-eda39cf916a4","owner":[],"postedDate":"May 14th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"153072533511337184889074248170911011026","date":"2026-05-16T12:13:07+00:00","index":56,"fulltext":""},{"type":"reviewerAgreed","content":"96575924597318344029443221711338555700","date":"2026-05-06T07:14:17+00:00","index":32,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-06T05:44:53+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T17:27:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-14 17:27:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9367328","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9367328","identity":"rs-9367328","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}