Impact of Anxiety Disorders Among Patients with Chronic Illnesses at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Impact of Anxiety Disorders Among Patients with Chronic Illnesses at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria | 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 Impact of Anxiety Disorders Among Patients with Chronic Illnesses at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria Opeyemi Adedapo Adetayo, Vivian Aderonke Adebayo, Akolo Yohanna Jaggu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8326949/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anxiety disorders are common among individuals living with chronic illnesses and can significantly impair cognitive functioning, social relationships, productivity, and overall quality of life. Despite their clinical importance, the functional and psychosocial impact of anxiety among chronically ill patients in Nigeria remains underexplored. This study assessed the impact of anxiety on daily functioning and productivity among patients receiving care at the University of Abuja Teaching Hospital (UATH), Gwagwalada. Methods A descriptive cross-sectional study was conducted among 206 adult outpatients with chronic medical conditions. Sociodemographic and clinical data were collected using a structured interviewer-administered questionnaire, and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale–Anxiety subscale (HADS-A). Descriptive statistics were used to determine the distribution of anxiety-related functional, psychosocial, and productivity impairments. Results More than half of respondents were aged 36–59 years (53.9%), 41.7% were aged 18–35 years, and 4.4% were ≥ 60 years. Women constituted 58.3% of the sample, and most participants were married (68.4%). Over half (56.3%) earned less than ₦100,000 monthly. Anxiety exerted notable cognitive impact, with 34.5% often and 13.6% usually experiencing difficulty concentrating or making decisions. Social functioning was similarly affected: 23.3% often and 8.7% usually had difficulty forming or maintaining relationships due to excessive worrying. Sleep disruption was prominent, with 35.9% often and 20.4% usually reporting poor sleep or insomnia due to anxiety. Additionally, anxiety frequently worsened physical symptoms (34.5% often; 16.0% usually). Productivity was also impaired, with 36.9% often and 13.1% usually reporting limited productivity at work or school due to excessive worrying. Furthermore, 36.9% often and 10.7% usually experienced difficulty completing daily tasks attributable to anxiety. Conclusion Anxiety significantly affects cognitive functioning, interpersonal relationships, sleep quality, productivity, and daily task performance among chronically ill patients at UATH. These findings highlight the need for routine anxiety screening and integration of mental health support into chronic disease management to improve patient functioning and overall well-being. Anxiety disorders Chronic illness Functional impairment Psychosocial impact HADS-A Nigeria Introduction Anxiety disorders are among the most prevalent mental health conditions globally and contribute substantially to disability, impaired functioning, and diminished quality of life. In 2019, an estimated 284 million people were living with anxiety disorders, making them one of the leading contributors to global mental health burden. 1 The prevalence is particularly pronounced in low- and middle-income countries (LMICs), where structural barriers to mental health care including limited workforce and fragmented services hinder early detection and treatment. 2 Chronic illnesses such as hypertension, diabetes mellitus, chronic kidney disease, heart failure, hepatitis B and C, and HIV/AIDS are strongly associated with higher levels of psychological distress, with anxiety consistently identified as a frequent comorbidity. 3 , 4 The relationship between chronic illness and anxiety is complex and mutually reinforcing. Chronic diseases often impose continuous physical symptoms, long-term medication use, lifestyle restrictions, and economic challenges that predispose individuals to anxiety. Conversely, anxiety negatively influences disease management by impairing adherence to medication, reducing clinic attendance, and increasing maladaptive health behaviours. Evidence demonstrates that anxiety worsens glycaemic control among individuals with diabetes, contributes to higher cardiovascular risk, and reduces overall treatment outcomes. 5 , 6 If undetected or untreated, anxiety can lead to increased healthcare utilization, extended hospital stays, and lower quality of life among chronically ill patients. 7 In Nigeria, the rising burden of chronic non-communicable and infectious diseases has been accompanied by increasing psychological morbidity. Despite this, mental health screening is generally not integrated into chronic care pathways, resulting in underdiagnosis of anxiety disorders. Studies across Nigerian tertiary hospitals have documented moderate to high prevalence rates of anxiety among patients with chronic diseases, influenced by socioeconomic challenges, stigma, limited health insurance coverage, and resource constraints in the health system. 8 , 9 These contextual pressures may place Nigerian patients at heightened risk for anxiety-related complications. The University of Abuja Teaching Hospital (UATH), located in Gwagwalada, serves a large and diverse population of patients with chronic diseases. However, there is limited empirical evidence characterizing the burden, correlates, and implications of anxiety disorders among this patient group. Understanding this burden is crucial for strengthening integrated mental health services, improving chronic disease outcomes, and informing evidence-based policy interventions. This study therefore aims to assess the impact of anxiety disorders among patients with chronic illnesses at UATH. Generating this evidence is important for enhancing comprehensive, patient-centred chronic care in Nigeria. Methods and Materials Study Setting The study was carried out at the University of Abuja Teaching Hospital (UATH), a 520-bed tertiary healthcare facility located in Gwagwalada, Federal Capital Territory, Nigeria. UATH provides specialized services to an estimated catchment population of more than 500,000 people and serves as a major referral centre within the region. Study Population The target population consisted of adult outpatients aged 18 years and above who had been diagnosed with chronic medical conditions. Eligible chronic illnesses included hypertension, diabetes mellitus, chronic kidney disease, heart failure, hepatitis B or C virus infection, and HIV/AIDS. Only patients who provided informed consent and were stable enough to participate were included in the study. Study Design and Sample Size A descriptive cross-sectional study design was employed. Sample size determination was based on Cochran’s formula for estimating proportions, yielding a minimum required sample size of 226 participants. Sampling Procedure A stratified sampling technique was used to ensure proportionate representation of major chronic disease categories. Patients were first grouped into strata comprising cardiovascular, endocrine, nephrological, neurological, pulmonological, gastroenterological, and infectious diseases. Within each stratum, proportional allocation was applied, followed by simple random sampling to select participants. Data Collection Instrument Data were collected using a structured, interviewer-administered questionnaire designed to assess the impact of anxiety among patients with chronic medical conditions. The instrument comprised four sections. The first section collected participants’ sociodemographic characteristics, including age, sex, marital status, educational level, and employment status, which were used as background variables. The second section obtained clinical information related to chronic illnesses, such as the type and duration of the condition, to provide contextual understanding of anxiety-related impact. The third section assessed anxiety symptoms using an adapted version of the Hospital Anxiety and Depression Scale–Anxiety subscale (HADS-A), originally developed by Zigmond and Snaith.¹⁰ Minor contextual modifications were made for clarity. This section was used to determine the presence and severity of anxiety among participants. The final section, which constituted the primary outcome measure, included structured items assessing the impact of anxiety on participants’ daily lives. These items evaluated functional impairment, psychosocial effects, sleep disturbance, and work or productivity limitations attributable to anxiety. The complete questionnaire is provided in Appendix I (Supplementary File). Data Analysis Completed questionnaires were checked for completeness, coded, and entered into IBM SPSS Statistics version 29 for analysis. Data cleaning was performed to ensure accuracy and consistency prior to analysis. Descriptive statistics were used to analyse and present the data in line with the study objective of assessing the impact of anxiety among patients with chronic medical conditions. Sociodemographic characteristics of respondents—including age group, sex, marital status, and monthly income—were summarized using frequencies and percentages. Anxiety-related impact variables were analysed descriptively. Responses to items assessing cognitive functioning (difficulty concentrating or making decisions), psychosocial functioning (difficulty forming or maintaining relationships), sleep disturbance (poor sleep quality or insomnia), perceived worsening of physical symptoms, productivity at work or school, and ability to complete daily tasks were summarized using frequencies and percentages across response categories (never, rarely, sometimes, often, usually). Results were presented in tables to illustrate the distribution and magnitude of functional, psychosocial, sleep-related, and productivity-related impacts of anxiety among participants. No inferential statistical tests were performed, as the primary focus of the study was to describe the extent and pattern of anxiety-related impact in the study population. Results The sociodemographic characteristics of the 206 participants were middle-aged adults (36–59 years, 53.9%), with 41.7% aged 18–35 years and 4.4% aged 60 years or older. Females made up the majority of the sample (58.3%), while males accounted for 41.7%. Most participants were married (68.4%), 28.2% were single, and 3.4% were separated or divorced. Over half of the respondents (56.3%) reported a monthly income below ₦100,000, 40.3% earned between ₦100,000 and ₦500,000, and only 3.4% earned above ₦500,000. Table 1 Functional and Psychosocial Impact Variable Frequency (n)(%) Difficulty concentrating or making decisions due to anxious thoughts Usually 28 (13.6) Often 71 (34.5) Sometimes 24 (11.7) Rarely 68 (33.0) Never 15 (7.3) Difficulty forming or maintaining relationships due to excessive worrying Usually 18 (8.7) Often 48 (23.3) Sometimes 30 (14.6) Rarely 83 (40.3) Never 27 (13.1) Poor sleep quality or insomnia due to anxiety Usually 42 (20.4) Often 74 (35.9) Sometimes 18 (8.7) Rarely 52 (25.2) Never 20 (9.7) Worsened symptoms of illness due to anxiety Usually 33 (16.0) Often 71 (34.5) Sometimes 30 (14.6) Rarely 56 (27.2) Never 16 (7.8) Table 1 above illustrates the functional and psychosocial impact of anxiety among respondents. Regarding cognitive symptoms, 34.5% of participants often found it difficult to concentrate or make decisions due to anxious thoughts, 13.6% usually experienced these difficulties, and 11.7% reported them sometimes, while 33.0% experienced them rarely and 7.3% never. In terms of social functioning, 23.3% often and 8.7% usually reported difficulty forming or maintaining relationships due to excessive worrying; 14.6% experienced this sometimes, 40.3% rarely, and 13.1% not at all. Sleep disruption was also common, with 35.9% often and 20.4% usually reporting poor sleep or insomnia due to anxiety; 8.7% experienced this sometimes, 25.2% rarely, and 9.7% never. Anxiety also worsened physical symptoms for many respondents, with 34.5% reporting this often, 16.0% usually, and 14.6% sometimes, while 27.2% experienced it rarely and 7.8% never. Table 2 Impact on Productivity and Daily Functioning Variables Frequency (n)(%) Limited productivity at work or school due to excessive worrying Usually 27 (13.1) Often 76 (36.9) Sometimes 15 (7.3) Rarely 76 (36.9) Never 12 (5.8) Anxiety affecting ability to complete daily tasks Usually 22 (10.7) Often 76 (36.9) Sometimes 14 (6.8) Rarely 78 (37.9) Never 16 (7.8) Table 2 above presents the impact of anxiety on respondents’ productivity and daily functioning. Over one-third (36.9%) often experienced limited productivity at work or school due to excessive worrying, while 13.1% reported this usually and 7.3% sometimes; however, 36.9% experienced it rarely and 5.8% never. Anxiety also interfered with the ability to complete daily tasks, with 36.9% often and 10.7% usually affected, while 6.8% reported this sometimes. Conversely, 37.9% experienced such difficulty rarely and 7.8% never. Discussion The findings of this study demonstrate that anxiety among individuals living with chronic illnesses exerts significant functional, cognitive, and psychosocial consequences that extend beyond emotional distress. Consistent with global evidence, anxiety appears to interfere with executive functioning, disrupt decision-making, and heighten perceptions of physical symptoms. Neurocognitive studies have shown that anxiety reduces attentional control and impairs prefrontal cortex functioning, which may explain the concentration difficulties observed clinically among chronically ill patients. 11 These cognitive effects are of particular concern in chronic disease management, as effective self-care requires sustained attention, planning, and adherence to complex regimens. Sleep disturbance observed among anxious patients in this study further reinforces the bidirectional relationship between insomnia and anxiety. Recent reviews confirm that anxiety contributes to hyperarousal-related insomnia, while inadequate sleep leads to daytime cognitive fatigue and worsened worry. 12 This interplay creates a self-reinforcing cycle that complicates long-term disease management. The association between anxiety and heightened symptom perception aligns with international evidence that anxiety amplifies somatic sensations, increases health-care utilization, and worsens chronic disease outcomes. Studies among individuals with diabetes and hypertension consistently report that anxiety predicts poorer glycaemic and blood pressure control largely through decreased medication adherence and increased bodily vigilance. 13 , 14 Similar patterns have been documented regionally across sub-Saharan Africa, where psychosocial factors, financial strain, low social support, stigma are recurrent determinants of psychiatric comorbidity among chronically ill patients. Nigerian studies echo these findings, highlighting high rates of anxiety among patients with diabetes, hypertension, and other chronic conditions, with clear implications for reduced clinical stability and increased symptom burden. 15 , 16 These converging data emphasize that anxiety is both common and clinically consequential across chronic disease populations in the West African context. The observed reductions in productivity and difficulty completing daily tasks correspond with global workplace mental-health literature indicating that anxiety significantly reduces both absenteeism and presenteeism. 17 For chronically ill individuals, many of whom already face socioeconomic vulnerabilities, the added burden of anxiety may exacerbate financial strain, reinforce worry, and further limit engagement with treatment plans. Biological, behavioural, and psychosocial mechanisms jointly contribute to these impairments. Chronic activation of the stress response associated with anxiety disrupts prefrontal cortical regulation and sleep architecture while elevating inflammatory signalling, all of which are linked to subjective cognitive decline and somatic symptom amplification. 18 Behaviourally, anxiety promotes avoidance of clinic visits, reduces adherence, and diminishes motivation for self-management, while psychosocial stressors such as poverty and limited support compound these effects. Together, these mechanisms explain the pattern of multidimensional functional impairment observed in this study. These findings have clear implications for clinical practice and public health. Routine screening for anxiety using brief validated tools such as the GAD-7 or HADS should be integrated into chronic care clinics, as international and Nigerian evidence demonstrates high rates of undetected anxiety among medically ill patients. Policy Implications The findings of this study underscore the need for mental-health integration into chronic disease management policies at tertiary and secondary healthcare levels in Nigeria. First, routine screening for anxiety using validated tools such as the GAD-7 or HADS should be institutionalized as part of national clinical guidelines for the management of chronic illnesses. Early detection policies would improve timely referral and treatment, thereby reduce functional impairment and enhance long-term disease control. Secondly, national and state health authorities should adopt a task-shifting approach that empowers nurses, community health officers, and primary health-care workers to deliver basic psychosocial interventions, including psychoeducation, brief cognitive-behavioural strategies, and sleep-focused counselling. This is particularly important in resource-limited settings where mental-health specialists are scarce. Thirdly, chronic disease programs should incorporate socioeconomic supports into routine care such as linkage to social welfare schemes, workplace accommodations, and community support groups given the demonstrated interplay between anxiety, economic strain, and poor treatment adherence. Policymakers should also develop cross-sectoral collaborations between the Ministry of Health, Ministry of Labour, and social protection agencies to support working-age individuals living with chronic conditions. Finally, hospital administrators should prioritize capacity-building for healthcare workers through continuous professional development in mental-health assessment and communication skills. Strengthening health-system responsiveness to comorbid anxiety will not only improve individual patient outcomes but also reduce the broader economic burden associated with reduced productivity and increased healthcare utilization. Strengths and Limitations This study provides important insights into the functional, psychosocial, and productivity-related impact of anxiety among patients with chronic illnesses in a Nigerian tertiary healthcare setting. However, some limitations should be considered when interpreting the findings. First, the cross-sectional design limits causal inference between anxiety and functional or productivity outcomes. Second, anxiety was assessed using an adopted version of the Hospital Anxiety and Depression Scale–Anxiety subscale (HADS-A). Although the HADS-A is a widely validated instrument, minor contextual modifications were made to enhance clarity and suitability for the study population, which may affect direct comparability with studies using the original unmodified scale. Nonetheless, the core structure and intent of the instrument were retained, and the full questionnaire is provided as Appendix I (Supplementary File). Finally, the reliance on self-reported data may introduce reporting or recall bias. Despite these limitations, the findings remain valuable for informing integrated mental health screening within chronic disease care in similar low-resource settings. Future Research Outlook Future research should prioritize longitudinal studies that examine causal pathways between anxiety and chronic disease outcomes, particularly in Nigerian and other low-resource settings where evidence remains limited. Prospective cohort studies would clarify the temporal relationship between anxiety, functional impairment, and clinical markers such as blood pressure control, glycaemic stability, and hospitalization rates. Additionally, intervention trials evaluating scalable psychological therapies such as task-shifted cognitive-behavioural therapy, digital mental-health tools, stress-management modules, and sleep-focused interventions are urgently needed to determine cost-effective strategies that can be integrated into existing chronic care systems. Mixed-methods research will also be critical in understanding how cultural beliefs, stigma, and health-system barriers influence anxiety recognition and care-seeking behaviours among chronically ill patients. Community-based studies could help uncover differences between hospital-attending populations and those who remain outside the formal healthcare system. Future work should also explore biological and inflammatory markers that may mediate the relationship between anxiety and disease progression, thereby opening pathways for personalized or precision-based interventions. Conclusion This study highlights that anxiety symptoms are commonly reported among individuals living with chronic illnesses at the University of Abuja Teaching Hospital and are associated with notable challenges in cognitive functioning, sleep quality, symptom perception, interpersonal relationships, and daily productivity. While the findings suggest that anxiety may play an important role in shaping patients’ functional and psychosocial experiences, the cross-sectional nature of the study does not permit causal inferences. Nonetheless, the observed patterns underscore the importance of recognizing and routinely screening for anxiety symptoms within chronic disease care settings. Integrating basic mental health assessment and supportive interventions into routine chronic care may help improve patient functioning and overall well-being, particularly in resource-limited settings such as Nigeria. Declarations Ethical Approval and Accordance Ethical approval for this study was obtained from the University of Abuja Teaching Hospital, Health Research Ethics Committee. (Approval Number: FCT/UATH/HREC/1085). The study was conducted in full accordance with the guidelines, regulations, and ethical standards set forth by the ethics committee. Consent to Participate Written informed consent was obtained from all participants before enrolment into the study. Participation was voluntary, and confidentiality was assured. Consent to Publish Not applicable: No identifying information or images of individual participants are included in this manuscript. Funding No external funding was obtained for this manuscript Data Availability Statement The datasets generated and analysed during this study contain sensitive personal information and are therefore not publicly available in order to protect participant confidentiality. 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Sensors 2025, Vol 25, Page 7108 [Internet]. 2025 Nov 21 [cited 2025 Nov 30];25(23):7108. Available from: https://www.mdpi.com/1424-8220/25/23/7108/htm Additional Declarations No competing interests reported. Supplementary Files AppendixIQuestionnaireontheImpactofAnxietyDisordersAmongPatientswithChronicIllnessesattheUniversityofAbujaTeachingHospital.docx Cite Share Download PDF Status: Posted Version 1 posted 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. 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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-8326949","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":570390591,"identity":"5070b79a-a7d5-478b-a935-8b4c26111e12","order_by":0,"name":"Opeyemi Adedapo Adetayo","email":"","orcid":"","institution":"University of Abuja Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Opeyemi","middleName":"Adedapo","lastName":"Adetayo","suffix":""},{"id":570390592,"identity":"a18cefa8-199b-4072-8275-ff5ea792f735","order_by":1,"name":"Vivian Aderonke Adebayo","email":"","orcid":"","institution":"University of 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09:30:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":675708,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8326949/v1/936f708b-2bf4-40e6-8a9d-9a31fc7abb12.pdf"},{"id":99821684,"identity":"b01232d2-5c26-4290-86fe-fd68716625be","added_by":"auto","created_at":"2026-01-08 15:31:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":22635,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixIQuestionnaireontheImpactofAnxietyDisordersAmongPatientswithChronicIllnessesattheUniversityofAbujaTeachingHospital.docx","url":"https://assets-eu.researchsquare.com/files/rs-8326949/v1/72f2a9f2a84893c210059c4c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Anxiety Disorders Among Patients with Chronic Illnesses at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnxiety disorders are among the most prevalent mental health conditions globally and contribute substantially to disability, impaired functioning, and diminished quality of life. In 2019, an estimated 284\u0026nbsp;million people were living with anxiety disorders, making them one of the leading contributors to global mental health burden.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The prevalence is particularly pronounced in low- and middle-income countries (LMICs), where structural barriers to mental health care including limited workforce and fragmented services hinder early detection and treatment.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Chronic illnesses such as hypertension, diabetes mellitus, chronic kidney disease, heart failure, hepatitis B and C, and HIV/AIDS are strongly associated with higher levels of psychological distress, with anxiety consistently identified as a frequent comorbidity.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe relationship between chronic illness and anxiety is complex and mutually reinforcing. Chronic diseases often impose continuous physical symptoms, long-term medication use, lifestyle restrictions, and economic challenges that predispose individuals to anxiety. Conversely, anxiety negatively influences disease management by impairing adherence to medication, reducing clinic attendance, and increasing maladaptive health behaviours. Evidence demonstrates that anxiety worsens glycaemic control among individuals with diabetes, contributes to higher cardiovascular risk, and reduces overall treatment outcomes.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e If undetected or untreated, anxiety can lead to increased healthcare utilization, extended hospital stays, and lower quality of life among chronically ill patients.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn Nigeria, the rising burden of chronic non-communicable and infectious diseases has been accompanied by increasing psychological morbidity. Despite this, mental health screening is generally not integrated into chronic care pathways, resulting in underdiagnosis of anxiety disorders. Studies across Nigerian tertiary hospitals have documented moderate to high prevalence rates of anxiety among patients with chronic diseases, influenced by socioeconomic challenges, stigma, limited health insurance coverage, and resource constraints in the health system.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e These contextual pressures may place Nigerian patients at heightened risk for anxiety-related complications.\u003c/p\u003e \u003cp\u003eThe University of Abuja Teaching Hospital (UATH), located in Gwagwalada, serves a large and diverse population of patients with chronic diseases. However, there is limited empirical evidence characterizing the burden, correlates, and implications of anxiety disorders among this patient group. Understanding this burden is crucial for strengthening integrated mental health services, improving chronic disease outcomes, and informing evidence-based policy interventions.\u003c/p\u003e \u003cp\u003eThis study therefore aims to assess the impact of anxiety disorders among patients with chronic illnesses at UATH. Generating this evidence is important for enhancing comprehensive, patient-centred chronic care in Nigeria.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eThe study was carried out at the University of Abuja Teaching Hospital (UATH), a 520-bed tertiary healthcare facility located in Gwagwalada, Federal Capital Territory, Nigeria. UATH provides specialized services to an estimated catchment population of more than 500,000 people and serves as a major referral centre within the region.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe target population consisted of adult outpatients aged 18 years and above who had been diagnosed with chronic medical conditions. Eligible chronic illnesses included hypertension, diabetes mellitus, chronic kidney disease, heart failure, hepatitis B or C virus infection, and HIV/AIDS. Only patients who provided informed consent and were stable enough to participate were included in the study.\u003c/p\u003e\n\u003ch3\u003eStudy Design and Sample Size\u003c/h3\u003e\n\u003cp\u003eA descriptive cross-sectional study design was employed. Sample size determination was based on Cochran\u0026rsquo;s formula for estimating proportions, yielding a minimum required sample size of 226 participants.\u003c/p\u003e\n\u003ch3\u003eSampling Procedure\u003c/h3\u003e\n\u003cp\u003eA stratified sampling technique was used to ensure proportionate representation of major chronic disease categories. Patients were first grouped into strata comprising cardiovascular, endocrine, nephrological, neurological, pulmonological, gastroenterological, and infectious diseases. Within each stratum, proportional allocation was applied, followed by simple random sampling to select participants.\u003c/p\u003e\n\u003ch3\u003eData Collection Instrument\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured, interviewer-administered questionnaire designed to assess the impact of anxiety among patients with chronic medical conditions. The instrument comprised four sections.\u003c/p\u003e \u003cp\u003eThe first section collected participants\u0026rsquo; sociodemographic characteristics, including age, sex, marital status, educational level, and employment status, which were used as background variables. The second section obtained clinical information related to chronic illnesses, such as the type and duration of the condition, to provide contextual understanding of anxiety-related impact.\u003c/p\u003e \u003cp\u003eThe third section assessed anxiety symptoms using an adapted version of the Hospital Anxiety and Depression Scale\u0026ndash;Anxiety subscale (HADS-A), originally developed by Zigmond and Snaith.\u0026sup1;⁰ Minor contextual modifications were made for clarity. This section was used to determine the presence and severity of anxiety among participants.\u003c/p\u003e \u003cp\u003eThe final section, which constituted the primary outcome measure, included structured items assessing the impact of anxiety on participants\u0026rsquo; daily lives. These items evaluated functional impairment, psychosocial effects, sleep disturbance, and work or productivity limitations attributable to anxiety. The complete questionnaire is provided in Appendix I (Supplementary File).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eCompleted questionnaires were checked for completeness, coded, and entered into IBM SPSS Statistics version 29 for analysis. Data cleaning was performed to ensure accuracy and consistency prior to analysis.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to analyse and present the data in line with the study objective of assessing the impact of anxiety among patients with chronic medical conditions. Sociodemographic characteristics of respondents\u0026mdash;including age group, sex, marital status, and monthly income\u0026mdash;were summarized using frequencies and percentages.\u003c/p\u003e \u003cp\u003eAnxiety-related impact variables were analysed descriptively. Responses to items assessing cognitive functioning (difficulty concentrating or making decisions), psychosocial functioning (difficulty forming or maintaining relationships), sleep disturbance (poor sleep quality or insomnia), perceived worsening of physical symptoms, productivity at work or school, and ability to complete daily tasks were summarized using frequencies and percentages across response categories (never, rarely, sometimes, often, usually).\u003c/p\u003e \u003cp\u003eResults were presented in tables to illustrate the distribution and magnitude of functional, psychosocial, sleep-related, and productivity-related impacts of anxiety among participants. No inferential statistical tests were performed, as the primary focus of the study was to describe the extent and pattern of anxiety-related impact in the study population.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe sociodemographic characteristics of the 206 participants were middle-aged adults (36\u0026ndash;59 years, 53.9%), with 41.7% aged 18\u0026ndash;35 years and 4.4% aged 60 years or older. Females made up the majority of the sample (58.3%), while males accounted for 41.7%. Most participants were married (68.4%), 28.2% were single, and 3.4% were separated or divorced. Over half of the respondents (56.3%) reported a monthly income below ₦100,000, 40.3% earned between ₦100,000 and ₦500,000, and only 3.4% earned above ₦500,000.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFunctional and Psychosocial Impact\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficulty concentrating or making decisions due to anxious thoughts\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (13.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (34.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (11.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (33.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (7.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDifficulty forming or maintaining relationships due to excessive worrying\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (8.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (23.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (14.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83 (40.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (13.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePoor sleep quality or insomnia due to anxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42 (20.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74 (35.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (8.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (25.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorsened symptoms of illness due to anxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (34.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (14.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (27.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (7.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above illustrates the functional and psychosocial impact of anxiety among respondents. Regarding cognitive symptoms, 34.5% of participants often found it difficult to concentrate or make decisions due to anxious thoughts, 13.6% usually experienced these difficulties, and 11.7% reported them sometimes, while 33.0% experienced them rarely and 7.3% never. In terms of social functioning, 23.3% often and 8.7% usually reported difficulty forming or maintaining relationships due to excessive worrying; 14.6% experienced this sometimes, 40.3% rarely, and 13.1% not at all. Sleep disruption was also common, with 35.9% often and 20.4% usually reporting poor sleep or insomnia due to anxiety; 8.7% experienced this sometimes, 25.2% rarely, and 9.7% never. Anxiety also worsened physical symptoms for many respondents, with 34.5% reporting this often, 16.0% usually, and 14.6% sometimes, while 27.2% experienced it rarely and 7.8% never.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact on Productivity and Daily Functioning\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited productivity at work or school due to excessive worrying\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (13.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (36.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (7.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (36.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (5.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety affecting ability to complete daily tasks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (36.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (37.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (7.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e above presents the impact of anxiety on respondents\u0026rsquo; productivity and daily functioning. Over one-third (36.9%) often experienced limited productivity at work or school due to excessive worrying, while 13.1% reported this usually and 7.3% sometimes; however, 36.9% experienced it rarely and 5.8% never. Anxiety also interfered with the ability to complete daily tasks, with 36.9% often and 10.7% usually affected, while 6.8% reported this sometimes. Conversely, 37.9% experienced such difficulty rarely and 7.8% never.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study demonstrate that anxiety among individuals living with chronic illnesses exerts significant functional, cognitive, and psychosocial consequences that extend beyond emotional distress. Consistent with global evidence, anxiety appears to interfere with executive functioning, disrupt decision-making, and heighten perceptions of physical symptoms. Neurocognitive studies have shown that anxiety reduces attentional control and impairs prefrontal cortex functioning, which may explain the concentration difficulties observed clinically among chronically ill patients.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e These cognitive effects are of particular concern in chronic disease management, as effective self-care requires sustained attention, planning, and adherence to complex regimens. Sleep disturbance observed among anxious patients in this study further reinforces the bidirectional relationship between insomnia and anxiety. Recent reviews confirm that anxiety contributes to hyperarousal-related insomnia, while inadequate sleep leads to daytime cognitive fatigue and worsened worry.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This interplay creates a self-reinforcing cycle that complicates long-term disease management.\u003c/p\u003e \u003cp\u003eThe association between anxiety and heightened symptom perception aligns with international evidence that anxiety amplifies somatic sensations, increases health-care utilization, and worsens chronic disease outcomes. Studies among individuals with diabetes and hypertension consistently report that anxiety predicts poorer glycaemic and blood pressure control largely through decreased medication adherence and increased bodily vigilance.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Similar patterns have been documented regionally across sub-Saharan Africa, where psychosocial factors, financial strain, low social support, stigma are recurrent determinants of psychiatric comorbidity among chronically ill patients. Nigerian studies echo these findings, highlighting high rates of anxiety among patients with diabetes, hypertension, and other chronic conditions, with clear implications for reduced clinical stability and increased symptom burden.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e These converging data emphasize that anxiety is both common and clinically consequential across chronic disease populations in the West African context.\u003c/p\u003e \u003cp\u003eThe observed reductions in productivity and difficulty completing daily tasks correspond with global workplace mental-health literature indicating that anxiety significantly reduces both absenteeism and presenteeism.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e For chronically ill individuals, many of whom already face socioeconomic vulnerabilities, the added burden of anxiety may exacerbate financial strain, reinforce worry, and further limit engagement with treatment plans. Biological, behavioural, and psychosocial mechanisms jointly contribute to these impairments. Chronic activation of the stress response associated with anxiety disrupts prefrontal cortical regulation and sleep architecture while elevating inflammatory signalling, all of which are linked to subjective cognitive decline and somatic symptom amplification.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Behaviourally, anxiety promotes avoidance of clinic visits, reduces adherence, and diminishes motivation for self-management, while psychosocial stressors such as poverty and limited support compound these effects. Together, these mechanisms explain the pattern of multidimensional functional impairment observed in this study.\u003c/p\u003e \u003cp\u003eThese findings have clear implications for clinical practice and public health. Routine screening for anxiety using brief validated tools such as the GAD-7 or HADS should be integrated into chronic care clinics, as international and Nigerian evidence demonstrates high rates of undetected anxiety among medically ill patients.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePolicy Implications\u003c/h2\u003e \u003cp\u003eThe findings of this study underscore the need for mental-health integration into chronic disease management policies at tertiary and secondary healthcare levels in Nigeria. First, routine screening for anxiety using validated tools such as the GAD-7 or HADS should be institutionalized as part of national clinical guidelines for the management of chronic illnesses. Early detection policies would improve timely referral and treatment, thereby reduce functional impairment and enhance long-term disease control. Secondly, national and state health authorities should adopt a task-shifting approach that empowers nurses, community health officers, and primary health-care workers to deliver basic psychosocial interventions, including psychoeducation, brief cognitive-behavioural strategies, and sleep-focused counselling. This is particularly important in resource-limited settings where mental-health specialists are scarce.\u003c/p\u003e \u003cp\u003eThirdly, chronic disease programs should incorporate socioeconomic supports into routine care such as linkage to social welfare schemes, workplace accommodations, and community support groups given the demonstrated interplay between anxiety, economic strain, and poor treatment adherence. Policymakers should also develop cross-sectoral collaborations between the Ministry of Health, Ministry of Labour, and social protection agencies to support working-age individuals living with chronic conditions. Finally, hospital administrators should prioritize capacity-building for healthcare workers through continuous professional development in mental-health assessment and communication skills. Strengthening health-system responsiveness to comorbid anxiety will not only improve individual patient outcomes but also reduce the broader economic burden associated with reduced productivity and increased healthcare utilization.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study provides important insights into the functional, psychosocial, and productivity-related impact of anxiety among patients with chronic illnesses in a Nigerian tertiary healthcare setting. However, some limitations should be considered when interpreting the findings. First, the cross-sectional design limits causal inference between anxiety and functional or productivity outcomes. Second, anxiety was assessed using an adopted version of the Hospital Anxiety and Depression Scale\u0026ndash;Anxiety subscale (HADS-A). Although the HADS-A is a widely validated instrument, minor contextual modifications were made to enhance clarity and suitability for the study population, which may affect direct comparability with studies using the original unmodified scale. Nonetheless, the core structure and intent of the instrument were retained, and the full questionnaire is provided as Appendix I (Supplementary File). Finally, the reliance on self-reported data may introduce reporting or recall bias. Despite these limitations, the findings remain valuable for informing integrated mental health screening within chronic disease care in similar low-resource settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFuture Research Outlook\u003c/h2\u003e \u003cp\u003eFuture research should prioritize longitudinal studies that examine causal pathways between anxiety and chronic disease outcomes, particularly in Nigerian and other low-resource settings where evidence remains limited. Prospective cohort studies would clarify the temporal relationship between anxiety, functional impairment, and clinical markers such as blood pressure control, glycaemic stability, and hospitalization rates. Additionally, intervention trials evaluating scalable psychological therapies such as task-shifted cognitive-behavioural therapy, digital mental-health tools, stress-management modules, and sleep-focused interventions are urgently needed to determine cost-effective strategies that can be integrated into existing chronic care systems.\u003c/p\u003e \u003cp\u003eMixed-methods research will also be critical in understanding how cultural beliefs, stigma, and health-system barriers influence anxiety recognition and care-seeking behaviours among chronically ill patients. Community-based studies could help uncover differences between hospital-attending populations and those who remain outside the formal healthcare system. Future work should also explore biological and inflammatory markers that may mediate the relationship between anxiety and disease progression, thereby opening pathways for personalized or precision-based interventions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights that anxiety symptoms are commonly reported among individuals living with chronic illnesses at the University of Abuja Teaching Hospital and are associated with notable challenges in cognitive functioning, sleep quality, symptom perception, interpersonal relationships, and daily productivity. While the findings suggest that anxiety may play an important role in shaping patients\u0026rsquo; functional and psychosocial experiences, the cross-sectional nature of the study does not permit causal inferences. Nonetheless, the observed patterns underscore the importance of recognizing and routinely screening for anxiety symptoms within chronic disease care settings. Integrating basic mental health assessment and supportive interventions into routine chronic care may help improve patient functioning and overall well-being, particularly in resource-limited settings such as Nigeria.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Accordance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the University of Abuja Teaching Hospital, Health Research Ethics Committee. (Approval Number: FCT/UATH/HREC/1085). The study was conducted in full accordance with the guidelines, regulations, and ethical standards set forth by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants before enrolment into the study. Participation was voluntary, and confidentiality was assured.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable: No identifying information or images of individual participants are included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was obtained for this manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during this study contain sensitive personal information and are therefore not publicly available in order to protect participant confidentiality. However, the identified data may be made available from the corresponding author upon reasonable request and subject to approval by the relevant ethics committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet [Internet]. 2020 Oct 17 [cited 2025 Nov 30];396(10258):1204\u0026ndash;22. Available from: https://pubmed.ncbi.nlm.nih.gov/33069326/\u003c/li\u003e\n\u003cli\u003eMental Health ATLAS 2017 [Internet]. [cited 2025 Nov 30]. Available from: https://www.who.int/publications/i/item/mental-health-atlas-2017\u003c/li\u003e\n\u003cli\u003eR JP, Ekstrand ML, Selvam S, Heylen E, Mony PK, Srinivasan K. Risk factors for severity of depression in participants with chronic medical conditions in rural primary health care settings in India. J Affect Disord Rep [Internet]. 2021 Jan 1 [cited 2025 Nov 30];3:100071. Available from: https://www.sciencedirect.com/science/article/pii/S2666915320300718\u003c/li\u003e\n\u003cli\u003ePan T, Mercer SW, Zhao Y, McPake B, Desloge A, Atun R, et al. The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis. BMC Public Health 2021 21:1 [Internet]. 2021 Feb 18 [cited 2025 Nov 30];21(1):376-. Available from: https://link.springer.com/article/10.1186/s12889-021-10414-7\u003c/li\u003e\n\u003cli\u003eSmith KJ, Desch\u0026ecirc;nes SS, Schmitz N. Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta-analysis. Diabetic Medicine [Internet]. 2018 Jun 1 [cited 2025 Nov 30];35(6):677\u0026ndash;93. Available from: /doi/pdf/10.1111/dme.13606\u003c/li\u003e\n\u003cli\u003eCelano CM, Villegas AC, Albanese AM, Gaggin HK, Huffman JC. Depression and Anxiety in Heart Failure: A Review. Harv Rev Psychiatry [Internet]. 2018 Jul 1 [cited 2025 Nov 30];26(4):175\u0026ndash;84. Available from: https://pubmed.ncbi.nlm.nih.gov/29975336/\u003c/li\u003e\n\u003cli\u003eRomanazzo S, Mansueto G, Cosci F. Anxiety in the Medically Ill: A Systematic Review of the Literature. Front Psychiatry [Internet]. 2022 Jun 3 [cited 2025 Nov 30];13:873126. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9203680/\u003c/li\u003e\n\u003cli\u003eMental Health and Psychosocial Support (MHPSS) of Women with Reproductive Cancers in Nigeria A LITERATURE REVIEW. \u003c/li\u003e\n\u003cli\u003eAtewologun F, Adigun OA, Okesanya OJ, Hassan HK, Olabode ON, Micheal AS, et al. A comprehensive review of mental health services across selected countries in sub-Saharan Africa: assessing progress, challenges, and future direction. Discover mental health [Internet]. 2025 Dec 1 [cited 2025 Nov 30];5(1). Available from: https://pubmed.ncbi.nlm.nih.gov/40195169/\u003c/li\u003e\n\u003cli\u003eZigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand [Internet]. 1983 Jun 1 [cited 2025 Dec 14];67(6):361\u0026ndash;70. Available from: /doi/pdf/10.1111/j.1600-0447.1983.tb09716.x\u003c/li\u003e\n\u003cli\u003ePark J, Moghaddam B. Impact of anxiety on prefrontal cortex encoding of cognitive flexibility. Neuroscience [Internet]. 2016 Mar 14 [cited 2025 Nov 30];345:193. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5159328/\u003c/li\u003e\n\u003cli\u003ePalagini L, Miniati M, Caruso V, Alfi G, Geoffroy PA, Domschke K, et al. Insomnia, anxiety and related disorders: a systematic review on clinical and therapeutic perspective with potential mechanisms underlying their complex link. Neuroscience Applied [Internet]. 2024 Jan 1 [cited 2025 Nov 30];3:103936. Available from: https://www.sciencedirect.com/science/article/pii/S2772408524000012\u003c/li\u003e\n\u003cli\u003eChantzaras A, Yfantopoulos J. Determinants of medication adherence in patients with diabetes, hypertension, and hyperlipidemia. Hormones (Athens) [Internet]. 2025 Jun 1 [cited 2025 Nov 30];24(2):443. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12339649/\u003c/li\u003e\n\u003cli\u003eŚwiątoniowska-Lonc N, Tański W, Polański J, Jankowska-Polańska B, Mazur G. Psychosocial Determinants of Treatment Adherence in Patients with Type 2 Diabetes \u0026ndash; A Review. Diabetes Metab Syndr Obes [Internet]. 2021 [cited 2025 Nov 30];14:2701. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8215904/\u003c/li\u003e\n\u003cli\u003eJackson IL, Adibe MO, Okonta MJ, Ukwe C V. Medication adherence in type 2 diabetes patients in Nigeria. Diabetes Technol Ther. 2015 Jun 1;17(6):398\u0026ndash;404. \u003c/li\u003e\n\u003cli\u003eOkunrinboye HI, Otakpor AN, Ilesanmi OS. Depression and medication-adherence in patients with hypertension attending a tertiary health facility in South-West Nigeria. Pan African Medical Journal. 2019;33. \u003c/li\u003e\n\u003cli\u003ede Oliveira C, Saka M, Bone L, Jacobs R. The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature. Appl Health Econ Health Policy [Internet]. 2022 Mar 1 [cited 2025 Nov 30];21(2):167. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9663290/\u003c/li\u003e\n\u003cli\u003eChatzaki C, Tsiknakis M. An Overview of Stress Analysis Based on Physiological Signals: Systematic Review of Open Datasets and Current Trends. Sensors 2025, Vol 25, Page 7108 [Internet]. 2025 Nov 21 [cited 2025 Nov 30];25(23):7108. Available from: https://www.mdpi.com/1424-8220/25/23/7108/htm\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxiety disorders, Chronic illness, Functional impairment, Psychosocial impact, HADS-A, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-8326949/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8326949/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAnxiety disorders are common among individuals living with chronic illnesses and can significantly impair cognitive functioning, social relationships, productivity, and overall quality of life. Despite their clinical importance, the functional and psychosocial impact of anxiety among chronically ill patients in Nigeria remains underexplored. This study assessed the impact of anxiety on daily functioning and productivity among patients receiving care at the University of Abuja Teaching Hospital (UATH), Gwagwalada.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA descriptive cross-sectional study was conducted among 206 adult outpatients with chronic medical conditions. Sociodemographic and clinical data were collected using a structured interviewer-administered questionnaire, and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale\u0026ndash;Anxiety subscale (HADS-A). Descriptive statistics were used to determine the distribution of anxiety-related functional, psychosocial, and productivity impairments.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMore than half of respondents were aged 36\u0026ndash;59 years (53.9%), 41.7% were aged 18\u0026ndash;35 years, and 4.4% were \u0026ge;\u0026thinsp;60 years. Women constituted 58.3% of the sample, and most participants were married (68.4%). Over half (56.3%) earned less than ₦100,000 monthly. Anxiety exerted notable cognitive impact, with 34.5% often and 13.6% usually experiencing difficulty concentrating or making decisions. Social functioning was similarly affected: 23.3% often and 8.7% usually had difficulty forming or maintaining relationships due to excessive worrying. Sleep disruption was prominent, with 35.9% often and 20.4% usually reporting poor sleep or insomnia due to anxiety. Additionally, anxiety frequently worsened physical symptoms (34.5% often; 16.0% usually). Productivity was also impaired, with 36.9% often and 13.1% usually reporting limited productivity at work or school due to excessive worrying. Furthermore, 36.9% often and 10.7% usually experienced difficulty completing daily tasks attributable to anxiety.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAnxiety significantly affects cognitive functioning, interpersonal relationships, sleep quality, productivity, and daily task performance among chronically ill patients at UATH. These findings highlight the need for routine anxiety screening and integration of mental health support into chronic disease management to improve patient functioning and overall well-being.\u003c/p\u003e","manuscriptTitle":"Impact of Anxiety Disorders Among Patients with Chronic Illnesses at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 15:31:45","doi":"10.21203/rs.3.rs-8326949/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fab20134-510f-4edb-b044-e3ed7e427371","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-28T06:42:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 15:31:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8326949","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8326949","identity":"rs-8326949","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}