High state boredom vastly affects psychiatric inpatients and predicts their treatment duration

Abstract

Boredom is a ubiquitous, aversive human experience typically elicited by low information and monotony. Boredom can occur either as a transient mental state that prompts individuals to adapt their behavior to avoid monotony or as a temporally stable trait, describing a chronic susceptibility to feeling bored. Increased trait boredom was found to correlate with various psychopathologies and indicators of mental burden. However, the role of state boredom in psychopathological conditions and its implications for psychiatric treatment remain elusive. Here, we address this issue by investigating state boredom and trait boredom in a cohort of psychiatric inpatients and a healthy control cohort. We find that in both groups, state boredom, even more than trait boredom, shows remarkable associations with psychopathology. In the inpatient group, state boredom is implicated broadly in multiple mental disorders and shows an association with treatment in closed psychiatric wards. Furthermore, through statistical modeling, we find that high-state boredom during inpatient therapy is predictive of a longer therapy duration. Thus, we show that state boredom constitutes an indicator of mild and severe psychopathology in different mental disorders, affecting the outcome of psychiatric patients. Potential therapeutic interventions are discussed, aiming to enhance information flow in the brain in order to alleviate boredom in clinical settings.

Fig. 1. Boredom is related to psychopathological symptoms in a cohort of healthy individuals.

A Pearson correlation matrix of various psychometric self-report assessments in a sample of n = 883 healthy individuals. The numbers indicate selected correlations of state boredom to psychopathological symptoms, which are further depicted in B. B Correlation scatter plots of state boredom and selected questionnaires reflecting psychopathology. State boredom is robustly correlated to 1: general symptoms of impaired mental health (General Health Questionnaire), 2: depressive symptoms (Beck’s depression inventory), 3: attentional deficits and hyperactivity (Conner’s Adult ADHD Rating Scale), 4: anxiety (State-Trait Anxiety Inventory). The black line indicates the linear fit. Lower n values for the correlation analyses result from the exclusion of subjects who incompletely filled out the questionnaires.

Fig. 2. State boredom during hospital care in a broad cohort of psychiatric patients.

A Schematic of the study flow. For a period of several weeks, all inpatients admitted to a psychiatric care clinic were screened for state and trait boredom at the beginning of their treatment (initial MSBS, BPS). Patients who stayed longer than 5d were surveyed again in respect to their state boredom (follow-up MSBS). Therapy duration ranged from zero (release on the day of admission) to 85 days. B Left panel: initial state boredom ratings for different patient groups (diagnosis groups) in comparison to the healthy sample (***p < 0.001 in a Wilcoxon rank sum test vs. healthy controls). Right panel: same analysis for the follow-up state boredom rating. C Equivalent analysis for the trait boredom ratings. Most diagnosis groups show higher trait boredom than healthy individuals (***p < 0.001, **p < 0.01, *p < 0.05 in a Wilcoxon rank sum test), but do not differ significantly between diagnosis groups. D Equivalent analysis for the duration of inpatient stay in the psychiatric hospital showing a significant difference between diagnosis groups.

Fig. 3. State boredom changes over inpatient treatment and depends on the underlying mental disorder.

A State boredom (MSBS) at the initial and follow-up assessment (n = 51 of 102 patients that completed both assessments). B Equivalent plot as in A, grouping patients into the three largest diagnosis groups. Addicted and depressive inpatients show a trend of decreased boredom over the course of inpatient therapy, whereas psychotic inpatients tend to show increased state boredom over the course of inpatient therapy.

Fig. 4. Treatment on open versus closed wards is associated with differences in state boredom.

State boredom (MSBS) at the initial and follow-up assessment for patients grouped according to treatment in an open vs. closed psychiatric ward. In both groups, state boredom (MSBS) is reduced over the course of therapy, whereas the overall mean state boredom tends to be higher in patients treated on closed wards.

Fig. 5. State boredom after therapy initiation predicts prolonged psychiatric therapy duration.

A Left panel: Pearson correlation of initial state boredom and therapy duration. Right panel: Pearson correlation of follow-up state boredom and therapy duration, showing a positive association. B Schematic of a multiple linear regression model that we use to predict therapy duration with the following parameters: initial and follow-up MSBS scores, BPS score, treatment on closed wards, and the respective diagnosis group (psychotic, addiction, borderline personality disorder, depression). For the regression, we only use data of inpatients that yield a full dataset (n = 46 patients with complete dataset, for regression coefficient estimates see Supplementary Table 3). C Comparison of parameter contributions, expressed as the absolute value of the product of the respective parameter weight (β_j) and the individual parameter score (x_j). Residual state boredom after therapy initiation (follow-up MSBS) shows the highest mean contribution to therapy duration. Single dots show the parameter contribution for single patients. For the binary model parameters, such as diagnosis groups, only two values – a zero or the coefficient value – were possible, explaining the clustered datapoints. Vertical bars indicate the SEM).