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

The study investigates how state boredom—a transient affective state elicited by monotonous or low-information contexts—relates to psychopathology and influences psychiatric treatment outcomes. Prior work has emphasized trait boredom (a chronic susceptibility to boredom) and its links to impulsivity, sensation seeking, addiction, ADHD, depression, and psychosis, yet the clinical role of state boredom remains unclear. The authors aim to characterize both state and trait boredom in psychiatric inpatients compared with healthy controls, examine how state boredom changes during inpatient treatment (including differences across diagnostic groups and open vs. closed wards), and test whether state boredom predicts treatment duration. The overarching purpose is to clarify whether state boredom is an indicator of current psychopathological burden and a determinant of clinical outcomes, thereby informing potential interventions to reduce boredom and improve care.

Prior literature shows robust associations between trait boredom and multiple psychopathologies and risk-related behaviors, including impulsivity, risk affinity, sensation seeking, ADHD, borderline personality disorder, pathological gambling, alcohol use, depression, and psychotic disorders. Boredom has also been linked to aggressive behavior in clinical settings. Despite these implications, boredom is often neglected in routine mental health care. Theoretical accounts frame boredom in terms of attention deficits, lack of agency, or reduced meaning, and recent work views state boredom as a signal of the need for information, prompting information-seeking behavior. Evidence from pandemic-related restrictions highlights boredom as a mental stressor and potential precursor to psychopathology. However, the specific role and clinical consequences of state boredom, as opposed to trait boredom, in psychiatric populations has been insufficiently studied.

Ethics: Approved by the local ethics committee (Ethikkommission der Landesärztekammer Rheinland-Pfalz; 2018-13164 and 2018-13164_1); conducted per Declaration of Helsinki; written informed consent obtained. Data were pseudonymized. Analyses performed in MATLAB (R2022a).

Healthy control cohort: Approximately 1800 adults (18–60 years) from the Gutenberg Brain Study pool were contacted; 883 provided valid consent and met inclusion criteria (no active psychiatric/neurological disorders). Participants completed self-report measures: state boredom (MSBS, momentary), trait boredom (BPS), general mental health (GHQ-28), depression (BDI-II), ADHD symptoms (CAARS-S:L), impulsivity (Impulsives-Verhalten-8), and anxiety (STAI-Y), plus sociodemographics and patient history. Participants received €5.

Inpatient cohort: All inpatients admitted to the Department of Psychiatry and Psychotherapy, University Medical Center Mainz, June–August 2021, were invited. N=102 consented. Assessments: initial MSBS (state boredom), BPS (trait boredom) at admission; follow-up MSBS after 5–7 days if still hospitalized. Clinical data: age, gender, main ICD-10 diagnosis, duration of inpatient therapy (proxy for outcome). Data analysis began after discharge of the last study patient.

Patient grouping: By primary ICD-10 diagnosis leading to admission: psychotic disorders, addictions, depressive disorders, borderline personality disorder, and ‘other’ diagnoses (drug-induced psychosis counted in psychotic and addiction groups as applicable).

Questionnaire scoring and exclusions: Sum scores computed. Subjects with missing items on a questionnaire/subscale were excluded from that analysis, causing variation in sample sizes across analyses.

Statistical analysis:

• Group comparisons: Wilcoxon rank-sum tests comparing inpatient subgroups to healthy controls for MSBS; Kruskal–Wallis tests for differences across diagnosis groups within inpatients. Trait boredom (BPS) analyzed analogously. Therapy duration compared across diagnosis groups using Kruskal–Wallis.
• Longitudinal change: Wilcoxon signed-rank tests comparing initial vs. follow-up MSBS among patients with both time points; repeated within diagnosis groups and by treatment setting (open vs. closed wards).
• Correlations: Pearson correlations among psychometric measures in healthy controls; Bonferroni correction applied for multiple testing. In inpatients, Pearson correlations tested relations among MSBS (initial and follow-up), BPS, and therapy duration.
• Multiple linear regression: Therapy duration regressed on MSBS_initial, MSBS_follow-up, BPS, treatment on closed ward (binary), and diagnosis binaries (psychotic, addiction, borderline personality disorder, depression). Model: duration = MSBS_initialβ1 + MSBS_follow-upβ2 + BPSβ3 + closedβ4 + psychoticβ5 + addictionβ6 + borderlineβ7 + depressionβ8. n=46 patients with complete datasets. Parameter contributions computed as |xjβj| per patient for comparison across predictors.

Ward environment: Patients treated at least transiently on closed wards were compared with those treated solely on open wards.

Demographics: Healthy cohort mean age 41.5±11.7 years, 66.4% female; inpatient cohort mean age 42±17.9 years, 45% female. Therapy duration range 0–85 days.

• Healthy cohort associations:

  • State boredom (MSBS) showed strong positive correlations with psychopathology measures: GHQ-28 (R=0.617, p<0.001; n≈859), BDI-II (R=0.673, p<0.001; n≈862), CAARS (R=0.559, p<0.001; n≈814), STAI-Y (R=0.668, p<0.001; n≈859). Many correlations remained significant after Bonferroni correction. State boredom correlated more robustly with psychopathology than trait boredom.

• Inpatient vs. healthy comparisons:

  • All diagnosis groups exhibited elevated state boredom (MSBS) at both initial and follow-up assessments compared with healthy controls (Wilcoxon rank-sum, p<0.001 for all groups). No significant differences among diagnosis groups (Kruskal–Wallis: initial p=0.589; follow-up p=0.765).
  • Trait boredom (BPS) was increased in most inpatient diagnosis groups versus healthy controls (4/5 with p<0.05), with no significant differences across diagnosis groups (Kruskal–Wallis p=0.332).
  • Therapy duration differed significantly by diagnosis (Kruskal–Wallis p<0.001): longest on average for depression, shortest for addictions.

• Longitudinal change during inpatient treatment:

  • Overall, state boredom declined over the first treatment week (n=51; Wilcoxon signed-rank p=0.009).
  • By diagnosis (exploratory): addictions and depression showed trends toward reduced boredom (p_signrank≈0.104 and 0.088, respectively), whereas psychotic disorders showed a trend toward increased boredom (p_signrank=0.086) after one week.

• Ward environment:

  • Both open-ward (n=39; p=0.049) and closed-ward (n=12; p=0.055) groups showed decreases in state boredom over one week. There was a trend toward higher overall state boredom in closed-ward patients versus open-ward patients (Wilcoxon rank-sum p=0.060).

• Predicting therapy duration:

  • Follow-up state boredom (MSBS after therapy initiation) positively correlated with therapy duration (n=55; R=0.274, p=0.043). Initial MSBS was not significantly correlated. Trait boredom (BPS) was not significantly correlated with duration.
  • Multiple linear regression (n=46 complete cases) indicated that follow-up MSBS had the strongest contribution to predicting therapy duration, followed by diagnosis groups and closed-ward treatment; initial MSBS and BPS contributed less. Thus, higher residual state boredom after therapy initiation predicted longer inpatient stays.

The findings demonstrate that state boredom, more than trait boredom, is closely associated with indicators of psychopathology in healthy individuals and is elevated across psychiatric diagnoses in inpatients. State boredom generally decreases with inpatient therapy, yet its trajectory differs by diagnosis, with psychotic patients tending to show increased boredom after one week, and addicted and depressive patients showing trends toward decreases. Treatment environment also relates to boredom levels, with a tendency toward higher boredom in closed wards.

Importantly, state boredom measured after therapy initiation predicts prolonged inpatient treatment duration, and its predictive contribution in a multivariable model rivals or exceeds that of diagnosis and treatment setting. Conceptually, the authors frame boredom as a signal of insufficient information flow (external stimuli and internal thought processes). Distinct psychopathologies may impair external or internal coping mechanisms, elevating state boredom and affecting treatment response. Consequently, persistent boredom during treatment likely indexes ongoing psychopathological burden and insufficient coping or environmental engagement, explaining its link to longer hospital stays.

These results suggest that assessing and addressing state boredom could improve clinical outcomes. Interventions may include increasing meaningful activities, environmental enrichment, mindfulness, and direct psychotherapeutic or pharmacologic strategies targeting boredom, tailored to whether deficits lie in internal or external information processing. Given the correlational nature of the data and reliance on self-report, further work with more frequent assessments and behavioral measures of boredom is warranted.

State boredom is a robust indicator of current psychopathological burden across healthy and psychiatric populations and is generally reduced with inpatient treatment. Critically, residual state boredom after therapy initiation predicts longer psychiatric inpatient treatment duration, surpassing trait boredom and contributing beyond diagnosis and ward setting. These findings highlight state boredom as a clinically relevant factor that can complicate treatment and should be targeted to improve outcomes. Future research should clarify causal mechanisms, refine frequent and multimodal (including behavioral) assessments of boredom, examine environmental contributors (especially in closed wards), and test tailored interventions that enhance internal and external information flow to alleviate boredom in diverse psychiatric conditions.

• Correlational design precludes causal inference between boredom and psychopathology or treatment outcomes.
• Follow-up and regression analyses were limited to subsets of inpatients who remained hospitalized and had complete data (e.g., n=51 for longitudinal MSBS, n=46 for regression), potentially introducing selection bias.
• Reliance on self-report scales; different boredom scales capture distinct constructs, and self-report may be influenced by psychopathology.
• Potential confounding by illness severity and ward assignment (closed vs. open), as patients on closed wards may have greater baseline psychopathology.
• Limited temporal resolution (initial and one follow-up at 5–7 days); more granular, repeated measures would better capture dynamics and environmental effects.
• Generalizability may be constrained to a single-center sample and specific diagnostic distributions.