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The Connection Between Mind and Skin: Implementing Anxiety Screenings Among Patients with Chronic Urticaria
Dissertation

The Connection Between Mind and Skin: Implementing Anxiety Screenings Among Patients with Chronic Urticaria

Kelsey O'Connor-Tranmer
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Chronic spontaneous urticaria (CU) is a condition characterized by the occurrence of hives and/or angioedema for at least six weeks and can significantly impact a patient’s quality of life due to symptom unpredictability and associated psychological distress. Research has shown that patients with CU can experience higher rates of anxiety than the general population. Purpose: This Doctor of Nursing Practice project addresses the comorbidity of CU patients with anxiety symptoms through the implementation of an evidence-based screening tool, the Generalized Anxiety Disorder-7 (GAD-7), among adult patients within an outpatient Allergy/Immunology (A/I) Clinic. Methods: Patients evaluated for CU in the A/I Clinic were asked to complete the GAD-7 at the start of their visit. Patients with a GAD-7 score of ≥ 5 were considered positive. Patients who screened positive were offered nurse-led anxiety education and were asked to complete a post-visit survey at the end of their visit to assess their perception of the relationship between CU and anxiety symptoms. GAD-7 scores and survey responses were collected and analyzed using Microsoft Excel. Findings: A total of thirty-three patients with CU participated in this quality improvement project. Fifteen of these patients (45.5%) screened positive for having at least mild anxiety symptoms. Of the patients who screened positive, twelve patients (80%) were offered anxiety education from nursing staff with a total of ten patients (66.7%) accepting education at the end of their visit. Additionally, 60% of clinic staff members demonstrated an increase level of confidence in administering the GAD-7 among clinic patients after receiving brief education on the topic. Discussion: Implementation of a standardized anxiety screening tool is feasible within an outpatient A/I clinic and integrating mental health screenings into CU management aligns with current recommendations advocating for routine assessment of psychiatric symptoms among patients with allergic conditions. Standardized screening tools, combined with targeted training, can improve provider confidence and consistency in mental health screening practices, even within non-psychiatric, specialty clinics.
 chronic urticaria hives anxiety GAD-7 Iowa Model of Evidence-Based Practice

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