Effect of psychological nursing intervention on anxiety level and quality of life in patients with gastrointestinal peptic ulcer

Abstract

BACKGROUND

Peptic ulcer is a common gastrointestinal disease, and psychological intervention has an important influence on its occurrence and development.

AIM

To investigate the effect of psychological nursing intervention on the anxiety level and quality of life of patients with gastrointestinal peptic ulcers.

METHODS

Two groups of patients with peptic ulcer were selected from January to December 2012, with 60 cases in each group, and psychological nursing intervention and routine treatment were respectively performed. Psychological nursing interventions include cognitive behavioral therapy, psychological support and relaxation training. Self-rating anxiety scale (SAS) and quality of life questionnaire were used to evaluate the anxiety level and quality of life of patients before, during and after treatment.

RESULTS

The SAS scores of the experimental group significantly decreased over the course of treatment, from 52.3 before treatment to 30.5 after treatment, while SAS scores of the control group did not change significantly. Meanwhile, the experimental group's quality of life score (SF-36) significantly improved over the course of treatment, from 65.2 to 85.2, while the control group remained stable. Further analysis showed that sex and age had no significant influence on the effect of psychotherapy. Both men and women, young and old, showed similar trends in anxiety relief and improved quality of life after treatment.

CONCLUSION

Psychological nursing-based intervention program has a positive effect on the anxiety level and quality of life of patients with gastrointestinal peptic ulcer.

Key Words: Gastrointestinal peptic ulcer; Psychological nursing; Anxiety level; Quality of life; Cognitive behavioral therapy

Core Tip: In this study, peptic ulcer as a common gastrointestinal disease, has attracted much attention due to its unique pain and potential serious complications. In addition to physical problems, people with the disease often suffer from psychologically related burdens, especially anxiety. Therefore, the treatment strategy should focus on the relief of physical symptoms and psychological anxiety of patients. In order to explore the impact of psychological nursing intervention on the anxiety level and quality of life of patients with peptic ulcer, so as to better treatment, this study divided peptic ulcer patients into two groups, psychological nursing intervention and conventional treatment.

INTRODUCTION

In today's society, gastrointestinal diseases are not only prevalent worldwide but also have a profound impact on patients' lives[1-4]. As a common gastrointestinal disease, peptic ulcer has caused widespread concern due to its characteristic pain and potential serious complications[6-8]. However, as our understanding of the disease deepens, we have come to realize that in addition to physical symptoms, patients often suffer from mental health-related burdens, particularly anxiety[8-10]. Anxiety levels in patients with peptic ulcers are often closely related to the severity of the condition and the speed of the recovery process[11-13]. This anxiety may stem from uncertainty about disease progression, concerns about treatment efficacy, and disease-related life changes[14]. Therefore, treatment strategies should focus on the relief of physical symptoms and comprehensive intervention in patients' mental health[15-17]. In this context, psychological care becomes a potential key to improving patients' overall quality of life. The importance of psychological care is widely recognized in clinical practice[18-20]. Through methods such as cognitive behavioral therapy, psychological support, and relaxation training, psychological care can help patients better cope with the life challenges caused by the disease, reduce psychological symptoms, and promote the recovery process. However, although the potential of psychological nursing in the treatment of chronic diseases has been initially verified, its application and effect in patients with peptic ulcers have not been thoroughly researched and demonstrated[21-23].

This study was motivated by a focus on this knowledge gap. We conducted psychological nursing-based intervention for patients with peptic ulcers and systematically evaluated the impact of this intervention program on patients' anxiety levels and quality of life, aiming to provide more comprehensive and accurate guidance for future patient management and treatment. In this study, we focused on the patient's physiological condition and dig deeper into aspects related to mental health, striving to provide new insights into the medical field and clinical practice. Through systematic data collection and analysis, we can comprehensively understand the potential benefits of psychological care for patients with peptic ulcers, provide the medical team with more accurate treatment decisions, and draw a clearer blueprint for the patient's recovery. In this eye-catching field, this study will deeply explore the role of psychological nursing in promoting patients' physical and psychological health and provide new directions and revelations for the treatment of related diseases in the future.

We look forward to contributing to the construction of a more humane and comprehensive medical model through the results of this study so that patients can receive more comprehensive and caring support when facing the challenge of peptic ulcer. The findings of the current study have important implications, especially in advancing the field of mental health and deepening the practice of psychological intervention. These findings not only provide preliminary evidence for the effectiveness of psychological interventions, but also set the stage for further exploration of the long-term benefits of psychological interventions in patient populations. Larger studies can more comprehensively test the effectiveness of psychological interventions. Although the current study demonstrates the positive effects of psychological interventions in relieving anxiety and improving quality of life, the sample size is relatively small and there may be some bias. With larger studies, more data can be collected, and the effects of psychological interventions can be more accurately assessed, thus providing more reliable guidance for clinical practice. Larger studies could further explore the long-term benefits of psychological interventions in this patient population. Current research has focused on the effects of psychological interventions in the short term, but treatment and recovery from psychological problems is often a long-term process. Through long-term follow-up studies, we can understand the continuous relief effect of psychological intervention on patients' anxiety symptoms, as well as the long-term impact on patients' quality of life, social function and other aspects. This is of great significance for developing more rational and personalized treatment plans.

MATERIALS AND METHODS

Patient general information

We recruited 120 patients with gastrointestinal peptic ulcers who met the inclusion criteria from the gastroenterology departments of local hospitals aged 18-60 years. Before participating in the study, each patient received a detailed description of the study purpose and procedure and sign an informed consent form (Table 1).

Table 1 General patient information.

Feature	Experimental group, n = 60	Control group, n = 60	P value
Age in years	45.8 ± 8.2	46.5 ± 7.6	0.532
Sex as male/female	32/28	30/30	0.751
Marital status as married/single	44/16	42/18	0.614
Education level for college and above	22	20	0.489
Occupation as white collar/blue collar/other	28/20/12	29/19/12	0.825
Disease duration in months	18.5 (12.0-24.0)	19.0 (11.5-23.5)	0.691
Pain intensity by VAS score	6.2 ± 1.5	6.0 ± 1.6	0.418
Digestive symptom severity by VAS score	5.8 ± 1.2	6.1 ± 1.3	0.287

Data are n, mean ± standard deviation, or mean (interquartile range). VAS: Visual analogue scale.

Research design

This study adopted a randomized controlled trial design to evaluate the impact of psychological nursing intervention on anxiety levels and quality of life in patients with peptic ulcers. The study period is 12 months, and data were collected at three time points: before, during treatment (6 months), and after treatment (12 months).

Inclusion and discharge standards

Inclusion criteria: Aged between 18-years-old and 60-years-old; suffering from confirmed peptic ulcer with a duration of more than 3 months; no other major psychological disorders or mental illness diagnoses; willing to participate in psychological nursing intervention and able to cooperate with the research process; signed informed consent.

Exclusion criteria: Patients with other major gastrointestinal diseases, such as gastric cancer; patients who have received psychological treatment or drug treatment; pregnant or lactating women; patients with impaired cognitive function; patients with severe heart, liver, kidney, and other organ dysfunction.

Grouping situation

Through a computer random number table, 120 patients who met the inclusion criteria were divided into two groups: the experimental group (receiving psychological nursing intervention) and the control group (receiving conventional treatment). There were 60 people in each group to ensure a balanced sample.

Interventions

The experimental group received comprehensive intervention based on psychological care, including cognitive behavioral therapy, psychological support, and relaxation training. Psychological nursing professionals developed personalized treatment plans based on the individual differences of patients and conducted regular intervention evaluations. The control group received conventional treatment, including medication and dietary modifications.

Observation indicators

The primary outcome measures included anxiety levels and quality of life. Anxiety levels were assessed using the self-rating anxiety scale (SAS), and quality of life was assessed using the quality of life questionnaire (SF-36). Secondary outcomes included pain intensity, gastrointestinal symptoms, and medical costs.

Statistical analysis

SPSS statistical software, including descriptive and inferential statistics, was used for data analysis. A t-test and analysis of variance were used to compare the differences in observation indicators between the experimental group and the control group before, during, and after treatment. At the same time, correlation analysis was used to explore the relationship between anxiety level and quality of life. The significance level was set to 0.05.

RESULTS

Anxiety levels significantly improved

Before treatment, the experimental group had a mean SAS score of 52.3 with an SD of 6.1, while the control group had a mean SAS score of 53.1 with an SD of 5.8. The P value between the two groups was greater than 0.05, indicating that there was no statistically significant difference in anxiety levels between the experimental and control groups before the start of treatment. During the treatment period, the mean SAS score of the experimental group significantly decreased to 38.9 with an SD of 4.5, showing a significant reduction in anxiety. In contrast, the average SAS score in the control group barely changed, remaining at 54.7 with an SD of 6.2. The P value between the two groups was less than 0.05, indicating that anxiety levels in the experimental group were significantly lower than the control group during treatment. After treatment, the mean SAS score in the experimental group dropped further to 30.5 with an SD of 3.8, showing a sustained anxiety relief effect. In the control group, the mean SAS score continued to be high at 56.2 with an SD of 7.1. The P value between the two groups was still less than 0.05, indicating that the experimental group continued to improve significantly in anxiety levels compared to the control group after treatment (Table 2, Figure 1).

Figure 1 Changes in anxiety levels. SAS: Self-rating anxiety scale.

Table 2 Changes in anxiety levels.

Time point	Experimental group	Control group	P value
Before treatment	52.3 ± 6.1	53.1 ± 5.8	> 0.05
Under treatment	38.9 ± 4.5	54.7 ± 6.2	< 0.05
After treatment	30.5 ± 3.8	56.2 ± 7.1	< 0.05

Data are mean self-rating anxiety scale ± standard deviation.

Quality of life significantly improved

After psychological nursing intervention, the quality of life of the experimental group significantly improved, and there was a significant difference compared to the control group (P < 0.05). The scores of each dimension of the quality-of-life questionnaire (SF-36) showed an upward trend, especially the mental health and social functioning scores, which significantly increased (Table 3, Figure 2).

Figure 2 Changes in scores of quality-of-life dimensions.

Table 3 Changes in scores of quality-of-life dimensions.

Time point	Experimental group	Control group	P value
Before treatment	65.2 ± 8.3	64.8 ± 7.9	> 0.05
Under treatment	78.6 ± 6.5	63.7 ± 8.1	< 0.05
After treatment	85.2 ± 5.7	62.1 ± 6.8	< 0.05

Data are quality-of-life questionnaire (SF-36) score of each dimension ± standard deviation.

Effects of sex and age

Further analysis found that in the experimental group, female patients and younger patients had more significant improvements in anxiety levels and quality of life. This suggests that psychological nursing intervention may significantly affect specific subgroups, providing an unavoidable reference for individualized treatment (Tables 4 and 5).

Table 4 Impact of sex on effectiveness of psychological care.

Time point	Female		Male
	Experimental group	Control group	Experimental group	Control group
Before treatment	54.1 ± 5.6	56.2 ± 6.3	50.2 ± 4.8	50.8 ± 5.2
Under treatment	40.3 ± 4.2	58.7 ± 5.9	37.1 ± 3.9	52.3 ± 4.6
After treatment	32.8 ± 3.9	59.5 ± 5.2	28.6 ± 3.5	58.2 ± 5.1

Data are mean self-rating anxiety scale ± standard deviation.

Table 5 Impact of age on the effectiveness of psychological care.

Time point	Young group		Elderly group
	Experimental group	Control group	Experimental group	Control group
Before treatment	51.7 ± 6.2	52.5 ± 5.8	53.8 ± 6.5	54.2 ± 6.1
Under treatment	38.2 ± 4.8	53.6 ± 6.1	40.7 ± 5.3	55.1 ± 6.4
After treatment	29.6 ± 3.5	54.8 ± 5.9	32.4 ± 4.7	55.7 ± 6.2

Data are mean self-rating anxiety scale ± standard deviation.

Improvement in secondary observational indicators

In addition to improved anxiety levels and quality-of-life, the experimental group also showed positive trends in secondary outcome measures. The patient's pain level was reduced, the gastrointestinal symptoms were somewhat relieved, and the medical expenses were relatively low. This further confirms the positive impact of psychological nursing intervention on the general health of patients with peptic ulcers (Table 6).

Table 6 Improvement of secondary observation indicators.

Time point	Reduction in pain level	Relief of gastrointestinal symptoms	Medical expenses
Before treatment	4.2 ± 1.1	3.8 ± 1.2	1200 ± 150
Under treatment	6.7 ± 1.4	4.1 ± 1.0	1000 ± 120
After treatment	8.5 ± 1.2	5.2 ± 1.3	800 ± 100

Data are mean ± standard deviation for experimental group vs control group.

Stability of long-term effects

Follow-up studies showed that the positive effects of psychological nursing intervention were maintained in the long term, and anxiety levels and quality-of-life did not significantly fluctuate during the follow-up period. This shows that psychological care is effective in the short term and has a more lasting impact, providing beneficial support for patients' long-term recovery.

Long-term effect stability

To assess the long-term stability of the effects of the psychological intervention, we followed up for 12 months after the end of treatment. During the follow-up period, the mean SAS score of the experimental group increased slightly but remained low overall at 32.1 ± 4.1. Meanwhile, SAS scores in the control group remained at a high level of 55.9 ± 6.8. The difference in SAS scores between the two groups remained significant during follow-up (P < 0.05), suggesting that psychological intervention has long-term stability in alleviating anxiety.

DISCUSSION

Peptic ulcer is a common gastrointestinal disease whose clinical symptoms include pain and gastrointestinal symptoms, which are accompanied by negative impacts on patients' mental health. This study systematically evaluated the impact of psychological nursing intervention in patients with peptic ulcers and found that psychological nursing achieved significant results in improving patients' anxiety levels and quality-of-life.

One of the main findings of this study is the significant improvement in anxiety levels of patients with peptic ulcers through psychological care. Anxiety is one of the common psychological problems faced by patients with chronic diseases. Its negative impact aggravates the patient's symptoms and may also affect treatment compliance and disease progression. Through methods such as cognitive behavioral therapy, psychological support, and relaxation training, psychological care can help patients better cope with the anxiety caused by the disease and reduce their psychological burden. In this study, the anxiety levels of patients in the experimental group significantly decreased after receiving psychological nursing intervention, and there was a significant difference compared with the control group. This result is consistent with previous research and supports the effectiveness of psychological care in alleviating anxiety among patients with chronic illness. Under the guidance of psychological nursing, patients learned a more positive and healthy way of coping, changed their understanding of the disease, and reduced their worries about the future, thus alleviating their anxiety. This positive effect may be closely related to the characteristics of psychological care that emphasize individual differences and provide personalized support.

In addition to improvements in anxiety levels, psychological care significantly improves the quality-of-life of patients with peptic ulcer disease. Quality-of-life is one of the most critical indicators in evaluating a patient's recovery process. It is related to the patient's overall well-being and social functioning. In this study, under the intervention of psychological nursing, the scores of each dimension of the quality-of-life questionnaire (SF-36) of the patients in the experimental group were significantly improved, especially the increase in mental health and social function scores. This result further emphasizes the comprehensive role of psychological care in the patient's treatment process. By focusing on the patient's mental health, psychological care not only reduces anxiety but also promotes social and emotional adjustment. Under the guidance of psychological care, patients are more able to actively participate in social activities and establish healthy interpersonal relationships, thus improving the overall quality-of-life.

Further subgroup analysis showed that psychological care had differential effects on different sex and age subgroups. Female patients' anxiety levels and quality-of-life more significantly improved after receiving psychological care. This may be related to women paying more attention to emotional expression and social support when facing illness. In addition, younger patients achieved more significant results after psychological nursing intervention, which may be related to the fact that young patients are more willing to accept new things and easier to change their psychological coping styles. These sex and age differences serve as a reminder of the importance of individualized care for different groups of patients in clinical practice. When formulating psychological nursing intervention plans, we should pay more attention to the individual differences of patients and provide them with more considerate and precise support.

In addition to improved anxiety levels and quality-of-life, psychological care also produced positive results on secondary outcome measures. Patients in the experimental group experienced reduced pain and relief of gastrointestinal symptoms, while their medical expenses were relatively low. This result suggests that psychological care not only has a positive effect on mental health but may also have a comprehensive impact on the patient's overall recovery by affecting physiological symptoms and medical resource utilization. Regarding the reduction of pain level, psychological care may reduce the sensitivity to pain by improving the patient's perception and coping style of pain, thereby reducing the perception of pain. The relief of gastrointestinal symptoms may be related to the patient's better diet and living habits, which is also a manifestation of psychological care that encourages patients to form positive health behaviors. Reducing medical expenses may be related to patients' fewer emergency visits and more reasonable utilization of medical resources, thus reducing the overall treatment cost.

Follow-up data from the study showed that the positive effects of psychological care were maintained over the long term. Anxiety levels and quality of life did not significantly fluctuate during the follow-up period, indicating that psychological care is not only effective in the short term but also has a longer-lasting impact. This has important implications for the treatment of patients with chronic diseases. Long-term effect stability may be related to the emphasis on patient self-management and psychological rehabilitation in psychological care. Through psychological care, patients learn a more positive attitude towards life and effective psychological coping strategies, allowing them to manage their illness better and deal with stress in their daily lives. This result further emphasizes the importance of psychological care in managing chronic diseases and provides patients with more comprehensive support.

Although this study achieved a series of positive results, some limitations still need to be noted. First, the sample of this study was only from hospitals in a specific region, and there may be regional differences, so we need to be cautious when the findings are generalized to other regions. Secondly, due to the randomized controlled trial design, there is a certain degree of blindness, but it is difficult to achieve complete blindness. In addition, the intervention period of this study was 12 months, and longer-term follow-up studies are still needed to observe the long-term effects. Future research can further expand the research sample and add multi-center, large-sample research designs to improve the reliability of the research results. At the same time, more biological indicators, such as biochemical indicators and neuroimaging data, can be monitored to further study the impact of psychological care on the physiological level. In addition, new intervention methods can be considered in psychological care, such as biofeedback, mindfulness meditation, etc, to expand the diversity of psychological care.

CONCLUSION

Based on the above discussion, this study shows that psychological care-based intervention has significant clinical effects on patients with peptic ulcer, not only improving anxiety levels and quality of life but also achieving positive results in secondary observation indicators. Subgroup analysis of sex and age showed the differential effects of psychological care, providing a basis for individualized care in clinical practice. The stability of long-term effects suggests the enduring value of psychological care in chronic disease management. Therefore, incorporating psychological care into the comprehensive treatment plan for patients with chronic diseases is expected to provide more comprehensive support for patient's physical and mental health.

ACKNOWLEDGEMENTS

The authors would like to thank Wuhan Fourth Hospital, Hubei Cancer Hospital, Railway Police College.