Motivational psychological nursing reduces anxiety and depression in patients with rheumatic and immunological diseases combined with nephropathy

Abstract

BACKGROUND

The coexistence of rheumatological and immunological diseases with nephropathy presents considerable clinical challenges. These challenges often result in heightened anxiety and depression, which detrimentally affect patient outcomes. Motivational psychological nursing, which incorporates motivational interview and cognitive-behavioral therapy, may offer a promising approach to address these psychological concerns.

AIM

To evaluate the effectiveness of motivational psychological nursing in the reduction of anxiety and depression and improvement of the quality of life of patients with rheumatological and immunological diseases complicated by nephropathy.

METHODS

We conducted a retrospective cohort study involving 206 patients with rheumatological and immunological diseases complicated by nephropathy and who were treated between January 2021 and January 2025. The inclusion criteria were as follows: Aged 18-75 years, met the diagnostic criteria for rheumatological and immunological diseases with a renal biopsy classification above type II, hospitalized in our facility, received consistent basic nursing care, and had complete clinical data available. Participants allotted to the observation group (n = 102) receiving motivational psychological nursing, and those in the control group (n = 104) received standard care. Psychological status was assessed using Self-Rating Anxiety Scale (SAS), Beck Anxiety Inventory, Hamilton Anxiety Rating Scale, Self-Rating Depression Scale (SDS), Patient Health Questionnaire-9, and other standardized measures. Intervention lasted throughout hospitalization, with follow-up assessments conducted before discharge.

RESULTS

Pre-intervention, anxiety, and depression scores were similar across groups. Postintervention, the observation group showed significant reductions in anxiety (SAS: 44.53 ± 6.72 vs 46.79 ± 6.94; P = 0.018) and depression (SDS: 45.20 ± 5.07 vs 46.97 ± 5.25; P = 0.014) compared with the control group. General self-efficacy (P = 0.044), health-related quality of life (P = 0.044), and World Health Organization Quality of Life (P = 0.040) scores also revealed significant improvement.

CONCLUSION

Motivational psychological nursing considerably reduces anxiety and depression in patients with rheumatological and immunological diseases complicated by nephropathy, which enhances the overall quality of life.

Key Words: Motivational psychological nursing; Rheumatological diseases; Immunological diseases; Nephropathy; Anxiety reduction; Depression management

Core Tip: This study investigates the impact of motivational psychological nursing on anxiety and depression in patients with rheumatological and immunological diseases complicated by nephropathy. By integrating motivational interviewing and cognitive-behavioral therapy, our findings demonstrate significant reductions in anxiety and depression scores, alongside improvements in self-efficacy and quality of life, highlighting a promising therapeutic approach for this complex patient group.

INTRODUCTION

The intersection of rheumatological and immunological diseases with nephropathy represents a challenging and multifaceted clinical scenario that requires comprehensive management strategies[1]. Rheumatological diseases, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc), are known for their chronic nature and systemic effect[2]. When compounded with renal involvement, as observed in lupus nephritis or vasculitis-associated nephropathy, the complexity of patient care escalates substantially[3]. These conditions are typically associated with substantial morbidity, which affects patients’ physical capabilities and overall quality of life[4].

Psychological comorbidities, such as anxiety and depression, are prevalent among this patient population and adversely affect their disease prognosis, adherence to treatment regimens, and their quality of life[5]. Management of these psychological aspects is crucial because mental health directly influences physiological outcomes in chronic disease states[6]. Traditional medical care models often inadequately address these psychological needs, which highlights a gap in comprehensive patient care[6]. Bridging this gap necessitates the exploration of innovative nursing and supportive care interventions aimed at holistic patient management[7].

Motivational psychological nursing emerges as a promising approach within this context. Rooted in principles of motivational interview and cognitive-behavioral therapy, this nursing intervention aims to enhance patients’ intrinsic motivation toward health-promoting behaviors while addressing the emotional and psychological barriers they encounter[8,9]. It emphasizes not only the provision of standard medical and nursing care but also incorporates dynamic psychological interventions tailored to individual patient needs, which fosters a supportive and therapeutic environment[10].

The integration of psychological support within nursing care remarkably reduces symptoms of anxiety and depression in chronic illnesses[11]. However, the specific effect of such interventions on patients suffering from compounded rheumatological and nephrological conditions remains underexplored[12]. Given the intricate interplay between psychological well-being and chronic disease management, the efficacy of motivational psychological nursing interventions must be investigated to reveal valuable insights into the improvement of comprehensive care strategies in this patient population[12]. This study employed a retrospective cohort design and examined the potential of motivational psychological nursing in influencing anxiety and depression levels in patients diagnosed with rheumatological and immunological diseases complicated by nephropathy.

MATERIALS AND METHODS

Case selection

This research utilized a retrospective cohort design to examine 206 patients diagnosed with rheumatological and immunological diseases combined with nephropathy and who received treatment at Shaanxi Provincial People’s Hospital and the Second Hospital of Shanxi Medical University between January 2021 and January 2025. Data on baseline characteristics, disease diagnoses, variations in anxiety and depression scores, and enhancements in the quality of life were collected from an electronic medical record system.

This work received approval from the Institutional Review Board and Ethics Committee of Shaanxi Provincial People’s Hospital. Informed consent was waived by the Committee because the research exclusively involved de-identified patient data, which eliminated potential harm or impact on patient care.

Sample selection and grouping criteria

The diagnosis of rheumatological and immunological diseases was determined based on clinical manifestations and auxiliary examinations, in accordance with the diagnostic criteria in Kelley and Firestein's Textbook of Rheumatology[13].

The specific criteria include the following: RA: Characterized by symmetrical swelling and pain in small joints and morning stiffness and confirmed by the presence of positive rheumatoid factor (RF) and anticyclic citrullinated peptide antibodies.

SLE: Manifested as multisystem involvement with positive antinuclear antibodies (ANA), antidouble-stranded DNA, and anti-Smith antibodies.

SSc: Features include Raynaud’s phenomenon and skin tightening, supported by positive ANA, antitopoisomerase I (anti-Scl-70), and anticentromere antibodies.

Gout: Identified by the detection of acute monoarthritis (e.g., the first metatarsophalangeal joint), elevated serum uric acid levels, and urate crystals in the joint fluid.

Behcet’s disease: Diagnosed through oral ulcers, genital ulcers, uveitis, and a positive pathergy test.

Psoriatic arthritis: Associated with psoriasis, negative RF, and imaging findings revealing bone erosion or new bone formation.

Renal biopsy classification: According to Brenner and Rector’s The Kidney[14], renal biopsy classification for nephropathy in the context of rheumatological and immunological diseases includes the following:

Types I and II: Denoted by mild pathological changes and negligible clinical symptoms and were therefore excluded from this study.

Type III: Characterized by focal proliferative glomerulonephritis with segmental inflammatory reactions, cellular proliferation, and inflammatory cell infiltration in the glomeruli.

Type IV: Indicated by diffuse proliferative glomerulonephritis, which is characterized by extensive inflammatory damage to the glomeruli, and potentially leads to rapid renal function deterioration.

Type V: Defined by membranous nephropathy with thickening of the glomerular basement membrane, immune complex deposition, and resulting massive proteinuria.

Type III + V: Described by concurrent focal glomerular inflammation and diffuse filtration barrier dysfunction.

Type IV + V: Displayed as the combination of diffuse glomerular inflammatory damage and filtration barrier dysfunction.

The inclusion criteria: Aged 18-75 years; met the diagnostic criteria for rheumatological and immunological diseases[13], with a renal biopsy classification above type II[14], hospitalized in our facility, received consistent basic nursing care, and had complete clinical data available.

The exclusion criteria: Cognitive impairment, severe underlying diseases, organ dysfunction, malignant tumors, alcohol or drug dependence, language barriers, neurodegenerative diseases (such as stroke, multiple sclerosis, and Parkinson’s disease), or diagnosed psychiatric disorders (excluding any degree of mental health conditions).

We enrolled 206 patients in accordance with these criteria. Using electronic medical records, patients were assigned to either the observation (n = 102) or the control group (n = 104) based on the nursing method of treatment they received.

Basic information

Patient data, including age, gender, occupation, marital status, educational level, medical history, laboratory test results, and details pertaining to rheumatological and immunological symptoms, were collected from an electronic medical record system. These information were obtained from records of the patients’ most recent diagnosis before hospitalization. In addition, patients completed a questionnaire assessing anxiety and depression upon admission, and it was administered again prior to discharge to evaluate alterations in their psychological status.

Laboratory tests

Prior to or on the day of hospitalization, the patients underwent laboratory tests to assess renal function. Each patient provided approximately 10 mL fresh morning urine for quantitative protein analysis and active urine sediment examination. The procedures were as follows:

Quantitative urine protein analysis: The pyrogallol red molybdate method was employed, and the reagent kit 05486962190 was used (F. Hoffmann-La Roche Ltd., Switzerland). The analysis was conducted by Hitachi 7180 Clinical Chemistry Analyzer by Hitachi High-Technologies Corporation, Japan.

Active urine sediment examination: Microscopic examination was performed using the fluorescence method with the UF-1000I/UF-1000IR urine sediment staining reagent kit (Sysmex Corporation, Japan).

Moreover, 3 mL fasting venous blood was drawn from each patient using a nonanticoagulant blood collection tube. Blood was allowed to clot for 30 minutes and then centrifuged at 3000 rpm for 10 minutes to separate the serum. The following serum tests were conducted:

Serum creatinine measurement: The sarcosine oxidase method was used (reagent kit 715062 from Beckman Coulter, United States.), and analysis was performed utilizing an AU5800 Series Clinical Chemistry Analyzer.

C3 and C4 measurement: Immunoturbidimetry was performed to measure the C3 and C4 Levels. The reagent kits for C3 (N0329) and C4 (OS65-21A) were supplied by Siemens Healthineers, Germany and Beckman Coulter Inc., United States., respectively. The PF-350 Specific Protein Analyzer (Dirui Industrial Co., Ltd., China) was used for these measurements.

Nursing approach

The control group received standard inpatient care during hospitalization. Nursing staff strictly adhered to medication management procedures, which ensured accurate dosage and timing, and documented any adverse drug reactions. The researchers also developed individualized nutrition and exercise plans for each patient and provided detailed guidance.

The observation group received additional motivational nursing interventions based on the standard protocol:

Psychological intervention: Nursing staff conducted dynamic assessments of patients’ psychological statuses to address their mental and physical conditions. They employed a positive expectation feedback mechanism to improve patients’ emotional states.

Family support: Psychology-trained nurses guided patients’ families to develop and implement family support plans tailored to the patients’ psychological needs, which enhances familial care.

Environmental motivation: A health -education display area on rheumatological and immunological nephropathy was set up in the ward, and a peer support mechanism was established to foster a positive treatment atmosphere.

Role model demonstration: Patients who recovered were invited to share their rehabilitation experiences through videos, face-to-face discussions, and organized experience-sharing sessions to help current patients build confidence in their recovery.

Assessment of anxiety and depression levels

A standardized psychological measurement tools was employed to assess anxiety and depression levels among hospitalized patients.

The specific scales for anxiety assessment: (1) Self-Rating Anxiety Scale (SAS) measures subjective anxiety levels using a Likert 4-point scoring system, with standardized scores ranging from 25 to 100. The scale comprises 20 items, with each rated on a scale from 1 (none or little of the time) to 4 (most or all of the time). Clinical grading was as follows: < 50 indicates the normal range; 50-59 suggests mild anxiety; 60-69 reflects moderate anxiety; ≥ 70 signifies severe anxiety. The scale’s reliability, as indicated by Cronbach’s alpha, was 0.820[15]; (2) Beck Anxiety Inventory (BAI): Consists of 21 items scored on a 0-3 scale, with the total score ranging from 0 to 63. Each item assesses specific symptoms of anxiety, such as nervousness, dizziness, and fear of losing control. Clinical grading criteria are as follows: 0-7, minimal anxiety; 8-15, mild; 16-25, moderate; 26-63, severe anxiety. BAI had a Cronbach’s alpha of 0.846[16]; and (3) Hamilton Anxiety Rating Scale (HAMA): Covers 14 items related to somatic and psychic anxiety symptoms, and it is scored on a 0-4 scale. The total score ranges from 0 to 56, with < 7 being normal, 7-14 indicating mild anxiety, 15-21 representing moderate anxiety, and > 21 signaling severe anxiety. Its Cronbach’s alpha coefficient was 0.756[17].

The scales for depression assessment: (1) Self-Rating Depression Scale (SDS) evaluates depressive symptom severity, with a standardized score range of 25 to 100. The clinical grading is as follows: < 53 for the normal range, 53-62 for mild depression, 63-72 for moderate depression, and ≥ 73 for severe depression. SDS had a Cronbach’s alpha of 0.81[18]; (2) Patient Health Questionnaire-9 (PHQ-9): Used to screen and assess depressive symptoms’ severity, with scores ranging from 0 to 27. Clinical grading is as follows: 0-4 for no depression, 5-9 for mild symptoms, 10-14 for moderate symptoms, 15-19 for moderately severe symptoms, and 20-27 for severe symptoms. PHQ-9 had a Cronbach’s alpha equal to 0.81[19]; (3) Center for Epidemiologic Studies Depression Scale (CES-D): Covers depressive mood, positive mood, somatic symptoms, and interpersonal relations, with scores ranging from 0 to 60. Clinical grading criteria include the following: < 16 for no or minimal depressive symptoms, 16-26 for mild to moderate symptoms, and > 26 for severe symptoms. Cronbach’s alpha was 0.87[20]; and (4) Hamilton Depression Rating Scale (HAMD): The study used the HAMD-6 version, with scores ranging from < 8 for no or minimal symptoms to > 24 for severe depression, which potentially indicates significant social functional impairment. Its Cronbach’s alpha was 0.86[19].

Additional assessments

For the comprehensive evaluation of nursing outcomes, the patients’ self-belief, quality of life, and rheumatological and immunological disease status were assessed using the following scales:

Self-belief assessment: The General Self-Efficacy Scale (GSES) measures an individual’s confidence in managing challenges using a 4-point scoring system. Scores are categorized as follows: < 20, low confidence; 20-30, moderate confidence; > 30 high confidence in handling various situations. The GSES showed a high reliability, with a Cronbach’s alpha coefficient of 0.91[21].

Quality of life assessment: Health-related quality of life (HRQL) was assessed using the Short-Form 36-item (SF-36) scale, which is scored from 0 to 100 (with 0 being the poorest and 100 being the best result). The widely used SF-36 had a Cronbach’s alpha coefficient ranging from 0.689 to 0.972[22]; World Health Organization Quality of Life (WHOQO)-BREF: This scale evaluates physical and psychological health, social relationships, and environmental factors using a Likert 5-point scale. It is useful for comparative analyses and had a Cronbach’s alpha coefficient ranging from 0.70 to 0.77[23].

Rheumatological and immunological disease assessment scales: Foot Function Scale (FF) assesses foot function, with scores ranging from 0 to 100. The scores are interpreted as follows: 0-20, mild impairment; 21-50, moderate impairment; 51-80, severe impairment; 81-100, extremely severe impairment. This scale exhibited a high reliability, with a Cronbach’s alpha of 0.94[24]; Health Assessment Questionnaire (HAQ): This questionnaire evaluates the functional status of patients with rheumatic diseases, with scores ranging from 0 to 3. Interpretation includes 0-1 for good functional status, 1-2 for moderate limitations, and 2-3 for severe limitations. The HAQ exhibited a Cronbach’s alpha of 0.83[25].

Statistical analysis

Data analysis was conducted using SPSS 29.0 (SPSS Inc., Chicago, IL, United States). Categorical variables were presented as frequencies and percentages [n (%)] and analyzed using χ² test. The normality of continuous variables was evaluated using the Shapiro-Wilk test. Normally distributed continuous variables were reported as mean ± SD, and group comparisons were conducted utilizing an independent samples t-test (with corrected variance). Nonnormally distributed continuous variables were reported as medians (25^th percentile, 75^th percentile), and group comparisons were performed using the Wilcoxon rank-sum test. No missing values were observed in our dataset. All statistical analyses were two-sided, with a P value < 0.05 indicating statistical significance.

RESULTS

Baseline characteristics of participants

Similar mean ages were observed between the observation (52.85 ± 9.75 years) and control groups (53.54 ± 9.33 years), with no statistically significant difference (t = 0.515, P = 0.607) (Table 1). Disease duration also showed no significant difference between the groups, with averages of 10.89 ± 2.27 and 11.26 ± 2.12 years in the observation and control groups (t = 1.230, P = 0.220), respectively. Gender distribution showed comparability, with males constituting 49.02% of the observation group and 44.23% of the control group, and females accounting for 50.98% and 55.77%, respectively (χ² = 0.475, P = 0.491). Employment status, living arrangements with family, education levels, and marital status were similarly distributed between the groups, with P values of 0.925, 0.972, 0.772, and 0.841, respectively, which indicate no significant differences. The prevalence of hypertension was nearly identical in both groups (50.98% and 50.96% in the observation and control groups, respectively; χ² = 0.000, P = 0.998), and diabetes incidence did not differ significantly (6.86% vs 10.58%, χ² = 0.891, P = 0.345). In addition, no significant variations were observed in the systolic and diastolic blood pressure readings or in estimated glomerular filtration rates, with P values of 0.707, 0.374, and 0.986, respectively. These results indicate that the two groups were well-matched across key demographic and clinical variables, which facilitates a reliable assessment of the intervention’s effect.

Table 1 Comparison of demographic characteristics between the two groups, n (%).

Parameters	Observation group (n = 102)	Control group (n = 104)	t/χ2	P value
Age, year	52.85 ± 9.75	53.54 ± 9.33	0.515	0.607
Disease duration, years	10.89 ± 2.27	11.26 ± 2.12	1.230	0.220
Gender			0.475	0.491
Male	50 (49.02)	46 (44.23)
Female	52 (50.98)	58 (55.77)
Employment			0.009	0.925
Yes	70 (68.63)	72 (69.23)
No	32 (31.37)	32 (30.77)
Live with family			0.001	0.972
Yes	96 (94.12)	98 (94.23)
No	6 (5.88)	6 (5.77)
Education			2.529	0.772
No education	11 (10.78)	7 (6.73)
Primary school	40 (39.22)	39 (37.50)
High school	17 (16.67)	16 (15.38)
Vocational education	19 (18.63)	24 (23.08)
Bachelor	14 (13.73)	15 (14.42)
Master degree	1 (0.98)	3 (2.88)
Marital status			0.834	0.841
Single	2 (1.96)	2 (1.92)
Married	83 (81.37)	88 (84.62)
Divorced/separated	4 (3.92)	2 (1.92)
Widowed	13 (12.75)	12 (11.54)
Hypertension	52 (50.98)	53 (50.96)	0.000	0.998
Diabetes	7 (6.86)	11 (10.58)	0.891	0.345
Systolic BP (mmHg)	126.22 ± 8.31	125.81 ± 7.51	0.377	0.707
Diastolic BP (mmHg)	77.60 ± 7.51	76.61 ± 8.42	0.892	0.374
Estimated GFR, mL/minute/1.73 m2	132.61 ± 44.02	132.71 ± 38.33	0.018	0.986

GFR: Glomerular filtration rate; BP: Blood pressure.

RA was the most common condition in both groups (47.06% in the observation group and 47.12% in the control group). SLE was detected in 11.76% of the observation group and 10.58% of the control group (Table 2). The control group displayed a slightly higher presence of SSc (11.54%) than the observation group (9.80%). Gout and Behcet disease were observed in approximately similar proportions in both groups (29.41% vs 28.85% for gout and 0.98% vs 0.96% for Behcet disease, respectively). Cases of psoriatic arthritis were also comparable, with one case each in both groups. The analysis of kidney biopsy class revealed no significant differences, with classes III or III+V observed in 30.39% of the observation group and 26.92% of the control group, and classes IV or IV + V were noted in 61.76% and 57.69%, respectively. The pure V class was more prevalent in the control group (15.38%) than in the observation group (7.84%). χ² tests for disease type and kidney biopsy class yielded P values of 0.995 and 0.238, respectively, which corroborates the lack of significant difference between the two groups. Overall, this balance in disease characteristics ensures that subsequent analyses can reliably attribute differences in psychological outcomes to the intervention.

Table 2 Comparison of disease diagnoses between the two groups, n (%).

Parameters	Observation group (n = 102)	Control group (n = 104)	t/χ2	P value
Type of disease			None	0.995
Rheumatoid arthritis	48 (47.06)	49 (47.12)
Systemic lupus erythematosus	12 (11.76)	11 (10.58)
Systemic sclerosis	10 (9.80)	12 (11.54)
Gout	30 (29.41)	30 (28.85)
Behcet disease	1 (0.98)	1 (0.96)
Psoriatic arthritis	1 (0.98)	1 (0.96)
Kidney biopsy class			2.873	0.238
III or III + V	31 (30.39)	28 (26.92)
IV or IV + V	63 (61.76)	60 (57.69)
Pure V	8 (7.84)	16 (15.38)

Laboratory tests

Similar 24 hours urinary protein excretions were observed between the groups, with the observation and control groups showing means of 442.98 ± 122.32 and 451.14 ± 126.12 mg, respectively (t = 0.471, P = 0.638) (Table 3). The prevalence of active urine sediment was observed in 6.86% of the observation group and 8.65% of the control group, with no significant difference (χ² = 0.231, P = 0.631). Serum creatinine levels were closely matched, with 67.21 ± 20.82 and 66.82 ± 19.98 μmol/L determined for the observation and control groups, respectively (t = 0.139, P = 0.889). Regarding immunologic factors, serum C3 levels reached 868.14 ± 236.12 mg/dL in the observation group and 891.12 ± 203.23 mg/dL in the control group, which yielded no significant difference (t = 0.749, P = 0.455). Similarly, serum C4 Levels showed no significant variance, with values of 180.85 ± 103.01 mg/dL observed in the observation group and 194.11 ± 70.96 mg/dL in the control group (t = 1.074, P = 0.284). These findings confirm the similar renal and immunologic profiles at baseline of both groups, which allowed for an unbiased evaluation of the psychological interventions’ effect on the targeted outcomes.

Table 3 Comparison of laboratory renal function tests between the two groups.

Parameters	Observation group (n = 102)	Control group (n = 104)	t/χ2	P value
Urinary protein, mg/24 hours	442.98 ± 122.32	451.14 ± 126.12	0.471	0.638
Active urine sediment, n (%)	7 (6.86)	9 (8.65)	0.231	0.631
SCr (μmol/L)	67.21 ± 20.82	66.82 ± 19.98	0.139	0.889
Immunologic factors, mg/dL
Serum C3	868.14 ± 236.12	891.12 ± 203.23	0.749	0.455
Serum C4	180.85 ± 103.01	194.11 ± 70.96	1.074	0.284

Assessment of anxiety and depression levels

Prior to nursing intervention, SAS scores were comparable between the observation (61.98 ± 6.46) and control groups (62.31 ± 6.98), with no statistically significant difference (t = 0.350, P = 0.727) (Figure 1). However, after nursing intervention, the SAS scores were significantly reduced in the observation group (44.53 ± 6.72) compared with that in the control group (46.79 ± 6.94), which indicates a statistically significant improvement (t = 2.373, P = 0.019). Similarly, BAI scores before the intervention did not differ significantly between groups (43.82 ± 13.57 for the observation group vs 45.28 ± 11.27 for the control group, t = 0.840, P = 0.402). Postintervention BAI scores revealed a trend toward reduction in the observation group (23.33 ± 10.25) compared with the control group (25.32 ± 10.33), although this difference did not reach statistical significance (t = 1.391, P = 0.166). Regarding HAMA scores, a trend toward baseline differences was observed (t = 1.736, P = 0.084), but postintervention results indicated a significant reduction in anxiety levels in the observation group (12.00 ± 2.75) compared with the control group (13.20 ± 3.90) (t = 2.556, P = 0.011). As revealed by these findings, motivational psychological nursing significantly alleviated anxiety in patients within the observation group, which demonstrates its efficacy as an intervention for anxiety reduction in patients with rheumatism and immunological diseases combined with nephropathy.

Figure 1 Comparison of anxiety levels between the two groups. A: Self-Rating Anxiety Scale (SAS)-before nursing; B: SAS-after nursing; C: Beck Anxiety Inventory (BAI)-before nursing; D: BAI-after nursing; E: Hamilton Anxiety Rating Scale (HAMA)-before nursing; F: HAMA-after nursing. ^aP < 0.05. SAS: Self-Rating Anxiety Scale; BAI: Beck Anxiety Inventory; HAMA: Hamilton Anxiety Rating Scale.

Similar initial SDS scores were observed between the observation (60.67 ± 5.61) and control groups (59.49 ± 5.75), with no significant difference (t = 1.496, P = 0.136) (Figure 2). However, postintervention, the observation group exhibited significantly reduced SDS scores (45.20 ± 5.07) compared with the control group (46.97 ± 5.25), which indicates a meaningful reduction in depression levels (t = 2.470, P = 0.014). On the other hand, PHQ-9 scores demonstrated no significant difference between groups before (12.51 ± 4.42 for the observation group vs 13.18 ± 4.58 for the control group, t = 1.062,P = 0.289) and after the intervention (9.39 ± 2.32 vs 9.18 ± 2.33, t = 0.621, P = 0.535). The CES-D baseline scores were comparable between the observation (16.33 ± 7.13) and control groups (16.25 ± 7.30) (t = 0.078, P = 0.938). a trend toward improvement was noted postintervention (12.44 ± 3.29 vs 13.30 ± 3.89), but it did not reach statistical significance (t = 1.715, P = 0.088). Similarly, HAMD scores displayed no significant differences pre- (14.31 ± 3.84 vs 15.35 ± 6.62, t = 1.381, P = 0.169) or post-intervention (8.93 ± 2.83 vs 9.25 ± 2.95, t = 0.785, P = 0.434). These findings demonstrate the effectiveness of motivational psychological nursing on the reduction of depression as reflected in SDS outcomes, which underscores its potential as a beneficial intervention for depressive symptoms in this patient population.

Figure 2 Comparison of depression levels between the two groups. A: Self-Rating Depression Scale (SDS)-before nursing; B: SDS-after nursing; C: Patient Health Questionnaire-9 (PHQ-9)-before nursing; D: PHQ-9-after nursing; E: Center for Epidemiologic Studies Depression Scale (CES-D)-before nursing; F: CES-D-after nursing; G: HAMD-before nursing; H: HAMD-after nursing. ^aP < 0.05. SDS: Self-Rating Depression Scale; PHQ-9: Patient Health Questionnaire-9; CES-D: Center for Epidemiologic Studies Depression Scale; HAMD: Hamilton Depression Scale.

Additional assessments

Before nursing intervention, similar GSES scores were observed between the observation (22.18 ± 2.52) and control groups (22.56 ± 2.78), with no statistically significant difference (t = 1.022, P = 0.308) (Table 4). However, after the intervention, the observation group showed a significantly higher increase in GSES scores (29.63 ± 2.72) compared with that in the control group (28.87 ± 2.69), which indicates a statistically significant enhancement in self-efficacy (t = 2.036, P = 0.043). This increase implies that the motivational psychological nursing intervention effectively bolstered the patients’ self-belief, which is an important component for the management of chronic conditions and improvement of overall mental well-being of individuals with rheumatism and immunological diseases combined with nephropathy.

Table 4 Self - belief related evaluation between the two groups.

Parameters	Observation group (n = 102)	Control group (n = 104)	t	P value
GSES
Before nursing	22.18 ± 2.52	22.56 ± 2.78	1.022	0.308
After nursing	29.63 ± 2.72	28.87 ± 2.69	2.036	0.043

GSES: General Self Efficacy Scale.

Similar HRQL scores were observed between the observation (75.34 ± 5.93) and control groups (74.55 ± 6.28), with no significant difference (t = 0.920, P = 0.359) (Table 5). Postintervention, the observation group displayed a significant improvement in HRQL scores (76.86 ± 6.24) compared with the control group (75.06 ± 6.59), which indicates an enhancement in the perceived HRQL (t = 2.020, P = 0.045). Regarding the WHOQOL scores, the baseline measurements were also comparable between the observation (49.13 ± 2.70) and control groups (48.86 ± 2.82) (t = 0.717, P = 0.474). After the intervention, the WHOQOL scores for the observation group (47.78 ± 3.05) exhibited a statistically significant improvement vs those for the control group (46.91 ± 3.03) (t = 2.050, P = 0.042). These findings indicate that the motivational psychological nursing intervention positively influenced the quality of life of the patients, which proves its efficacy in improving health-related and the overall quality of life measures in those with rheumatism and immunological diseases combined with nephropathy.

Table 5 Quality of life assessment between the two groups.

Parameters	Observation group (n = 102)	Control group (n = 104)	t	P value
HRQL
Before nursing	75.34 ± 5.93	74.55 ± 6.28	0.920	0.359
After nursing	76.86 ± 6.24	75.06 ± 6.59	2.020	0.045
WHOQOL
Before nursing	49.13 ± 2.70	48.86 ± 2.82	0.717	0.474
After nursing	47.78 ± 3.05	46.91 ± 3.03	2.050	0.042

HRQL: Health-related quality of life; WHOQOL: World Health Organization Quality of Life questionnaire.

Prior to the nursing intervention, the FF scores showed no significant difference between the observation (44.08 ± 12.43) and control groups (44.22 ± 12.3) (t = 0.080, P = 0.937) (Table 6). Following the intervention, both groups experienced improvements in FF scores, with the observation and control group scoring 27.95 ± 9.67 and 30.00 ± 10.21, respectively. However, this difference did not reach statistical significance (t = 1.480, P = 0.140). By contrast, the HAQ scores indicated significant improvements. Before nursing intervention, the HAQ scores between the observation (1.58 ± 0.65) and control groups showed no significant difference (1.67 ± 0.70) (t = 0.946, P = 0.345). Postintervention, the observation group displayed a notable reduction in HAQ scores (0.94 ± 0.25) compared with the control group (1.02 ± 0.30), which exhibited statistical significance (t = 2.040, P = 0.043). These results suggest that although the motivational psychological nursing intervention led to a meaningful improvement in overall physical functioning, as measured by HAQ, the changes observed in FF did not achieve statistical significance, which implies the intervention’s greater effect on general health assessment outcomes.

Table 6 Rheumatism and immunology disease assessment scale between the two groups.

Parameters	Observation group (n = 102)	Control group (n = 104)	t	P value
FF
Before nursing	44.08 ± 12.43	44.22 ± 12.3	0.080	0.937
After nursing	27.95 ± 9.67	30.00 ± 10.21	1.480	0.140
HAQ
Before nursing	1.58 ± 0.65	1.67 ± 0.70	0.946	0.345
After nursing	0.94 ± 0.25	1.02 ± 0.30	2.040	0.043

FF: Foot Function Index; HAQ: Health Assessment Questionnaire.

The effect sizes for key parameters and psychological scales were reported to address the concern regarding the clinical significance of the findings (Table 7). Scales, such as HAMA, SDS, WHOQOL, and GSES, showed moderate to large effect sizes, which suggests meaningful improvements in anxiety, depression, the quality of life, and self-efficacy following the intervention, respectively. These effect sizes provide additional insights into the clinical relevance of our intervention beyond statistical significance.

Table 7 Effect size.

Parameters	Cohen_d	Parameters	Cohen_d
Age, year	0.072	PHQ-9-before nursing	0.148
Disease duration, years	0.171	PHQ-9-after nursing	0.087
Systolic BP (mmHg)	0.052	CES-D-before nursing	0.011
Diastolic BP (mmHg)	0.124	CES-D-after nursing	0.239
Estimated GFR, mL/minute/1.73 m2	0.002	HAMD-before nursing	0.191
Urinary protein, mg/24 hours	0.066	HAMD-after nursing	0.109
SCr (μmol/L)	0.019	GSES-before nursing	0.142
Immunologic factors-Serum C3, mg/dL	0.104	GSES-after nursing	0.284
Immunologic factors-Serum C4, mg/dL	0.150	HRQL-before nursing	0.128
SAS-before nursing	0.049	HRQL-after nursing	0.281
SAS-after nursing	0.331	WHOQOL-before nursing	0.100
BAI-before nursing	0.117	WHOQOL-after nursing	0.286
BAI-after nursing	0.194	FF-before nursing	0.011
HAMA-before nursing	0.242	FF-after nursing	0.206
HAMA-after nursing	0.355	HAQ-before nursing	0.132
SDS-before nursing	0.208	HAQ-after nursing	0.284
SDS-after nursing	0.344

SDS: Self-Rating Depression Scale; PHQ-9: Patient Health Questionnaire-9; CES-D: Center for Epidemiologic Studies Depression Scale; HAMD: Hamilton Depression Scale; SAS: Self-Rating Anxiety Scale; BAI: Beck Anxiety Inventory; HAMA: Hamilton Anxiety Rating Scale; GFR: Glomerular filtration rate; BP: Blood pressure; FF: Foot Function Scale; GSES: General Self Efficacy Scale; HRQL: Health-related quality of life; WHOQOL: World Health Organization Quality of Life questionnaire; HAQ: Health Assessment Questionnaire.

DISCUSSION

In this study, we investigated the influence of motivational psychological nursing on anxiety and depression in patients with rheumatological and immunological diseases combined with nephropathy. The primary clinical outcomes, enhanced anxiety, and depression scores postintervention highlight the potential efficacy of interventions involving motivational psychological nursing. This improvement can be attributed to several underlying mechanisms[26,27]. A key component of this nursing strategy is the focus on psychological interventions that foster a positive feedback loop, which boost patients’ emotional well-being[28]. It leverages principles of cognitive-behavioral therapy, which encourages positive thinking patterns and emotional adjustment[29]. Psychological assessments and dynamic interactions with nursing staff likely create an environment where patients feel supported, which consequently reduces feelings of anxiety and depression[30].

The family support aspect of the intervention crucially contributes to these improvements[31]. By involving family members in the caregiving process, patients gain emotional support and a sense of community[31]. This outcome was consistent with that of existing literature suggesting that social support can buffer the adverse psychological effects of chronic illnesses[32]. Families were engaged through tailored support plans, which might have alleviated the psychological burdens typically borne solely by the patient[33]. This inclusion likely facilitated communication and understanding, which enhanced patients’ resilience and capacity to cope with their conditions.

Furthermore, the environmental motivation strategy cannot be underestimated. The creation of a positive ward atmosphere through health education and peer support might have contributed considerably to the observed outcomes[34]. Educational materials not only increase patients’ knowledge about their conditions but also empower them to actively participate in their care[35]. The introduction of recovered patients as role models likely provided hope and tangible evidence of potential recovery, which is crucial in fostering a healing mindset[35]. Such strategies align with the behavior change model, which posits that witnessing tangible examples of successful behavior change can motivate others to follow suit.

The observed enhancements in self-belief, as measured by the GSES, further elucidate the mechanism behind psychological improvements. An increase in self-efficacy suggests that patients feel more capable of managing their illness, which in itself can reduce anxiety and depression[36]. The intervention likely fortified the patients’ perceived control over their health, which is a crucial determinant of psychological well-being. The enhancement of self-efficacy can lead to better health outcomes given that individuals who believe in their ability to influence events that affect their lives engage more in proactive health behaviors and demonstrate an improved psychological adjustment.

Remarkably, the intervention also contributed to the improvement of HRQL and WHOQOL scores, which indicates that the benefits of the program extended beyond psychological improvements to affect overall life satisfaction and functioning. This holistic enhancement possibly resulted from the multifaceted nature of the intervention, which did not just exclusively focus on psychological support but also integrated physical health management through individualized nutrition and exercise plans[37]. Such comprehensive care probably improved the patients’ overall health perceptions not only through the management of the psychological components but also via the improvement of physical health status through better disease management.

Despite significant reductions in anxiety and depression scores, the rheumatological and immunological disease assessment scales, such as the FF and HAQ, respectively, displayed varying degrees of impact. Although the HAQ scores indicated significant improvements postintervention, changes in FF scores failed to reach statistical significance, which suggests a differential effect on physical function domains. This discrepancy may reflect the intervention’s stronger focus on psychological rather than physical rehabilitation efforts[38]. Future iterations of this program may benefit from a stronger emphasis on physical therapy elements to ensure the consistency of improvements across all functional domains.

Notably, this study also highlighted the potential of motivational psychological nursing to improve life quality measures, such as HRQL and WHOQOL. The inverse relationship observed between these variables and anxiety/depression scores underscores the intertwined nature of psychological health and life quality outcomes. Improved quality of life can be a vital determinant in the reduction of psychological distress because patients with high quality of life perceptions are often adequately positioned to engage with and respond positively to psychological interventions.

Our findings suggest that motivational psychological nursing can be effectively integrated into the routine care for patients with rheumatological and immunological diseases complicated by nephropathy. Specifically, structured motivational interviewing sessions and cognitive-behavioral therapy modules can enhance patient outcomes. Regular psychological assessments and the involvement of multidisciplinary teams can further support patients, which potentially leads to improved mental health and quality of life. These protocols provide practical guidance for healthcare providers aiming to improve psychological well-being in this vulnerable population.

Although motivational psychological nursing shows promise in the reduction of anxiety and depression, the present study encountered limitations. The use of retrospective design, despite matching baseline characteristics well, inherently limited causal claims. The lack of control for confounding variables, such as concurrent therapies and socioeconomic factors, might have influenced the results. The psychological measures rely heavily on self-reported scales, which possibly introduced response bias. Moreover, this research was conducted at a single institution, which may not fully represent the broader population. While employing objective measures of psychological and physical health, future research should incorporate longitudinal, randomized controlled trials using randomization and blinding to validate and extend these findings.

CONCLUSION

This study elucidated the potential of motivational psychological nursing as a viable intervention to alleviate anxiety and depression in patients with complex chronic health conditions, such as rheumatism and immunologic diseases complicated by nephropathy. By addressing psychological, social, and educational needs, the intervention fosters a multifaceted approach to patient care. Clinicians should implement structured motivational interviewing sessions and cognitive-behavioral therapy modules to enhance mental health outcomes in these patients. In addition, future strategies should aim to bolster physical rehabilitation alongside psychological support to maximize overall health outcomes and offer important benefits to patients’ psychological and physical well-being.