Psychological care and compliance management in patients with chronic respiratory diseases: A study based on psychological intervention strategies

Abstract

BACKGROUND

Chronic respiratory diseases (CRDs), such as chronic obstructive pulmonary disease and asthma, impose significant physical and psychological burdens on patients. Effective management requires medical treatment and psychological support to improve treatment compliance and overall well-being.

AIM

To improve the psychological care and compliance management of patients with CRDs.

METHODS

Pre- and post-intervention assessments were conducted with 128 patients diagnosed with CRDs. The patients were divided into two groups. The experimental group (EG) received innovative nursing interventions based on psychological techniques such as cognitive behavioral therapy, counseling, relaxation, and mindfulness-based exercises. The control group (CG) received traditional nursing care. Interventions were delivered through hospital visits, home care, and telemedicine over a two- or three-week period. Pre- and post-intervention assessment data were used to determine which method better supported the patients in managing their condition and enhanced their overall quality of life (QoL). Descriptive statistics, independent t-tests, analyses of variance and covariance, effect size calculations, and χ² tests were performed using SPSS v23.

RESULTS

Compared with the CG, the EG demonstrated significantly higher psychological well-being scores (13.4 ± 5. 2 vs 2.6 ± 4. 5, P < 0.001). A larger proportion of patients in the EG reported notable improvements in QoL (85% vs 45%, P < 0.001). Moreover, the EG showed significantly greater reductions than the CG in the Hamilton Anxiety Scale and Hamilton Depression Scale scores (both P < 0.01), along with substantially larger improvements across all dimensions of the 36-Item Short-Form Health Survey.

CONCLUSION

Integrating psychological intervention techniques with innovative nursing strategies led to a statistically significant improvement in psychological well-being and QoL (Cohen’s d = 1.22) compared with standard nursing care.

Key Words: Chronic respiratory diseases; Psychological intervention strategies; Psychological care; Nursing care; Cognitive behavioral therapy; Compliance management; Quality of life

Core Tip: This study demonstrates that integrating psychological intervention strategies, including cognitive behavioral therapy, counseling, relaxation, and mindfulness, into nursing care significantly improves psychological well-being, treatment compliance, and quality of life in patients with chronic respiratory diseases. The findings highlight the importance of combining psychological support with conventional medical treatment to achieve holistic and effective disease management.

INTRODUCTION

Chronic respiratory diseases (CRDs) are among the most prevalent noncommunicable illnesses worldwide, largely due to widespread exposure to hazardous environments, occupational risks, and harmful behaviors. These diseases include asthma, pulmonary sarcoidosis, interstitial lung disease, pneumoconiosis (e.g., asbestosis and silicosis), and chronic obstructive pulmonary disease (COPD)[1]. The main recognized risk factors for CRDs include occupational exposure, poor diet, obesity, physical inactivity, allergies, smoking, and exposure to indoor and outdoor pollutants. The global prevalence of CRDs continues to increase, driven by an aging population that is increasingly exposed to these risks[2].

Significant differences exist in the epidemiology and burden of CRDs worldwide. Studies have primarily reported prevalence at the regional or national levels, with limited global assessments. Understanding the global prevalence and incidence trends is crucial for improving CRD control and prevention[3]. During epidemics, promoting physical activity through sustained interventions is essential as it benefits patients and healthcare providers. Physical activity improves overall health, reduces the risk of complications, and enhances mental health[4]. Evidence indicates that home-based pulmonary rehabilitation can be as effective as traditional face-to-face sessions in randomized controlled trials. This approach provides flexibility, reduces exposure risk, alleviates the burden on healthcare providers, and can be tailored to individual needs, thereby offering a sustainable long-term solution[5]. Psychological interventions are also critical for patients with CRDs as they address the emotional and behavioral challenges frequently associated with these conditions. For example, cognitive behavioral therapy (CBT) helps patients recognize and replace negative thought patterns, thereby reducing anxiety and depression[6]. Additional coping strategies, such as relaxation techniques, stress management, and problem solving, equip patients to navigate the daily challenges of living with a chronic illness[7]. Improved mental health enhances adherence to treatment regimens, including medication compliance, pulmonary rehabilitation exercises, and lifestyle modifications. Patients who feel empowered and supported are more likely to actively engage in their care, reducing exacerbations and hospitalization rates[8]. Psychological support can also strengthen social functioning by helping patients maintain relationships and participate in community activities, thereby reducing isolation. This integrated approach acknowledges that managing chronic illnesses extends beyond treating physical symptoms and involves fostering overall health, emotional resilience, and improved quality of life (QoL)[9]. By combining mental health interventions with other therapeutic approaches, healthcare providers can deliver personalized care that addresses the full scope of a patient’s needs and increases the likelihood of recovery[10]. This study explored innovative nursing strategies that incorporate psychological intervention techniques to enhance the psychological care and compliance management of patients with CRDs.

According to an Italian study[11], prolonged exposure to air pollution increases the risk of developing chronic respiratory disorders. Data from two population-based studies conducted from 2007 to 2014 were analyzed as part of the Big Data for the Assessment of Health Effects of Air Pollution in the Italian Population project to identify cases of rhinitis, asthma, and chronic bronchitis or COPD. The results revealed a relationship between long-term exposure to air pollution and respiratory health problems. The genesis of antibiotic-resistant illnesses involves the resistome[12], which focuses on antibiotic resistance genes. The respiratory microbiome and dynamic interplay between bacteria and viruses can influence the response to antibiotics. Persistent respiratory disorders highlight the importance of developing tailored treatment plans and implementing responsible antibiotic stewardship. Understanding the respiratory resistome can help combat drug-resistant bacteria and improve therapeutic outcomes. Widely used drugs with antioxidant, anti-inflammatory, and mucolytic properties, such as N-acetylcysteine, have demonstrated efficacy in treating pulmonary silicosis, bronchial asthma, cystic fibrosis, idiopathic pulmonary fibrosis, and other chronic inflammatory and fibrosing respiratory illnesses[13]. N-acetylcysteine is affordable, readily available, and has minimal toxicity and side effects.

According to the Global Burden of Disease Study 2019, smoking is the world’s leading risk factor for mortality related to CRDs[14]. Particulate matter pollution remains the primary risk factor in low- and lower-middle sociodemographic index regions, whereas smoking is the dominant risk factor in middle and middle-to-high sociodemographic index regions. Variations in gender have been observed, with men showing slightly higher prevalence and age-standardized incidence rates than women. These findings suggest that reducing smoke pollution and improving air quality are the most effective strategies for reducing CRD mortality. The prevalence of CRDs is increasing worldwide, particularly among older adults[15]. These patients frequently present with other comorbidities, which complicate treatment. Research has examined the risk factors, interactions, reasons for investigating respiratory function in neurodegenerative illnesses, and drug-pathology interactions in relation to CRDs.

When compared with center-based pulmonary rehabilitation, home-based telerehabilitation did not show significant differences in patients with chronic lung disease[16]. By the end of treatment, both groups demonstrated improved exercise ability and reduced dyspnea. Moreover, telerehabilitation was not equivalent to center-based pulmonary rehabilitation in the primary outcome measure - the Change in CRQ Dyspnea score - at the end of therapy. However, by the time therapy concluded, telerehabilitation demonstrated comparable results in the six-minute walk test, with the potential to improve further after one year of therapy. These findings suggest that telerehabilitation may serve as a viable backup model when center-based pulmonary rehabilitation is not possible. The age-standardized death rate due to CRDs has decreased by an average of 2.41% annually. Analyses have revealed inverse relationships between mortality rates from asthma, pneumoconiosis, COPD, and sociodemographic indicators[17]. A cross-sectional study of 519 adult patients in Ethiopia, Kenya, and Sudan found that the most common diagnoses among individuals with persistent respiratory symptoms were post-tuberculosis lung disease, asthma, chronic bronchitis, and COPD[18]. Spirometry revealed a high rate of misdiagnosis of COPD and asthma, with 38% of the patients showing clear airflow limitations. These findings highlight the importance of spirometry in improving the diagnostic accuracy of these disorders. Efforts to track CRDs have increasingly explored the use of wearable technologies in pulmonary rehabilitation programs[19]. Databases such as EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials have been consulted. After the first review, unbiased reviewers choose publications, compile information, and assess methodological quality using the Physiotherapy Evidence Database tool.

Fatalities due to CRDs in Brazil, Russia, India, China, and South Africa accounted for 61.58% of global CRD deaths in 2022[20]. In 2019, 2.39 million people in these countries died from CRDs, representing 60.07% of the CRD fatalities that occur worldwide. Asthma and COPD were the primary causes. China has observed a notable decline in CRD mortality and suggested potential strategies for reducing the disease burden in emerging nations. Machine learning has also been used to detect and classify chronic respiratory and cardiovascular disorders[21]. Using tree-based pipeline optimization techniques and real-world vital sign data, machine learning models have improved classification accuracy compared with existing approaches. When coupled with the Facebook Prophet prediction algorithm, this approach can reliably identify abnormal vital signs, allowing for timely intervention and life-saving treatment. The Global Burden of Disease Study 2016 reported that pneumoconiosis, COPD, and asthma were the most prevalent occupational respiratory diseases, contributing to 519000 deaths in 2016[22]. The highest rates were observed in men and older adults. In Oceania, Asia, and sub-Saharan Africa, the total burden was 13.6 million. These findings highlight the significant role of occupational exposure in the global burden of CRDs.

Despite the established benefits of psychological interventions in CRD management, current nursing practices often overlook the integration of structured psychological support with routine care. Traditional approaches largely focus on physical symptom management, with limited emphasis on mental health and treatment compliance. This study aimed to address this gap by evaluating the effectiveness of innovative nursing strategies that incorporate evidence-based psychological interventions such as CBT and mindfulness to enhance psychological well-being and treatment adherence in patients with CRDs.

MATERIALS AND METHODS

The study gathered pre- and post-intervention data from 128 patients with CRDs, who were divided into two groups: The experimental group (EG) and control group (CG). The EG received psychological interventions such as counseling, CBT, relaxation techniques, and mindfulness exercises via home visits, hospital visits, and telemedicine. The CG received traditional nursing care only. Several statistical analyses including descriptive statistics, independent t-tests, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were conducted using SPSS v23 to examine how different variables influenced patients’ QoL. The overall research flow is illustrated in Figure 1.

Figure 1 Overall flow. CRDs: Chronic respiratory diseases; QoL: Quality of life.

Data collection

Data were collected through the pre- and post-intervention evaluations of 128 patients with CRDs. To ensure equitable representation, the patients were randomly assigned to the CG or EG. Psychological well-being was assessed using the Hospital Anxiety and Depression Scale, which consists of 14 items that measure anxiety and depressive symptoms. Furthermore, QoL was evaluated using the 36-Item Short-Form (SF-36) Health Survey, which covers physical and mental health domains. Both instruments have demonstrated high reliability and validity in populations with chronic diseases. The EG received innovative nursing interventions that included psychological approaches such as CBT, counseling, relaxation, and mindfulness techniques. These interventions were delivered through hospital visits, home care, and telemedicine sessions over a two- to three-week period. The CG received only traditional nursing care without any psychological components. To evaluate the effectiveness of the interventions in helping patients manage their illness and improve their overall QoL, both groups underwent assessments before and after the intervention.

The EG consisted of 64 patients diagnosed with CRDs who received innovative nursing interventions. These interventions were based on psychological techniques designed to enhance psychological health and support disease management, as illustrated in Figure 2. First, the patients received 2.5 weekly sessions of CBT, each lasting 60 minutes, focused on identifying and restructuring negative thoughts related to their condition. Second, individual counseling sessions were conducted biweekly and supplemented with progressive muscle relaxation techniques. Third, the patients engaged in daily 20-minute mindfulness sessions, including guided meditation and breathing exercises delivered via a mobile application. Telemedicine data, home care, and hospital visits were used to deliver these interventions, offering flexibility and accessibility. The sessions lasted for two to three weeks, enabling patients to practice these strategies in multiple settings. This approach was designed to evaluate whether innovative psychological methods could improve QoL and disease self-management.

Figure 2 Innovative nursing interventions based on psychological techniques and traditional nursing care. CBT: Cognitive behavioral therapy.

The CG comprised 64 patients with CRDs who received only traditional nursing care without any psychological intervention. Standard nursing care included routine medical management (e.g., administering prescribed medications), general health monitoring (e.g., checking vital signs and symptom assessment), and the provision of basic educational materials on CRD management. No structured psychological components were included (Figure 2).

This study used the Hamilton Anxiety Rating Scale (HAMA) to assess patients’ anxiety levels and the Hamilton Depression Scale (HAMD) to assess patients’ depression levels. The Medical Outcomes Study’s SF-36 survey was used to evaluate QoL. Uniformly trained healthcare professionals conducted the evaluations through semi-structured interviews with the patients. In this study, the HAMA, HAMD, and SF-36 assessments were administered to both patient groups before and after the intervention to compare improvements.

Statistical analysis

SPSS v23 was used to conduct statistical analyses to investigate treatment efficacy. The fundamental characteristics of the data (mean ± SD) were summarized using descriptive statistics. Independent t-tests were used to compare the pre- and post-intervention QoL scores between the experimental and CGs. The ANCOVA was used to adjust for baseline differences and assess how the interventions affected outcomes. The effect size calculation measured the magnitude of the intervention’s impact. Furthermore, the ANOVA assessed the differences in QoL changes between the groups. χ² tests were used to examine the proportion of patients with significant improvement in each group, indicating the efficacy of psychological interventions in improving CRD management compared with traditional care. P < 0.05 was considered statistically significant.

RESULTS

Table 1 summarizes the demographic and clinical characteristics of the participants in the CG (n = 64) and EG (n = 64). The mean values were similar between the groups, and the sex distributions were nearly identical. Most participants had COPD (60.9%), whereas the others had asthma (39.1%). The mean disease duration was 8.5 ± 5.2 years in both groups. Regarding smoking history, 29.7% were current smokers, 35.9% were former smokers, and 34.4% had never smoked. The average intervention period was similar in both groups (P > 0.05).

Table 1 Statistical details of the participants in the experimental group and control group, n (%)/mean ± SD.

Characteristic		CG (n = 64)	EG (n = 64)	Total (n = 128)
Age		63.1 ± 7.9	62.5 ± 8.2	62.8 ± 8.1
Sex	Male	30 (46.9)	32 (50.0)	62 (48.4)
	Female	34 (53.1)	32 (50.0)	66 (51.6)
Disease type	COPD	40 (62.5)	38 (59.4)	78 (60.9)
	Asthma	24 (37.5)	26 (40.6)	50 (39.1)
Disease duration (years)		8.7 ± 5.3	8.4 ± 5.1	8.5 ± 5.2
Smoking status	Current smoker	18 (28.1)	20 (31.3)	38 (29.7)
	Former smoker	22 (34.4)	24 (37.5)	46 (35.9)
	Never smoked	24 (37.5)	20 (31.3)	44 (34.4)
Intervention duration (weeks)		2.0 ± 0.4	2.5 ± 0.5	2.3 ± 0.5

COPD: Chronic obstructive pulmonary disease; CG: Control group; EG: Experimental group.

QoL

The QoL outcomes of both groups are summarized in Table 2. Prior to the intervention, no significant difference in QoL was observed between the groups (P > 0.05). Subsequently, the EG exhibited a substantial enhancement in QoL scores (t = 8.95, P < 0.01), whereas the CG displayed a marginal increase (t = 0.67, P > 0.05). A statistically significant difference in the mean change in QoL between the groups confirmed the efficacy of the intervention (t = 9.75, P < 0.01). Furthermore, the ANCOVA adjusted for baseline scores corroborated these findings, revealing a significantly greater improvement in the EG than in the CG (F = 15.67, P < 0.001), as detailed in Table 3.

Table 2 Pre-intervention and post-intervention quality of life scores for the experimental group and control group, mean ± SD.

Groups	QoL pre-intervention	QoL post-intervention	Change in QoL
EG (n = 64)	45.3 ± 7.8	58.7 ± 6.5	13.4 ± 5.2
CG (n = 64)	44.6 ± 8.1	47.2 ± 7.4	2.6 ± 4.5

QoL: Quality of life; CG: Control group; EG: Experimental group.

Table 3 Adjusted pre- and post-intervention quality of life scores with analysis of covariance results.

Groups	Adjusted mean QoL post-intervention	Mean QoL pre-intervention	F value	P value
EG (n = 64)	58.3	45.3	15.67	< 0.001
CG (n = 64)	47.1	44.6	4.12	0.045

QoL: Quality of life; CG: Control group; EG: Experimental group.

Table 3 compares the QoL scores of the two groups before and after the intervention. The adjusted mean QoL after the intervention in the EG was 58.3, which was a significant increase from the pre-intervention mean of 45.3. This change was supported by an F value of 15.67 (P < 0.001), indicating a statistically significant improvement. The CG had an adjusted post-intervention QoL mean of 47.1, which increased slightly from 44.6. The CG had an F value of 4.12 (P = 0.045), demonstrating a smaller but statistically significant effect. Overall, these findings highlight the greater effectiveness of the psychological intervention in enhancing QoL.

The F values and P values in Table 4 show the variations in the EG and CG in terms of pretreatment QoL levels. The F value depicted an estimate of the variance in the post-intervention QoL that can be attributed to the interventions. The results confirmed that the intervention had a stronger effect in the EG than in the CG.

Table 4 Analysis of variance summary for quality of life scores.

Source	df	F value	MS	P value	SS
Between groups	1	29.80	2894.67	< 0.001	2894.67
Within groups	127	-	97.44	-	12342.56
Total	128	-	-	-	15237.23

SS: Sum of squares; MS: Mean square.

HAMA, HAMD, and SF-36 Health Survey

As shown in Table 5, before the intervention, there were no significant differences in the HAMA or HAMD scores between the EG and CG (P > 0.05), indicating comparable baselines. After the intervention, both groups showed significant increases in HAMA and HAMD scores compared with their respective pre-intervention values (P < 0.01), and the EG had significantly higher post-intervention HAMA and HAMD scores than the CG (P < 0.01). Table 6 shows the SF-36 scores of the EG and CG before and after the intervention. At baseline, all subscale scores were comparable between groups (P > 0.05). Following the intervention, every SF-36 domain in both groups improved significantly (all P < 0.01), with the EG exhibiting substantially larger gains.

Table 5 Hamilton Anxiety Scale and Hamilton Depression Scale scores in the experimental group and control group, mean ± SD.

Group	HAMA score			HAMD score
	Pre-intervention	Post-intervention	t	Pre-intervention	Post-intervention	t
EG (n = 64)	47.25 ± 6.14	30.12 ± 4.13a,b	19.526	38.15 ± 5.35	28.15 ± 3.42a,b	16.834
CG (n = 64)	47.18 ± 6.09	35.27 ± 5.18b	13.826	38.32 ± 5.17	32.16 ± 4.04b	9.426
t	0.423	7.814		0.567	7.259

^aP < 0.01, vs control group.

^bP < 0.01, vs pre-intervention.

HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale; EG: Experimental group; CG: Control group.

Table 6 36-Item Short-Form Health Survey scores in the experimental group and control group, mean ± SD.

Item	EG (n = 64)			CG (n = 64)
	Pre-intervention	Post-intervention	t	Pre-intervention	Post-intervention	t
Mental health	61.27 ± 5.19	82.79 ± 4.59	16.953	61.16 ± 4.27	75.44 ± 5.13	11.025
Emotional role	62.23 ± 6.16	85.13 ± 4.27	17.278	62.24 ± 6.97	76.38 ± 5.06	11.264
Body pain	59.19 ± 7.42	84.56 ± 4.28	23.825	59.15 ± 6.38	73.37 ± 6.25	15.972
Physical functioning	60.35 ± 6.22	83.53 ± 4.35	12.753	60.33 ± 6.16	72.05 ± 5.16	6.825

G: Experimental group; CG: Control group.

Effect size calculation

The magnitude of the intervention’s impact was assessed using Cohen’s d to estimate the effect size. This analysis yielded a Cohen’s d value of 1.22 for the change in QoL between the EG and CG. According to conventional interpretations, this represents a large effect, suggesting that the intervention produced a clinically meaningful improvement in the patients’ QoL. Using standard benchmarks, effect sizes of 0.2, 0.5, and 0.8 are considered small, medium, and large, respectively. Thus, the observed effect size of 1.22 reflects a substantial and practically significant benefit of the psychological nursing intervention.

As mentioned previously, the effect size, which was measured using Cohen’s d, reflected the difference in QoL scores between the EG and CG. Cohen’s d indicated the magnitude of improvement in QoL resulting from the intervention, with higher values representing more substantial effects. Beyond statistical significance, the effect size provides insight into the practical relevance of the intervention, highlighting the real-world importance of the observed improvements in patients’ QoL.

In the EG, 85% (54 out of 64) of the patients showed significant improvement, whereas in the CG, the proportion was 45% (29 out of 64). This difference was statistically significant (χ² = 15.82, P < 0.001), suggesting a strong association between the psychological nursing intervention and improved QoL outcomes.

DISCUSSION

This study examined the QoL and psychological well-being of patients with CRDs and introduced new nursing intervention methods that incorporated psychological strategies[6]. The findings emphasize the effectiveness of equipping patient healthcare with various forms of CBT, counseling, relaxation, and mindfulness, underscoring the value of integrated care approaches for chronic respiratory conditions[7,23]. For instance, a 2025 randomized controlled trial demonstrated that CBT delivered by respiratory nurses significantly reduced anxiety and depression in patients with COPD and improved treatment adherence and QoL[24]. In a study of patients with COPD, CBT significantly reduced anxiety and depressive symptoms, and this effect was amplified when CBT was combined with exercise training and education[25]. Positive effects have also been reported in asthma; CBT improved QoL and asthma control, but its impact on depressive symptoms was modest[26]. By modifying illness-related cognitions and behavioral responses, CBT helps patients manage psychological stress and disease symptoms more effectively, thereby enhancing overall health[27]. Beyond CBT, other psychological interventions, such as supportive counseling and mindfulness-based programs, have benefited the mental health of people with COPD. These approaches strengthen emotional regulation and self-management, enabling patients to cope better with the psychological burden of CRDs[28,29]. Multicomponent strategies that integrate psychological support with exercise training have produced consistent improvements in anxiety and depression, underscoring the value of multidisciplinary, individualized care[30,31].

After the intervention, the EG had significantly higher psychological well-being scores than the CG, indicating substantial positive effects of the therapies on the patients’ emotional and psychological states. This finding is crucial for improving the well-being of patients with CRDs, who often experience severe psychological distress besides physical symptoms, and underscores the need for interventions that address psychosocial barriers to effective self-management[9,32]. The QoL scores also improved substantially from pre- to post-intervention in the EG than in the CG. The mean change in QoL scores was greater in the EG, demonstrating that psychological interventions addressed immediate emotional needs and contributed to long-term improvements in QoL. The larger number of patients in the EG who experienced meaningful progress supports the usefulness of these interventions. The results were confirmed through multiple statistical analyses, including t-tests and ANCOVA, which demonstrated significant differences between the EG and CG. Even after adjusting for baseline QoL status, the ANCOVA showed significantly higher post-intervention QoL scores in the EG. This indicates that the improvements were attributable to the interventions rather than to preexisting differences between the groups.

Furthermore, a large effect size, as calculated using Cohen’s d, highlights the clinical relevance of the interventions. A higher effect size demonstrates that the observed improvements were not only statistically significant but also meaningful in practice. Similarly, the ANOVA results confirmed significant group differences, reinforcing the strong impact of the interventions. The χ² test, which examined the proportion of patients with marked improvements, provided additional evidence of the effectiveness of the interventions, as a notably higher percentage of patients in the EG reported improvement. Particularly, marked reductions in the HAMA and HAMD scores and across-the-board improvements in all SF-36 domains confirm the comprehensive benefits of psychological intervention in alleviating patients’ anxiety and depression and enhancing their physical functioning and mental well-being. Overall, the substantial number of EG patients who benefited from the interventions highlights the importance of integrating psychological strategies into nursing care. These results demonstrate that psychological interventions can significantly improve outcomes in patients with CRDs.

This study had several limitations. First, the relatively small sample size (n = 128) might have limited the generalizability of our findings. Second, the short intervention duration (two to three weeks) precluded conclusions regarding the long-term sustainability of the observed improvements. Third, the reliance on self-reported measures for psychological well-being and QoL might have introduced a response bias. Future studies should include larger multicenter cohorts, longer follow-up periods, and more objective biomarkers to validate these findings.

CONCLUSION

This study concluded that innovative nursing strategies supported by psychological interventions have a notable impact on the psychological well-being and QoL of patients with CRDs. Patients in the EG who underwent CBT, counseling, and mindfulness exercises experienced significant improvements than those in the CG. Therefore, combining psychological support with traditional medical care is extremely effective as it addresses the patients’ emotional and psychological needs, overall health, and daily functioning. This study highlights the value of holistic care models in managing chronic diseases and suggests that incorporating psychological interventions can substantially reduce depression and improve QoL in patients with CRDs.