Original Article

Effectiveness of psychological intervention package on

anxiety and wellness level among patients with anxiety
disorders
Binu Mathew
Department of Psychiatric Nursing, College of Nursing, All India Institute of Medical Sciences Raipur, GE Road, Tatibandh,
Raipur, Chhattisgarh, India

A bstract
Background of the Study: Anxiety disorders are among the most common mental disorders in all age groups and they are associated
with short‑term and long‑term impairment in social, academic, familial, and psychological functioning. The purpose of this study was
to evaluate the impact of psychological interventions to decrease anxiety thereby improving the wellness level of patients with anxiety
disorder. Methods: A quasi‑experimental research design (a nonequivalent control group design) for evaluating the effectiveness of
the psychological intervention on anxiety and wellness level among neurotic patients (n = 100). Psychological interventions consisted
of psychoeducation and simple relaxation exercises was administered. Results: The study findings revealed that in pre‑test, there
is no significant difference between experimental and control groups, but in post‑test significant difference is observed between
experimental group and control group as depicted by the t values at first post‑test was t = 2.04 at P = 0.04, df = 98, at third month
post‑test t = 6.32 at P = 0.001, df = 98 and at sixth month post‑test t = 11.03 at P = 0.001, df = 98. The experimental group patients
are having 20.3% anxiety reduction and 23.0% improved wellness score, whereas in control group anxiety reduction is only 1.4% and
only 2.4% improved wellness score which shows the effectiveness of psychological intervention. Interpretation and Conclusion: The
results demonstrated the importance of improving patient’s awareness of anxiety and how to manage and access help. Nurses can
play a vital role in screening and managing anxiety, and educating people in strategies to prevent episodes of panic. This nurse‑led
intervention, increased perceived self‑efficacy in patients with anxiety disorders, compared with control patients.

Keywords: Anxiety, anxiety disorder patients, nursing interventional package, wellness level

Introduction issue (Baxter 2014).[2] Anxiety disorders, including generalized

anxiety disorder, panic disorder, social phobia, and obsessive‐
For all individuals, mental, physical, and social health is vital compulsive disorder, are the most common mental health issues,
strands of life that are closely interwoven and interdependent. As with lifetime prevalence reported to be as high as 30% (Kessler
understanding of this relationship grows, it becomes even more 2005). The present treatment focuses on unnecessary
apparent that mental health is crucial to the overall well‑being of investigations and costly medications that are not only inadequate
individuals, societies, and countries.[1] Mental illness is a leading and ineffective, but also produce widespread frustration in both
cause of disability worldwide and an important public health seekers and providers of healthcare services Government of
India (GOI). There are lacunae in psychiatric epidemiology
Address for correspondence: Dr. Binu Mathew,
College of Nursing, All India Institute of Medical Sciences Raipur,
due to intricacy related to defining a case, diagnosis, sampling
GE Road, Tatibandh, Raipur, Chhattisgarh ‑ 492 099, India. methodology, underreporting, and stigma, lack of adequate
E‑mail: [email protected] findings and trained labor, and low priority of mental health in
Received: 24‑03‑2021 Revised: 10-09-2021 health policy.
Accepted: 30‑09‑2021 Published: 16-12-2022
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DOI: How to cite this article: Mathew B. Effectiveness of psychological

10.4103/jfmpc.jfmpc_561_21 intervention package on anxiety and wellness level among patients with
anxiety disorders. J Family Med Prim Care 2022;11:6704-13.

© 2022 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer ‑ Medknow 6704
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

Figure 1: Multiple Bar Diagram Showing Pre‑test Level of Anxiety Figure 2: Multiple Bar Diagram Showing Pre‑test Level of Wellness
Score of Neurotic Patients Score of Neurotic Patients

Figure 4: Scatter Plot With Regression Estimate Shows the Fair,

Figure 3: Scatter Plot With Regression Estimate Shows the Substantial,
Negative Correlation Between Post‑test Anxiety Score And Wellness
Negative Correlation Between Post‑test Anxiety Score and Wellness
Score (R = −0.30) Among Control Group Patients
Score (R = −0.66) Among Experiment Group Patients

Figure 6: Box Plot Compares Pre‑test and Post‑test Mean Wellness

Figure 5: Box Plot Compares Pre‑test and Post‑test Mean Anxiety Score Between Experimental and Control Group Patients
Score Between Experimental and Control Group Patients
their thinking, decision‑making ability, perceptions of the
Anxiety disorder is an umbrella term that covers several different environment, learning, and concentration get affected.[3]
forms of a type of common psychiatric disorder. The disorders
once classified as neuroses are now considered anxiety/neurotic Prevalence of CMDs in primary care settings has varied from
disorders and Common Mental Disorders (CMDs). CMDs are about 11–34.6% in different Indian studies (Nambi et al.).
a functional clinical classification of the group of disorders A recent study from India reported a prevalence of 42%
that describe the deeper psychological distress states of an inpatients attending a clinic in a tertiary care hospital (Avasthi
individual. They include anxiety disorders, somatoform disorders, et al. 2008). Prevalence of generalized anxiety disorder in primary
dissociative disorders, phobia, and depression. For people with care settings is reported to be in the range of 5–16% (Wittchen
anxiety disorders, worry and fear are constant, overwhelming, and 2002) and that of panic disorder is 1.5–1.3% (Craske et al. 2002).
crippling. The condition turns their life into a continuous journey According to the National Mental Health Survey undertaken by
of unease and fear and can interfere with their relationships NIMHANS across 12 selected states of India during 2015–2016,
with family, friends, and colleagues. But all too often they are reported that CMDs, including depression, anxiety disorders,
mistaken for mental weakness or instability and resulting social and substance use disorders are a huge burden affecting nearly
stigma can discourage people with anxiety/neurotic disorders 10.0% of the population. Neurosis and stress‑related disorders
from seeking help. Patients with these disorders experience high affected 3.5% of the population and were reported to be higher
levels of distress and impaired social functioning. If untreated, among women (nearly twice as much as men). Neurosis and

Journal of Family Medicine and Primary Care 6705 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

stress‑related disorders are commonly encountered in primary care Along with psychosocial approaches studies support that exercise,
settings where they are usually missed or misdiagnosed. Among sleep, hygiene and self-care activities are effective means of
the major mental disorders that manifest predominantly during treatment of such patient[8] psychoeducational intervention is
adulthood, the crude prevalence for both depressive disorders and based on cognitive behavioral principles and have better effect
anxiety disorders was 3.3% (3.1–3.6 for depressive disorders and on worry symptoms and reduction of anxiety therefore due
3.0–3.5 for anxiety disorders).[1] Psychosocial care is increasingly to multipronged nature, psychoeducation can be suited to any
recognized as an essential component of the comprehensive care mental health setting.[9]
of neurotic disorders. Improving patients’ access to psychosocial
care is important. Among the mental disorders that manifest Materials and Methods
predominantly during adulthood, the highest disease burden in
India was caused by depressive and anxiety disorders, followed by This study adopted a single‑blind quasi‑experimental study
schizophrenia and bipolar disorder (Kyu 2018) To give high‑quality comprising of a group of 100 neurotic patients (50 experimental
care, it is essential that mental health nurses have a solid grasp group and 50 control group) selected through purposive sampling
of the most common therapies and interventions used in mental from outpatient clinics in three mental hospitals in Chhattisgarh. The
healthcare. If nurses understand, what the various interventions samples were fulfilling the criteria of age 20 years or more with no
involve then they will be much better equipped to support major visual or motor handicap or other chronic diseases, diagnosed
patients through their recovery.[4] A range of psychological and with neurotic/anxiety disorders by psychiatrists of selected mental
psychosocial treatments for depression and anxiety (including hospitals of Chhattisgarh, willing to cooperate, and provide consent
depression with a chronic physical health problem) have been for the study. The study was approved by the Institutional Ethics
shown to relieve the symptoms of depression and there is growing Committee of Jawaharlal Nehru Hospital and Research Centre, Bhilai
evidence that psychological and psychosocial therapies can help Manopchar Hospital Mana Raipur, and CIIMHANS Anjora Durg.
people recover from depression in the longer‑term relaxation Both groups matched on various socio‑demographic correlates. To
training is effective in reducing anxiety in all participants for judge the similarity of two groups, a pre‑test or pre‑measurement was
anxiety disorders and increase the quality of life.[5,6] People with made in the “before” time period. Consecutive eligible patients who
depression often prefer psychological and psychosocial treatments scored more than 17 on Sinha’s Comprehensive Anxiety Test (SCAT)
to medication (Prins et al., 2008) and value outcomes beyond were randomly assigned to experimental group who was administered
symptom reduction that include positive mental health and a psychological intervention and to control group with standard care.
return to usual functioning (Zimmerman et al, 2006) management
options for anxiety disorders include psychoeducation, Data were collected using socio‑demographic datasheet, Freeman
psychological treatment and pharmacological treatments.[7] This et al. Wellness Assessment Tool, SCAT and Rathus Assertiveness
improves health outcomes by optimizing self‑care skills, engaging Schedule, physiological parameters such as self checking of pulse
family and community supports, and promoting early recognition and respiration before and after intervention and at 3 months
of problems and appropriate interventions. and 6 months post‑intervention. Socio‑demographic datasheet
included age and gender, education, family income, residence and
Within the limitations placed on modern mental healthcare, it is marital status, main feature of illness, adherence to treatment,
a challenge for the nurses to take the responsibility of providing frequency of admission to hospital, participation in social activity,
evidence‑based holistic nursing interventions for anxiety disorder occupational status and frequency of change of employment,
patients. Moreover, such studies are woefully inadequate in the functional level of patient, year of onset of illness and type of
Indian context. Although neurotic/anxiety disorders are the family. Data were collected using face‑to‑face interview method.
commonest mental disorders, they receive scant attention. It is
useful to devote attention to the management of these mental Psychological interventions was administered to experimental
disorders because they are the commonest mental disorders in group with routine care and control group is given only the
the general population. Considering the above‑stated factors, routine care. Routine care included administration of anti‑anxiety
the investigator felt the need to address psychosocial aspects of medicines and general advice by doctors and other health team
anxiety disorders and the present investigation makes an earnest members. Psychological intervention was planned in two sessions
effort to plan psychological interventions to decrease anxiety for 2 days in the experimental group. First session was held on
thereby improving the wellness level of neurotic patients. The Day 1 and second session on Day 2, that is, one session each on
present study also helps to make society and government aware both days. First session on Day 1 comprised of administration
of the mental health needs of the population and take necessary of pre‑test followed by group discussion on anxiety and its
steps for the development of the same. effects on the respondents, psycho‑education on anxiety and
its management. The session lasted for one and half hours. In
The objectives of the study were to assess the socio‑demographic the second session, review of the previous sessions, followed
profile of the neurotic patients, pre‑interventional level of by simple relaxation therapy and checking of physiological
anxiety and wellness of the neurotic patients, and to evaluate parameters, that is, pulse and respiration were done. This was
the effectiveness of psychological interventions on the anxiety followed by feedback and post‑test on second day after second
and wellness level among anxiety disorder patients. session. This session lasted for one and half hours. So, total of

Journal of Family Medicine and Primary Care 6706 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

2 hours per group. Each group constituted of 10 respondents. pre interventional level of wellness score was low to moderate
In the control group, only one session was utilized. This session in experimental and control group as depicted in [Figure 2].
included the administration of pre‑test followed by feedback and
post‑test. The time taken for the session was one and half hours. Section 3: Association between anxiety and selected
Post‑test was done again at 3 and 6 months for both groups. socio‑demographic variables

The collected data were analyzed using statistical package of social Association between anxiety and selected socio‑demographic
sciences (SPSS) 12. First, the socio‑demographic characteristics variables
were presented as frequency, percentage, average, and SD. Second,
the general characteristics of the experimental and control groups In the experimental group, the association between post‑test
were analyzed using t‑test, and Chi‑square test. Major variables level of anxiety and their demographic variables in [Table 2]
such as anxiety and wellness were analyzed using independent depicted that elders, more educated, employed, and complete
samples t‑test. Third, to test the effectiveness of the psychological adherence patients are having more reduced anxiety than others.
intervention, the comparison of the differences before and after In the control group, none of the demographic variables are
the intervention on anxiety and wellness was analyzed using significantly associated with their post‑test level of anxiety. In
repeated analysis of co variance (ANOVA) measurements. post‑test considering level of anxiety, there is statistically significant
difference between experimental group and control group as
Results the Chi‑square values at first post‑test is (c2 = 8.31, P = 0.03***,
df = 2), at third month post‑test is (c2 = 34.03, P = 0.001***,
The analysis of data was organized and presented under the df = 2), and at sixth month is (c2 = 52.73, P = 0.001***, df = 2).
following headings: Statistical significance was calculated using Pearson Chi‑square
Section 1: Analysis of socio‑demographic characteristics test. It was inferred that there was no significant difference in the
of study subjects. pre‑test anxiety between the experimental group and the control
Section 2: Distribution of subjects according to the level group, whereas in the experimental group there was significant
of anxiety and wellness difference in the post‑test anxiety scores.
Section 3: Association between anxiety and selected
socio‑demographic variables Section 4: Association between wellness and selected
Section 4: Association between wellness and selected socio‑demographic variables
socio‑demographic variables
Section 5: Evaluate the effectiveness of psychological Association between wellness and selected
intervention on level of anxiety and wellness. socio‑demographic variables

Section 1: Analysis of socio‑demographic characteristics In the experimental group, the association between post‑test
of study subjects. level of anxiety and their demographic variables depicted that
more education, occupation, and more income have significantly
The socio‑demographic profile is shown in Table 1. As per gained more wellness scores than others as shown in [Table 3].
socio‑demographic variables amongst two groups, it can be
concluded that both the groups were comparable with regard to The data presented in [Table 4 and Figures 3 and 4] show that the
the age, educational status, and age of onset of illness, whereas Karl Pearson correlation coefficient in the experimental group
it differed in other socio‑demographic characteristics such as is r = −0.66 and in the control group is r = −0.30. The findings
educational status, marital status, etc. reveal that there is a fair negative correlation between sixth month
post‑test anxiety and wellness score. Results indicate that level
Section 2: Distribution of subjects according to the level of wellness increase when anxiety level decreases and vice versa.
of anxiety and wellness
Section 5: Evaluate the effectiveness of psychological
Pre‑interventional level of anxiety and wellness score intervention on level of anxiety and wellness.

Out of the 100 patients who participated in the study, majority The Tables 5 and 6 shows the comparison between experimental
i.e. 68% of the patients were having mild anxiety and, 88% of group and control group score was analyzed using students’
them were having moderate level of wellness in the experimental independent t‑test. In pre‑test, there is no significant difference
group, 88% of the patients were having mild anxiety, and 90% of between experimental group and control group, but in post‑test
them were having moderate level of wellness in the control group. significant difference is observed between experimental group
Experimental group patients are having 123.36 wellness score of and control group as depicted by the t values at first post‑test was
200, whereas in control group it is 122.58 of 200. It is inferred t = 2.04 at P = 0.04, df = 98, at third month post‑test t = 6.32
that pre‑interventional level of anxiety was higher in both at P = 0.001, df = 98, and at sixth month post‑test t = 11.03
control and experimental groups as depicted in [Figure 1] and at P = 0.001, df = 98. Findings reveal that there is consistent

Journal of Family Medicine and Primary Care 6707 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

Table 1: Distribution of Subjects according to socio‑demographic variables n=50+50

Demographic profile Variables Group
Experimental Control
n % n %
Gender Male 21 42.0% 21 42.0%
Female 29 58.0% 29 58.0%
Age < 20 yrs 12 24.0% 12 24.0%
20‑30 yrs 13 26.0% 13 26.0%
30‑40 yrs 20 40.0% 20 40.0%
> 40 yrs 5 10.0% 5 10.0%
Education Primary/middle 21 42.0% 21 42.0%
High school 14 28.0% 14 28.0%
Under Graduate 11 22.0% 11 22.0%
Post Graduate 2 4.0% 2 4.0%
Professional 2 4.0% 2 4.0%
Occupation Employed 11 22.0% 9 18.0%
Self‑employed 11 22.0% 11 22.0%
Unemployed 28 56.0% 30 60.0%
Marital status Married 32 64.0% 30 60.0%
Separated 3 6.0% 3 6.0%
Single/Unmarried 15 30.0% 17 34.0%
Residence Pucca house in Urban area 36 72.0% 31 62.0%
Pucca house in Rural area 3 6.0% 3 6.0%
Kutcha house in Urban area 8 16.0% 13 26.0%
Kutcha house in Rural area 3 6.0% 3 6.0%
Monthly income No income 18 36.0% 18 36.0%
< Rs. 2000 6 12.0% 7 14.0%
Rs. 2000‑5000 1 2.0% 1 2.0%
Rs. 5000‑10000 10 20.0% 7 14.0%
>Rs. 10000 15 30.0% 17 34.0%
Changing Employment Never 31 62.0% 32 64.0%
1‑3 times 7 14.0% 6 12.0%
>3 times 2 4.0% 2 4.0%
NA 10 20.0% 10 20.0%
Age of Onset of Illness 10‑20 years 12 24.0% 12 24.0%
20‑30 years 13 26.0% 13 26.0%
30‑40 years 20 40.0% 20 40.0%
> 40 years 5 10.0% 5 10.0%
Socialization of Patient Not socialize and remain at home 13 26.0% 13 26.0%
Talk when spoken to 22 44.0% 20 40.0%
Normal 15 30.0% 15 30.0%
Familiarity to unfamiliar 0 0.0% 2 4.0%
Main Feature of Illness Not attending daily routine activities 4 8.0% 2 4.0%
Anxiety/Apprehension 46 92.0% 48 96.0%
Adherence to Treatment Complete adherence 17 34.0% 13 26.0%
Non adherence, Very rarely 6 12.0% 10 20.0%
Non adherence, Very often 0 0.0% 3 6.0%
Not taking medicine 27 54.0% 24 48.0%
Frequency of Hospitalization Once 47 94.0% 43 86.0%
Twice 3 6.0% 7 14.0%
Functional Level of Patient) Need supervision 4 8.0% 2 4.0%
Independent 46 92.0% 48 96.0%
Type of Family Nuclear family 18 36.0% 22 44.0%
Joint family 28 56.0% 19 38.0%
Extended family 2 4.0% 5 10.0%
Single 2 4.0% 4 8.0%

significant difference between experimental and control group at an effect on anxiety reduction and it is sustained even at sixth
third and sixth month which means that the treatment produced month post‑test. Comparison of pre‑test and post‑test anxiety

Journal of Family Medicine and Primary Care 6708 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

Table 2: Association between post‑test level of anxiety and demographic variables (Experimental group)
Demographic variable Items Posttest Level of Anxiety Total Chi square
Normal Mild Moderate test
n % n % n %
Gender Male 14 66.7% 6 28.6% 1 4.8% 21 χ2=0.51 P=0.77
Female 22 75.9% 6 20.7% 1 3.4% 29 DF=2
Age <20 yrs 5 41.7% 5 41.7% 2 16.6% 12 χ2=15.03
20‑30 yrs 8 61.5% 5 38.5% 0 0.0% 13 P=0.02* DF=6
30‑40 yrs 18 90.0% 2 10.0% 0 0.0% 20
>40 yrs 5 100.0% 0 0.0% 0 0.0% 5
Education Primary/middle 9 42.8% 10 47.6% 2 9.5% 21 χ2=16.27
High school 12 85.7% 2 14.3% 0 0.0% 14 P=0.03* DF=8
Under Graduate 11 100.0% 0 0.0% 0 0.0% 11
Post Graduate 2 100.0% 0 0.0% 0 0.0% 2
Professional 2 100.0% 0 0.0% 0 0.0% 2
Occupation Employed 11 100.0% 0 0.0% 0 0.0% 11 χ2=13.80
Self‑employed 11 100.0% 0 0.0% 0 0.0% 11 P=0.01**
Unemployed 14 50.0% 12 42.8% 2 7.2% 28 DF=4
Marital status Married 21 65.6% 9 28.1% 2 6.3% 32 χ2=2.81 P=0.59
Separated 3 100.0% 0 0.0% 0 0.0% 3 DF=4
Single/Unmarried 12 80.0% 3 20.0% 0 0.0% 15
Residence Pucca house in Urban area 24 66.7% 11 30.6% 1 2.8% 36 χ2=5.15 P=0.52
Pucca house in Rural area 3 100.0% 0 0.0% 0 0.0% 3 DF=6
Kutcha house in Urban 6 75.0% 1 12.5% 1 12.5% 8
Kutcha house in Rural 3 100.0% 0 0.0% 0 0.0% 3
Monthly income No income 10 55.6% 7 38.9% 1 5.6% 18 χ2=4.98 P=0.75
< 2000 5 83.3% 1 16.7% 0 0.0% 6 DF=8
Rs. 2000‑5000 1 100.0% 0 0.0% 0 0.0% 1
Rs. 5000‑10000 8 80.0% 2 20.0% 0 0.0% 10
>Rs. 10000 12 80.0% 2 13.3% 1 6.7% 15
Changing Employment Never 23 74.2% 7 22.6% 1 3.2% 31 χ2=4.24 P=0.64
1‑3 times 6 85.7% 1 14.3% 0 0.0% 7 DF=6
>3 times 2 100.0% 0 0.0% 0 0.0% 2
NA 5 50.0% 4 40.0% 1 10.0% 10
Age of Onset of Illness 10‑20 years 9 75.0% 3 25.0% 0 0.0% 12 χ2=5.12 P=0.52
20‑30 years 8 61.5% 5 38.5% 0 0.0% 13 DF=6
30‑40 years 15 75.0% 3 15.0% 2 10.0% 20
> 40 years 4 80.0% 1 20.0% 0 0.0% 5
Socialization of Patient Not socialize and remain at home 10 76.9% 2 15.4% 1 7.7% 13 χ2=2.12 P=0.71
Talk when spoken to 16 72.7% 5 22.7% 1 4.5% 22 DF=4
Normal 10 66.7% 5 33.3% 0 0.0% 15
Main Feature of Illness Not attending daily routine activities 2 50.0% 2 50.0% 0 0.0% 4 χ2=1.69 P=0.42
Anxiety/Apprehension 34 73.9% 10 21.7% 2 4.3% 46 DF=2
Adherence to Complete adherence 17 100.0% 0 0.0% 0 0.0% 17 χ =10.78
2

Treatment Non adherence, Very rarely 5 83.3% 1 16.7% 0 0.0% 6 P=0.05* DF=4
Not taking medicine 15 55.5% 10 37.0% 2 7.4% 27
Frequency of Once 33 70.2% 12 25.5% 2 4.3% 47 χ2=1.24 P=0.53
Hospitalization Twice 3 100.0% 0 0.0% 0 0.0% 3 DF=4
Functional Level of Need supervision 2 50.0% 2 50.0% 0 0.0% 4 χ2=1.69 P=0.43
Patient Independent 34 73.9% 10 21.7% 2 4.3% 46 DF=4
Type of Family Nuclear family 12 66.7% 6 33.3% 0 0.0% 18 χ2=9.97 P=0.13
Joint family 21 75.0% 6 21.4% 1 3.6% 28 DF=6
Extended family 1 50.0% 0 0.0% 1 50.0% 2
Single 2 100.0% 0 0.0% 0 0.0% 2

score was analyzed using one‑way ANOVA F‑test. In experimental which is highly significant, that is, greater than the table value at
group, there is a significant difference between pre‑test and P ≤ 0.001 level of significance at df = 98, the data signifies that
post‑test and in control group, no significant difference was the NIP was very effective in reducing anxiety level. The obtained
found. As the “F” value calculated for experimental group is 54.84 F values were significant in experimental group.

Journal of Family Medicine and Primary Care 6709 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

Table 3: Association between post‑test level of wellness and demographic variables (Experimental group) n=50+50
Demographic variables Variable Post‑test level of wellness Total Chi‑square test
Moderate High
n % n %
Gender Male 8 38.1% 13 61.9% 21 χ2=0.61 P=0.43 df=1
Female 8 27.6% 21 72.4% 29
Age <20 yrs 3 25.0% 9 75.0% 12 χ2=3.41 P=0.49 df=3
20‑30 yrs 6 46.2% 7 53.8% 13
30‑40 yrs 6 30.0% 14 70.0% 20
>40 yrs 1 20.0% 4 80.0% 5
Education Primary/middle 12 57.1% 9 42.9% 21 χ2=11.35 P=0.02* df=4
High school 3 21.4% 11 78.6% 14
Under Graduate 2 18.2% 9 81.8% 11
Post Graduate 0 0.0% 2 100.0% 2
Professional 0 0.0% 2 100.0% 2
Occupation Employed 2 18.2% 9 81.8% 11 χ2=6.29 P=0.04* df=2
Self‑employed 1 9.1% 10 90.9% 11
Unemployed 13 46.4% 15 53.6% 28
Marital status Married 10 31.3% 22 68.7% 32 χ2=0.02P=0.98 df=2
Separated 1 33.3% 2 66.7% 3
Single/Unmarried 5 33.3% 10 66.7% 15
Residence Pucca house in Urban area 14 38.9% 22 61.1% 36 χ2=3.59 P=0.30 df=3
Pucca house in Rural area 0 0.0% 3 100.0% 3
Kutcha house in Urban area 1 12.5% 7 87.5% 8
Kutcha house in Rural area 1 33.3% 2 66.7% 3
Monthly income No income 9 50.0% 9 50.0% 18 χ2=9.71 P=0.04* df=4
<2000 2 33.3% 4 66.7% 6
Rs. 2000‑5000 1 100.0% 0 0.0% 1
Rs. 5000‑10000 0 0.0% 10 100.0% 10
>Rs. 10000 4 26.7% 11 73.3% 15
Changing Employment Never 11 35.5% 20 64.5% 31 χ2=4.95 P=0.17 df=3
1‑3 times 1 14.3% 6 85.7% 7
>3 times 0 0.0% 2 100.0% 2
NA 4 40.0% 6 60.0% 10
Age of Onset of Illness 10‑20 years 3 25.0% 9 75.0% 12 χ2=2.41 P=0.49 df=3
20‑30 years 6 46.2% 7 53.8% 13
30‑40 years 6 30.0% 14 70.0% 20
>40 years 1 20.0% 4 80.0% 5
Socialization of Patient Not socialize and remain at home 4 30.8% 9 69.2% 13 χ2=0.02 P=0.98 df=2
Talk when spoken to 7 31.8% 15 68.2% 22
Normal 5 33.3% 10 66.7% 15
Main Feature of Illness Not attending daily routine activities 3 75.0% 1 25.0% 4 χ2=3.69 P=0.06 df=2
Anxiety/Apprehension 13 28.3% 33 71.7% 46
Adherence to Treatment Complete adherence 7 41.2% 10 58.8% 17 χ2=1.37 P=0.50 df=2
Non adherence, Very rarely 1 16.7% 5 83.3% 6
Not taking medicine 8 29.6% 19 70.4% 27
Frequency of Hospitalization Once 16 34.0% 31 66.0% 47 χ2=1.50P=0.22 df=1
Twice 3 100.0% 3
Functional Level of Patient Need supervision 3 75.0% 1 25.0% 4 χ2=3.69 P=0.06 df=1
Independent 13 28.3% 33 71.7% 46
Type of Family Nuclear family 6 33.3% 12 66.7% 18 χ2=0.76 P=0.82 df=3
Joint family 8 28.6% 20 71.4% 28
Extended family 1 50.0% 1 50.0% 2
Single 1 50.0% 1 50.0% 2
*Significant at P≤0.05 ** highly significant at P≤0.01 ***very high significant at P≤0.001

The experimental g roup patients are having 20.3% reduction, experimental group patients are having 23.0%
anxiety reduction, whereas in control group it is only 1.4% improved wellness score whereas in control group it is only
which clearly shows the effectiveness of NIP on anxiety 2.4%.

Journal of Family Medicine and Primary Care 6710 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

Table 4: Correlation between post‑test anxiety and wellness n=50+50

Groups Variables Mean±SD Karl pearson correlation coefficient Interpretation
Experimental Anxiety & 12.02±4.87 r=‑0.66, P=0.001*** Negative correlation between post‑test anxiety and wellness score
group Wellness 169.94±6.87 It means when wellness increases their anxiety decrease fairly.
Control group Anxiety & 27.08±7.58 r=‑0.30, P=0.02* Negative correlation between post‑test anxiety and wellness score
Wellness 127.41±10.58 It means when wellness increases their anxiety decrease fairly.

Table 5: Comparison of anxiety between experimental and control group, n=50+50

Anxiety Experimental Control Student’s
Mean SD Mean SD Independent t‑test
Pre‑test 30.22 8.71 28.36 7.94 t=1.11 P=0.27 DF=98, not significant
Post‑test 24.00 7.82 28.20 7.87 t=2.04 P=0.04* DF=98, significant
Third month 18.44 6.27 27.32 7.70 t=6.32 P=0.001*** DF=98, significant
Sixth month 12.02 4.87 27.08 7.58 t=11.03 P=0.001*** DF=98, significant
One‑way ANOVA, F‑test F=54.84 P=0.001***, significant F=0.33 P=0.77, not significant

Table 6: Comparison of overall wellness between experimental group and control group, n=50+50
Wellness Experimental Control Student’s
Mean SD Mean SD Independent t‑test
Pre‑test 123.36 12.54 122.58 12.90 t=0.30, P=0.76, df=98, not significant
Post‑test 131.41 13.82 122.96 12.67 t=3.19, P=0.01**, df=98, significant
Third month 155.06 7.80 126.48 10.80 t=17.19, P=0.001***, df=98, significant
Sixth month 169.94 6.87 127.41 10.58 t=25.75, P=0.001***, df=98, significant
One‑way ANOVA, F‑test F=215.84, P=0.001***, significant F=2.04, P=0.10, not significant
*Significant at P≤0.05; **highly significant at P≤0.01; ***very high significant at P≤0.001

The Tables 5 and 6 presents the results of analysis based on nurses have a unique role: they promote the psychological health
variances based on the overall clinical symptoms of the study of individuals, families, and communities and help people deal with
group. For this purpose, the study groups were divided into eight grief, crisis, or developmental difficulties. They also care for those
subgroups, the first four groups are the experimental groups at four with intractable illnesses such as schizophrenia, depression, and
levels of assessment, that is, group refers to nursing intervention posttraumatic stress disorder. The focus of caring for the client
baseline data, group 2 refers to first post‑test after nursing is also based on the continuum of psychiatric nursing care, from
intervention, group 3 refers to nursing intervention after 3 months, emergency units to inpatient units to the community, where the
and group 4 refers to nursing intervention after 6 months. Likewise, emphasis on contemporary psychiatric nursing, that is, caring for
the control group at the respective levels of assessments are client and their families in the community and with helping them
represented by groups 5–8. The analysis of variance shows that mobilize community resources.[10]
there is a statistically significant difference among the groups in
respect of clinical symptoms are more than differences within the Psychiatric nursing can be seen as a dynamic interplay between
groups as depicted in [Figures 5 and 6]. To find out which groups the nurse and the patient that encompasses knowledge and
are significantly different, post hoc test Seheffe procedure revealed skillful application of the concept of behavior, personality, the
that there is a statistical difference among the groups at 0.05 level. mind, psychopathology and most importantly, the process of
interpersonal relationship. This implies that the nurse must have
an awareness of herself, her behavior, her needs, and her ways of
Tables 5 and 6 also portrays the mean, SD, standard error, t value,
relating and handling stress whether she is to see clearly where her
and levels of significance of both groups in all four phases of
problems and responses end and where the patient’s begin. This
assessment in relation to overall clinical symptom (anxiety and
is of prime importance because the identification and evaluation
wellness level). It is observed that there is a difference between the
of patient’s behavior are paramount in establishing an effective
mean score of experimental and control group. The difference is
nursing care plan approach. This implies the need for empathy
found to be statistically significant indicating the effect of nursing
qualities in mental health nurse and the importance of developing
intervention in reduction of clinical symptoms in experimental empathy‑based nurse–patient relationship is perhaps one of the
group compared with control group. nurse’s most important therapeutic tools. The psychiatric nurse
must use herself and her total personality as the main implement
The role of nurses in providing clinical care for effective care. Physical manipulative skills are limited here
Psychiatric nurses use a number of interpersonal and communication because the nurse meets the patient on a communication level,
skills to help clients cope with their psychiatric problems. Psychiatric social and recreational activities serve as a bridge to open

Journal of Family Medicine and Primary Care 6711 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

communication. Psychiatric nursing is comprehensive nursing care. The concept of primary, secondary, and tertiary prevention
This suggests the acknowledgment of the patient as a total person provides a framework for discussing psychiatric nursing activities
who possesses the needs concerning all inspects of life‑ physical, primary prevention is a community concept. It is a concept that
psychological, social, environmental, religions, occupational, and precedes disease and is applied to a generally healthy population.
recreational. Thus, the role of psychiatric nurse of the day is far Nursing goal is to decrease the vulnerability of individuals to
different from that of the psychiatric nurse of the past, whose job illness and to strengthen their capacity to withstand stressors.
was to “take care” of the hospitalized mental patients.
In secondary prevention, the nursing goal becomes the reduction
Given its high prevalence and burden for anxiety disorders and of actual illness by early detection and treatment of the problems.
existence of treatment barriers there is a clear need for brief In tertiary presentation, nursing goal is to reduce the residual
inexpensive effective intervention such as psychoeducation.[7,11,12] impairment or disability resulting from an illness.

Psychiatric‑mental health nursing has evolved into a unique Psychiatric nurses become members of multidisciplinary team,
discipline. It now combines the knowledge, experience, and skills having members of different disciplines who each provide
of nursing and mental health. In actuality, the term psychiatric specific services to the patient and a member of interdisciplinary
mental health nursing implies two different areas of nursing that team, having members of different disciplines involved
often interact and overlap. Psychiatric nursing focuses on the care in a formal arrangement to provide patient services while
and rehabilitation of those with identifiable emotional disorders. maximizing educational interchange. In both the teams, nurses
Mental health nursing focuses on well populations; it intervenes are accountable and responsible for the patient’s milieu and for
in crises and with high‑risk individuals or groups to prevent the implementing the nursing process, dealing with the daily activity
development of mental illness or disorder.[13] of patients, and evaluating the outcome of nursing care.

Functions include: The nurses play a vital role in psycho education and improves
1. C o l l e c t i n g s i g n i f i c a n t d a t a t h a t h e l p i d e n t i f y the psychological distress, pain and quality of life of anxiety
problems (e.g., observing behavior, and recording observations.) disorder patients.[14]
2. Making inferences and/or judgments based on these data
Thus, nature of psychiatric nursing is conceptualized as an
and leading to action (e.g., interpreting the behavior of the
interpersonal process that strives to promote and maintain
patient and seeking to understand patients’ needs).
behavior that contributes to integrate functioning. The patient
3. Acting or intervening based on inferences (e.g., clarifying with
may be an individual, family, or community. Nurses would play
a patient the meaning of a procedure, discussing and acting
an active role in team functioning through cooperation and
to solve problems in work situations).
collaboration both in the hospital and community.
4. Evaluating the process based on whether identified problems
have been solved (e.g., mutually evaluating experience and
learning). Conclusion
The findings of the present study indicate that potentially evident
The American nurses association has identified nine major anxiety in anxiety prone patients can be managed by nurse‑led
activities involved in the practice of psychiatric nursing. They interventions. The results of this study suggest that NIP is
are as follows: effective. Patients who received psychological interventions
1. Providing a therapeutic milieu. comprising of psychoeducation, and relaxation therapy have
2. Working with here and now problems of clients. achieved a significant improvement, with reduced severity of
3. Using the surrogate–parent role. anxiety symptoms and improving the overall performance, faster
4. Caring for some somatic aspects of the client’s health than the control group treated only with the routine care. These
problem. improvements were clinically significant, as indicated by the
5. Teaching factors related to emotional health. positive response. Importantly, these effects were maintained
6. Acting as a social agent. and extended over a period of 6 months. This nurse‑led
7. Providing leadership to other personnel. intervention, increased perceived self‑efficacy in patients with
8. Conducting psychotherapy. anxiety disorders, compared with control patients.
9. Engaging in social and community activities related to mental
health. Projected outcome
The finding of this study also suggests that mental health nurses
Importance in the practice by primary care physicians with appropriate education and supervision can provide an
The creation of a new primary care role for psychiatric nurses effective therapeutic approach to patients who are experiencing
developed in liaison with community health nurses brought in anxiety in the mental health settings. The results of the study
a system of mutual referral and consultation. Primary are roles demonstrated the importance of improving patients’ awareness
involved assessment, direct patient care, and case management. on anxiety and how to access help when it occurs. The positive

Journal of Family Medicine and Primary Care 6712 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients

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Journal of Family Medicine and Primary Care 6713 Volume 11 : Issue 11 : November 2022