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

For all individuals, mental, physical, and social health is vital
strands of life that are closely interwoven and interdependent. As
understanding of this relationship grows, it becomes even more
apparent that mental health is crucial to the overall well‑being of
individuals, societies, and countries.[1] Mental illness is a leading
cause of disability worldwide and an important public health
Address for correspondence: Dr. Binu Mathew,
College of Nursing, All India Institute of Medical Sciences Raipur,
GE Road, Tatibandh, Raipur, Chhattisgarh ‑ 492 099, India.
E‑mail: binu2mathew@gmail.com
Received: 24‑03‑2021 Revised: 10-09-2021
Accepted: 30‑09‑2021 Published: 16-12-2022
Access this article online
Quick Response Code:
Website:
www.jfmpc.com
anxiety disorder, panic disorder, social phobia, and obsessive‐
compulsive disorder, are the most common mental health issues,
with lifetime prevalence reported to be as high as 30% (Kessler
2005). The present treatment focuses on unnecessary
investigations and costly medications that are not only inadequate
and ineffective, but also produce widespread frustration in both
seekers and providers of healthcare services Government of
India (GOI). There are lacunae in psychiatric epidemiology
due to intricacy related to defining a case, diagnosis, sampling
methodology, underreporting, and stigma, lack of adequate
findings and trained labor, and low priority of mental health in
health policy.
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is
given and the new creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

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
Score of Neurotic Patients
Figure 3: Scatter Plot With Regression Estimate Shows the Substantial,
Negative Correlation Between Post‑test Anxiety Score and Wellness
Score (R = −0.66) Among Experiment Group Patients
Figure 5: Box Plot Compares Pre‑test and Post‑test Mean Anxiety
Score Between Experimental and Control Group Patients
Anxiety disorder is an umbrella term that covers several different
forms of a type of common psychiatric disorder. The disorders
once classified as neuroses are now considered anxiety/neurotic
disorders and Common Mental Disorders (CMDs). CMDs are
a functional clinical classification of the group of disorders
that describe the deeper psychological distress states of an
individual. They include anxiety disorders, somatoform disorders,
dissociative disorders, phobia, and depression. For people with
anxiety disorders, worry and fear are constant, overwhelming, and
crippling. The condition turns their life into a continuous journey
of unease and fear and can interfere with their relationships
with family, friends, and colleagues. But all too often they are
mistaken for mental weakness or instability and resulting social
stigma can discourage people with anxiety/neurotic disorders
from seeking help. Patients with these disorders experience high
levels of distress and impaired social functioning. If untreated,
Journal of Family Medicine and Primary Care
Figure 2: Multiple Bar Diagram Showing Pre‑test Level of Wellness
Score of Neurotic Patients
Figure 4: Scatter Plot With Regression Estimate Shows the Fair,
Negative Correlation Between Post‑test Anxiety Score And Wellness
Score (R = −0.30) Among Control Group Patients
Figure 6: Box Plot Compares Pre‑test and Post‑test Mean Wellness
Score Between Experimental and Control Group Patients
their thinking, decision‑making ability, perceptions of the
environment, learning, and concentration get affected.[3]
Prevalence of CMDs in primary care settings has varied from
about 11–34.6% in different Indian studies (Nambi et al.).
A recent study from India reported a prevalence of 42%
inpatients attending a clinic in a tertiary care hospital (Avasthi
et al. 2008). Prevalence of generalized anxiety disorder in primary
care settings is reported to be in the range of 5–16% (Wittchen
2002) and that of panic disorder is 1.5–1.3% (Craske et al. 2002).
According to the National Mental Health Survey undertaken by
NIMHANS across 12 selected states of India during 2015–2016,
reported that CMDs, including depression, anxiety disorders,
and substance use disorders are a huge burden affecting nearly
10.0% of the population. Neurosis and stress‑related disorders
affected 3.5% of the population and were reported to be higher
among women (nearly twice as much as men). Neurosis and
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 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients
stress‑related disorders are commonly encountered in primary care
settings where they are usually missed or misdiagnosed. Among
the major mental disorders that manifest predominantly during
adulthood, the crude prevalence for both depressive disorders and
anxiety disorders was 3.3% (3.1–3.6 for depressive disorders and
3.0–3.5 for anxiety disorders).[1] Psychosocial care is increasingly
recognized as an essential component of the comprehensive care
of neurotic disorders. Improving patients’ access to psychosocial
care is important. Among the mental disorders that manifest
predominantly during adulthood, the highest disease burden in
India was caused by depressive and anxiety disorders, followed by
schizophrenia and bipolar disorder (Kyu 2018) To give high‑quality
care, it is essential that mental health nurses have a solid grasp
of the most common therapies and interventions used in mental
healthcare. If nurses understand, what the various interventions
involve then they will be much better equipped to support
patients through their recovery.[4] A range of psychological and
psychosocial treatments for depression and anxiety (including
depression with a chronic physical health problem) have been
shown to relieve the symptoms of depression and there is growing
evidence that psychological and psychosocial therapies can help
people recover from depression in the longer‑term relaxation
training is effective in reducing anxiety in all participants for
anxiety disorders and increase the quality of life.[5,6] People with
depression often prefer psychological and psychosocial treatments
to medication (Prins et al., 2008) and value outcomes beyond
symptom reduction that include positive mental health and a
return to usual functioning (Zimmerman et al, 2006) management
options for anxiety disorders include psychoeducation,
psychological treatment and pharmacological treatments.[7] This
improves health outcomes by optimizing self‑care skills, engaging
family and community supports, and promoting early recognition
of problems and appropriate interventions.
Within the limitations placed on modern mental healthcare, it is
a challenge for the nurses to take the responsibility of providing
evidence‑based holistic nursing interventions for anxiety disorder
patients. Moreover, such studies are woefully inadequate in the
Indian context. Although neurotic/anxiety disorders are the
commonest mental disorders, they receive scant attention. It is
useful to devote attention to the management of these mental
disorders because they are the commonest mental disorders in
the general population. Considering the above‑stated factors,
the investigator felt the need to address psychosocial aspects of
anxiety disorders and the present investigation makes an earnest
effort to plan psychological interventions to decrease anxiety
thereby improving the wellness level of neurotic patients. The
present study also helps to make society and government aware
of the mental health needs of the population and take necessary
steps for the development of the same.
The objectives of the study were to assess the socio‑demographic
profile of the neurotic patients, pre‑interventional level of
anxiety and wellness of the neurotic patients, and to evaluate
the effectiveness of psychological interventions on the anxiety
and wellness level among anxiety disorder patients.
Journal of Family Medicine and Primary Care
Along with psychosocial approaches studies support that exercise,
sleep, hygiene and self-care activities are effective means of
treatment of such patient[8] psychoeducational intervention is
based on cognitive behavioral principles and have better effect
on worry symptoms and reduction of anxiety therefore due
to multipronged nature, psychoeducation can be suited to any
mental health setting.[9]
Materials and Methods
This study adopted a single‑blind quasi‑experimental study
comprising of a group of 100 neurotic patients (50 experimental
group and 50 control group) selected through purposive sampling
from outpatient clinics in three mental hospitals in Chhattisgarh. The
samples were fulfilling the criteria of age 20 years or more with no
major visual or motor handicap or other chronic diseases, diagnosed
with neurotic/anxiety disorders by psychiatrists of selected mental
hospitals of Chhattisgarh, willing to cooperate, and provide consent
for the study. The study was approved by the Institutional Ethics
Committee of Jawaharlal Nehru Hospital and Research Centre, Bhilai
Manopchar Hospital Mana Raipur, and CIIMHANS Anjora Durg.
Both groups matched on various socio‑demographic correlates. To
judge the similarity of two groups, a pre‑test or pre‑measurement was
made in the “before” time period. Consecutive eligible patients who
scored more than 17 on Sinha’s Comprehensive Anxiety Test (SCAT)
were randomly assigned to experimental group who was administered
psychological intervention and to control group with standard care.
Data were collected using socio‑demographic datasheet, Freeman
et al. Wellness Assessment Tool, SCAT and Rathus Assertiveness
Schedule, physiological parameters such as self checking of pulse
and respiration before and after intervention and at 3 months
and 6 months post‑intervention. Socio‑demographic datasheet
included age and gender, education, family income, residence and
marital status, main feature of illness, adherence to treatment,
frequency of admission to hospital, participation in social activity,
occupational status and frequency of change of employment,
functional level of patient, year of onset of illness and type of
family. Data were collected using face‑to‑face interview method.
Psychological interventions was administered to experimental
group with routine care and control group is given only the
routine care. Routine care included administration of anti‑anxiety
medicines and general advice by doctors and other health team
members. Psychological intervention was planned in two sessions
for 2 days in the experimental group. First session was held on
Day 1 and second session on Day 2, that is, one session each on
both days. First session on Day 1 comprised of administration
of pre‑test followed by group discussion on anxiety and its
effects on the respondents, psycho‑education on anxiety and
its management. The session lasted for one and half hours. In
the second session, review of the previous sessions, followed
by simple relaxation therapy and checking of physiological
parameters, that is, pulse and respiration were done. This was
followed by feedback and post‑test on second day after second
session. This session lasted for one and half hours. So, total of
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 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.
In the control group, only one session was utilized. This session
included the administration of pre‑test followed by feedback and
post‑test. The time taken for the session was one and half hours.
Post‑test was done again at 3 and 6 months for both groups.
The collected data were analyzed using statistical package of social
sciences (SPSS) 12. First, the socio‑demographic characteristics
were presented as frequency, percentage, average, and SD. Second,
the general characteristics of the experimental and control groups
were analyzed using t‑test, and Chi‑square test. Major variables
such as anxiety and wellness were analyzed using independent
samples t‑test. Third, to test the effectiveness of the psychological
intervention, the comparison of the differences before and after
the intervention on anxiety and wellness was analyzed using
repeated analysis of co variance (ANOVA) measurements.
Results
The analysis of data was organized and presented under the
following headings:
Section 1: Analysis of socio‑demographic characteristics
of study subjects.
Section 2: Distribution of subjects according to the level
of anxiety and wellness
Section 3: Association between anxiety and selected
socio‑demographic variables
Section 4: Association between wellness and selected
socio‑demographic variables
Section 5: Evaluate the effectiveness of psychological
intervention on level of anxiety and wellness.
Section 1: Analysis of socio‑demographic characteristics
of study subjects.
The socio‑demographic profile is shown in Table 1. As per
socio‑demographic variables amongst two groups, it can be
concluded that both the groups were comparable with regard to
the age, educational status, and age of onset of illness, whereas
it differed in other socio‑demographic characteristics such as
educational status, marital status, etc.
Section 2: Distribution of subjects according to the level
of anxiety and wellness
Pre‑interventional level of anxiety and wellness score
Out of the 100 patients who participated in the study, majority
i.e. 68% of the patients were having mild anxiety and, 88% of
them were having moderate level of wellness in the experimental
group, 88% of the patients were having mild anxiety, and 90% of
them were having moderate level of wellness in the control group.
Experimental group patients are having 123.36 wellness score of
200, whereas in control group it is 122.58 of 200. It is inferred
that pre‑interventional level of anxiety was higher in both
control and experimental groups as depicted in [Figure 1] and
Journal of Family Medicine and Primary Care
pre interventional level of wellness score was low to moderate
in experimental and control group as depicted in [Figure 2].
Section 3: Association between anxiety and selected
socio‑demographic variables
Association between anxiety and selected socio‑demographic
variables
In the experimental group, the association between post‑test
level of anxiety and their demographic variables in [Table 2]
depicted that elders, more educated, employed, and complete
adherence patients are having more reduced anxiety than others.
In the control group, none of the demographic variables are
significantly associated with their post‑test level of anxiety. In
post‑test considering level of anxiety, there is statistically significant
difference between experimental group and control group as
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***,
df = 2), and at sixth month is (c2 = 52.73, P = 0.001***, df = 2).
Statistical significance was calculated using Pearson Chi‑square
test. It was inferred that there was no significant difference in the
pre‑test anxiety between the experimental group and the control
group, whereas in the experimental group there was significant
difference in the post‑test anxiety scores.
Section 4: Association between wellness and selected
socio‑demographic variables
Association between wellness and selected
socio‑demographic variables
In the experimental group, the association between post‑test
level of anxiety and their demographic variables depicted that
more education, occupation, and more income have significantly
gained more wellness scores than others as shown in [Table 3].
The data presented in [Table 4 and Figures 3 and 4] show that the
Karl Pearson correlation coefficient in the experimental group
is r = −0.66 and in the control group is r = −0.30. The findings
reveal that there is a fair negative correlation between sixth month
post‑test anxiety and wellness score. Results indicate that level
of wellness increase when anxiety level decreases and vice versa.
Section 5: Evaluate the effectiveness of psychological
intervention on level of anxiety and wellness.
The Tables 5 and 6 shows the comparison between experimental
group and control group score was analyzed using students’
independent t‑test. In pre‑test, there is no significant difference
between experimental group and control group, 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. Findings reveal that there is consistent
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 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
variances based on the overall clinical symptoms of the study
group. For this purpose, the study groups were divided into eight
subgroups, the first four groups are the experimental groups at four
levels of assessment, that is, group refers to nursing intervention
baseline data, group 2 refers to first post‑test after nursing
intervention, group 3 refers to nursing intervention after 3 months,
and group 4 refers to nursing intervention after 6 months. Likewise,
the control group at the respective levels of assessments are
represented by groups 5–8. The analysis of variance shows that
there is a statistically significant difference among the groups in
respect of clinical symptoms are more than differences within the
groups as depicted in [Figures 5 and 6]. To find out which groups
are significantly different, post hoc test Seheffe procedure revealed
that there is a statistical difference among the groups at 0.05 level.
Tables 5 and 6 also portrays the mean, SD, standard error, t value,
and levels of significance of both groups in all four phases of
assessment in relation to overall clinical symptom (anxiety and
wellness level). It is observed that there is a difference between the
mean score of experimental and control group. The difference is
found to be statistically significant indicating the effect of nursing
intervention in reduction of clinical symptoms in experimental
group compared with control group.
The role of nurses in providing clinical care
Psychiatric nurses use a number of interpersonal and communication
skills to help clients cope with their psychiatric problems. Psychiatric
nurses have a unique role: they promote the psychological health
of individuals, families, and communities and help people deal with
grief, crisis, or developmental difficulties. They also care for those
with intractable illnesses such as schizophrenia, depression, and
posttraumatic stress disorder. The focus of caring for the client
is also based on the continuum of psychiatric nursing care, from
emergency units to inpatient units to the community, where the
emphasis on contemporary psychiatric nursing, that is, caring for
client and their families in the community and with helping them
mobilize community resources.[10]
Psychiatric nursing can be seen as a dynamic interplay between
the nurse and the patient that encompasses knowledge and
skillful application of the concept of behavior, personality, the
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
relating and handling stress whether she is to see clearly where her
problems and responses end and where the patient’s begin. This
is of prime importance because the identification and evaluation
of patient’s behavior are paramount in establishing an effective
nursing care plan approach. This implies the need for empathy
qualities in mental health nurse and the importance of developing
empathy‑based nurse–patient relationship is perhaps one of the
nurse’s most important therapeutic tools. The psychiatric nurse
must use herself and her total personality as the main implement
for effective care. Physical manipulative skills are limited here
because the nurse meets the patient on a communication level,
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.
This suggests the acknowledgment of the patient as a total person
who possesses the needs concerning all inspects of life‑ physical,
psychological, social, environmental, religions, occupational, and
recreational. Thus, the role of psychiatric nurse of the day is far
different from that of the psychiatric nurse of the past, whose job
was to “take care” of the hospitalized mental patients.
Given its high prevalence and burden for anxiety disorders and
existence of treatment barriers there is a clear need for brief
inexpensive effective intervention such as psychoeducation.[7,11,12]
Psychiatric‑mental health nursing has evolved into a unique
discipline. It now combines the knowledge, experience, and skills
of nursing and mental health. In actuality, the term psychiatric
mental health nursing implies two different areas of nursing that
often interact and overlap. Psychiatric nursing focuses on the care
and rehabilitation of those with identifiable emotional disorders.
Mental health nursing focuses on well populations; it intervenes
in crises and with high‑risk individuals or groups to prevent the
development of mental illness or disorder.[13]
Functions include:
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
problems (e.g., observing behavior, and recording observations.)
2. Making inferences and/or judgments based on these data
and leading to action (e.g., interpreting the behavior of the
patient and seeking to understand patients’ needs).
3. Acting or intervening based on inferences (e.g., clarifying with
a patient the meaning of a procedure, discussing and acting
to solve problems in work situations).
4. Evaluating the process based on whether identified problems
have been solved (e.g., mutually evaluating experience and
learning).
The American nurses association has identified nine major
activities involved in the practice of psychiatric nursing. They
are as follows:
1. Providing a therapeutic milieu.
2. Working with here and now problems of clients.
3. Using the surrogate–parent role.
4. Caring for some somatic aspects of the client’s health
problem.
5. Teaching factors related to emotional health.
6. Acting as a social agent.
7. Providing leadership to other personnel.
8. Conducting psychotherapy.
9. Engaging in social and community activities related to mental
health.
Importance in the practice by primary care physicians
The creation of a new primary care role for psychiatric nurses
developed in liaison with community health nurses brought in
a system of mutual referral and consultation. Primary are roles
involved assessment, direct patient care, and case management.
Journal of Family Medicine and Primary Care
The concept of primary, secondary, and tertiary prevention
provides a framework for discussing psychiatric nursing activities
primary prevention is a community concept. It is a concept that
precedes disease and is applied to a generally healthy population.
Nursing goal is to decrease the vulnerability of individuals to
illness and to strengthen their capacity to withstand stressors.
In secondary prevention, the nursing goal becomes the reduction
of actual illness by early detection and treatment of the problems.
In tertiary presentation, nursing goal is to reduce the residual
impairment or disability resulting from an illness.
Psychiatric nurses become members of multidisciplinary team,
having members of different disciplines who each provide
specific services to the patient and a member of interdisciplinary
team, having members of different disciplines involved
in a formal arrangement to provide patient services while
maximizing educational interchange. In both the teams, nurses
are accountable and responsible for the patient’s milieu and for
implementing the nursing process, dealing with the daily activity
of patients, and evaluating the outcome of nursing care.
The nurses play a vital role in psycho education and improves
the psychological distress, pain and quality of life of anxiety
disorder patients.[14]
Thus, nature of psychiatric nursing is conceptualized as an
interpersonal process that strives to promote and maintain
behavior that contributes to integrate functioning. The patient
may be an individual, family, or community. Nurses would play
an active role in team functioning through cooperation and
collaboration both in the hospital and community.
Conclusion
The findings of the present study indicate that potentially evident
anxiety in anxiety prone patients can be managed by nurse‑led
interventions. The results of this study suggest that NIP is
effective. Patients who received psychological interventions
comprising of psychoeducation, and relaxation therapy have
achieved a significant improvement, with reduced severity of
anxiety symptoms and improving the overall performance, faster
than the control group treated only with the routine care. These
improvements were clinically significant, as indicated by the
positive response. Importantly, these effects were maintained
and extended over a period of 6 months. This nurse‑led
intervention, increased perceived self‑efficacy in patients with
anxiety disorders, compared with control patients.
Projected outcome
The finding of this study also suggests that mental health nurses
with appropriate education and supervision can provide an
effective therapeutic approach to patients who are experiencing
anxiety in the mental health settings. The results of the study
demonstrated the importance of improving patients’ awareness
on anxiety and how to access help when it occurs. The positive
6712 Volume 11 : Issue 11 : November 2022
 Mathew: Impact of nursing interventional package on anxiety and wellness level among anxiety disorders patients
mental health nursing contribution should include teaching
more productive coping techniques and relapse prevention.
Working closely with patients and promoting hope for relatives
is another area that services should focus on as it has been
shown that involving patients and relatives is critical when
planning appropriate and acceptable care for them. The results
highlighted the contribution of nurses in assisting patients in
coping with difficulties associate with anxiety and for patients to
begin to understand their illness symptoms and prevent further
deterioration. Giving patients a sense of optimism and control
in the future management of their anxiety is a significant part
of support. Empowering patients with mental health illness
and specifically anxiety are central to their own coping. The
importance of nurturing a sense of empowerment is the mental
health nurses’ role by providing encouragement and support and
developing connections with patients and family.
Key points
• Anxiety disorders are the most common and disabling
psychiatric disorders. These disorders cause significant
distress and disability like any other medical ailments such
as hypertension and interfere with the ability to relax and
experience a sense of enjoyment and wellbeing.
• The patients with these disorders visit primary healthcare
and other practice settings.
• Nurses are in a vital position to identify symptoms of
different types of anxiety disorders, start appropriate
interventions, counsel, or refer these patients for treatment
major nursing interventions include making an accurate
diagnosis, initiating appropriate NIPs like the package by
the research consisting of psychoeducation, focus group
discussion, and relaxation therapies contributed to a higher
level of wellness and quality of life. These person‑centered
interventions improve anxiety outcomes in the patient.
• Anxiety disorder can be managed effectively in the primary
healthcare settings with access to the psychological
interventions and therapies the nurse play a crucial role in
assessment and collaborating with primary care physicians
in early identification and management which is key to the
patient recovery and can prevent secondary disorders such
as depression and substance use disorders.[15]
Financial support and sponsorship
Self‑funding.
Conflicts of interest
There are no conflicts of interest.
Journal of Family Medicine and Primary Care
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