Narrative Review: Nursing Interventions for Managing Anxiety and Depression in Acute Care Settings
Abstract
Background: Anxiety and depression are highly prevalent comorbidities in acute care settings, affecting up to 30-40% of inpatients. Despite their high prevalence and profound impact, these conditions are frequently under-recognized and sub-optimally managed within the fast-paced, biomedically focused environment of acute care units.
Aim: This narrative review aims to synthesize contemporary evidence on effective, nurse-led interventions for the screening, assessment, and management of anxiety and depression in adult patients within acute medical and surgical inpatient settings.
Methods: A comprehensive search of PubMed, CINAHL, PsycINFO, and the Cochrane Library was conducted for literature published between 2010 and 2024. Keywords included "acute care," "general hospital," "inpatient," "anxiety," "depression," "nursing interventions," "screening," and "management."
Results: Effective management is underpinned by systematic screening using validated tools like the GAD-2/7 and PHQ-2/9. Evidence supports a multi-modal approach: foundational therapeutic communication (active listening, validation); psychoeducation to demystify the illness experience; targeted psychological strategies (problem-solving therapy, behavioral activation, relaxation techniques); collaborative medication management; and structured family involvement.
Conclusion: Nurses are pivotal in mitigating the adverse effects of anxiety and depression in acute care. Moving from tacit to explicit, protocol-driven care requires empowering nurses with knowledge, skills, and systemic support. Integrating evidence-based psychosocial interventions into standard nursing practice is not an optional adjunct but an essential component of holistic, high-quality acute care that can improve patient experience, clinical outcomes, and healthcare efficiency.
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References
Al-Moteri, M., Plummer, V., Cooper, S., & Symmons, M. (2019). Clinical deterioration of ward patients in the presence of antecedents: a systematic review and narrative synthesis. Australian Critical Care, 32(5), 411-420. https://doi.org/10.1016/j.aucc.2018.06.004
Alruqi, A. F., Qaisi, H. M., Alosaimi, N. F., Alotibi, J. D., Majrashi, S. A. A., Al-Mutairi, M. A. F., ... & Mobarki, S. A. I. (2024). Tele-ICU and Critical Care Patient Nursing Care through Remote Monitoring. Saudi Journal of Medicine and Public Health, 1(1), 85-93. https://doi.org/10.64483/jmph-50
Avery, J., Schreier, A., & Swanson, M. (2020). A complex population: Nurse's professional preparedness to care for medical-surgical patients with mental illness. Applied Nursing Research, 52, 151232. https://doi.org/10.1016/j.apnr.2020.151232
Bello, O. (2017). Effective communication in nursing practice: A literature review. https://urn.fi/URN:NBN:fi:amk-2017053011199
Bianchi, R., Verkuilen, J., Toker, S., Schonfeld, I. S., Gerber, M., Braehler, E., & Kroenke, K. (2022). Is the PHQ-9 a unidimensional measure of depression? A 58,272-participant study. Psychological Assessment, 34(6), 595. https://psycnet.apa.org/doi/10.1037/pas0001124
Celano, C. M., Villegas, A. C., Albanese, A. M., Gaggin, H. K., & Huffman, J. C. (2018). Depression and anxiety in heart failure: a review. Harvard review of psychiatry, 26(4), 175-184. DOI: 10.1097/HRP.0000000000000162
Chernoff, R. A., Messineo, G., Kim, S., Pizano, D., Korouri, S., Danovitch, I., & IsHak, W. W. (2022). Psychosocial interventions for patients with heart failure and their impact on depression, anxiety, quality of life, morbidity, and mortality: a systematic review and meta-analysis. Biopsychosocial Science and Medicine, 84(5), 560-580. DOI: 10.1097/PSY.0000000000001073
Coates, D., Coppleson, D., & Schmied, V. (2020). Integrated physical and mental healthcare: an overview of models and their evaluation findings. JBI Evidence Implementation, 18(1), 38-57. DOI: 10.1097/XEB.0000000000000215
Duong, J., Wang, G., Lean, G., Slobod, D., & Goldfarb, M. (2024). Family-centered interventions and patient outcomes in the adult intensive care unit: a systematic review of randomized controlled trials. Journal of critical care, 83, 154829. https://doi.org/10.1016/j.jcrc.2024.154829
Farrand, P., Pentecost, C., Greaves, C., Taylor, R. S., Warren, F., Green, C., ... & Taylor, A. H. (2014). A written self-help intervention for depressed adults comparing behavioural activation combined with physical activity promotion with a self-help intervention based upon behavioural activation alone: study protocol for a parallel group pilot randomised controlled trial (BAcPAc). Trials, 15(1), 196. https://doi.org/10.1186/1745-6215-15-196
Gilbody, S., Brabyn, S., Mitchell, A., Ekers, D., McMillan, D., Bailey, D., ... & Bosanquet, K. (2022). Can we prevent depression in at-risk older adults using self-help? the UK SHARD trial of behavioral activation. The American Journal of Geriatric Psychiatry, 30(2), 197-207. https://doi.org/10.1016/j.jagp.2021.06.006
Haddad, P. M., Brain, C., & Scott, J. (2014). Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient related outcome measures, 43-62. https://doi.org/10.2147/PROM.S42735
Happell, B., & Platania-Phung, C. (2005). Mental health issues within the general health care system: The challenge for nursing education in Australia. Nurse Education Today, 25(6), 465-471. https://doi.org/10.1016/j.nedt.2005.04.005
Happell, B., Furness, T., Jacob, A., Stimson, A., Curtis, J., Watkins, A., ... & Stanton, R. (2023). Nurse-led physical health interventions for people with mental illness: A scoping review of international literature. Issues in mental health nursing, 44(6), 458-473. https://doi.org/10.1080/01612840.2023.2212772
Hazazi, Y. O. (2025). Strengthening Postpartum Depression Screening and Treatment within Primary Healthcare Centers in Riyadh 1st Cluster. Saudi Journal of Medicine and Public Health, 2(2), 105-113. https://doi.org/10.64483/jmph-56
Huang, X., Sun, Y., Wu, A., & Zhang, X. Y. (2023). Prevalence and clinical profile of abnormal glucose in first-episode and drug-naïve patients with major depressive disorder with comorbid abnormal thyroid function: a large-scale cross-sectional study. BMC psychiatry, 23(1), 362. https://doi.org/10.1186/s12888-023-04842-5
Krittanawong, C., Maitra, N. S., Qadeer, Y. K., Wang, Z., Fogg, S., Storch, E. A., ... & Lavie, C. J. (2023). Association of depression and cardiovascular disease. The American journal of medicine, 136(9), 881-895. https://doi.org/10.1016/j.amjmed.2023.04.036
Martínez-Martínez, C., Esteve-Claramunt, F., Prieto-Callejero, B., & Ramos-Pichardo, J. D. (2022). Stigma towards mental disorders among nursing students and professionals: a bibliometric analysis. International journal of environmental research and public health, 19(3), 1839.
Mohammed, F., Geda, B., Yadeta, T. A., & Dessie, Y. (2024). Antipsychotic medication non-adherence and factors associated among patients with schizophrenia in eastern Ethiopia. BMC psychiatry, 24(1), 108. https://doi.org/10.1186/s12888-024-05554-0
Moreno‐Poyato, A. R., Rodríguez‐Nogueira, Ó., & MiRTCIME. CAT Working Group. (2021). The association between empathy and the nurse–patient therapeutic relationship in mental health units: a cross‐sectional study. Journal of psychiatric and mental health nursing, 28(3), 335-343. https://doi.org/10.1111/jpm.12675
Olding, M., McMillan, S. E., Reeves, S., Schmitt, M. H., Puntillo, K., & Kitto, S. (2016). Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expectations, 19(6), 1183-1202. https://doi.org/10.1111/hex.12402
Perez, D. L., Keshavan, M. S., Scharf, J. M., Boes, A. D., & Price, B. H. (2018). Bridging the great divide: what can neurology learn from psychiatry?. The Journal of neuropsychiatry and clinical neurosciences, 30(4), 271-278. https://doi.org/10.1176/appi.neuropsych.17100200
Plummer, F., Manea, L., Trepel, D., & McMillan, D. (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. General hospital psychiatry, 39, 24-31. https://doi.org/10.1016/j.genhosppsych.2015.11.005
Richardson, A., Richard, L., Gunter, K., Cunningham, R., Hamer, H., Lockett, H., ... & Derrett, S. (2020). A systematic scoping review of interventions to integrate physical and mental healthcare for people with serious mental illness and substance use disorders. Journal of psychiatric research, 128, 52-67. https://doi.org/10.1016/j.jpsychires.2020.05.021
Stanley, M. P., Silbersweig, D. A., & Perez, D. L. (2023). Toward a unified classification system for brain–mind disorders: putting calls for integrated clinical neuroscience into action. Cognitive and Behavioral Neurology, 36(4), 199-201. DOI: 10.1097/WNN.0000000000000353
Suraya, C. S. C., bin Sansuwito, T., Dioso, R. I., & Wisuda, A. C. (2024). Effective communication in nursing: A comprehensive systematic review of best practices. Journal Of Nursing Science Research, 1(1), 34-48. https://doi.org/10.33862/jnsr.v1i1.450
Thornicroft, G., Ahuja, S., Barber, S., Chisholm, D., Collins, P. Y., Docrat, S., ... & Zhang, S. (2019). Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries. The Lancet Psychiatry, 6(2), 174-186. https://doi.org/10.1016/S2215-0366(18)30298-0
Traeger, L., Park, E. R., Sporn, N., Repper-DeLisi, J., Convery, M. S., Jacobo, M., & Pirl, W. F. (2013, July). Development and evaluation of targeted psychological skills training for oncology nurses in managing stressful patient and family encounters. In Oncol Nurs Forum (Vol. 40, No. 4, pp. E327-E336).
van Klinken, M., Hafkamp, E., van Weezel, A. G., Hales, S., Lanceley, A., Rodin, G., ... & de Vries, F. (2023, December). Teaching oncology nurses a psychosocial intervention for advanced cancer: A mixed-methods feasibility study. In Seminars in Oncology Nursing (Vol. 39, No. 6, p. 151507). WB Saunders. https://doi.org/10.1016/j.soncn.2023.151507
Walker, J., Magill, N., Rosenstein, D. L., Frost, C., & Sharpe, M. (2022). Suicidal thoughts in patients with cancer and comorbid major depression: findings from a depression screening program. Journal of the Academy of Consultation-Liaison Psychiatry, 63(3), 251-259. https://doi.org/10.1016/j.jaclp.2021.09.003
Wand, T., Collett, G., Keep, J., Cutten, A., Stack, A., & White, K. (2021). Mental health nurses’ experiences of working in the emergency department of two rural Australian settings. Issues in Mental Health Nursing, 42(10), 893-898. https://doi.org/10.1080/01612840.2021.1913773
Zhang, A., Park, S., Sullivan, J. E., & Jing, S. (2018). The effectiveness of problem-solving therapy for primary care patients' depressive and/or anxiety disorders: A systematic review and meta-analysis. The Journal of the American Board of Family Medicine, 31(1), 139-150. https://doi.org/10.3122/jabfm.2018.01.170270
Authors
Copyright (c) 2025 Fatimah Haidar Hussein Abutalib, Zailaey Ashwaq Naser, Anoud Ibrahim Ahmd Ahmdini, Nawal Ali Ali Awaji, Reham Abdu Abdallah Refaee, Kamlah Mahdi Mohammed Khardali, Sharifah Husain Yahya Dabash
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