Compared to the general population, patients with psychiatric disorders, especially patients receiving electroconvulsive therapy due to its nature, and lack of psychiatric nursing counseling have worse physical health and lower self-esteem. The aim of this study was to determine the effect of psychiatric nursing counseling on self-esteem and health-promoting behaviors of patients receiving electroconvulsive therapy in hospitalized patients.

 

This clinical trial was conducted on 114 patients undergoing ECT at Farshchian Hospital in Hamadan, Iran, in 2019. The participants were divided into two groups of intervention (n=57) and control (n=57) by block randomization. Data collection tools included demographic, Rosenberg self-esteem, and health-promoting behaviors questionnaires. The intervention in the experimental group was held in the form of 4 sessions of individual counseling. Data were analyzed using frequency, percentage, mean and standard deviation statistics, Chi-square, and t-tests in SPSS software version 20 (SPSS Inc., Chicago, IL., USA).

The aim of this study was to determine the effect of psychiatric nursing counseling on self-esteem and health-promoting behaviors of patients receiving electroconvulsive therapy. The results showed no significant difference between the mean scores of self-esteem in the experimental and control groups before the intervention. In contrast, the mean self-esteem score decreased immediately after the intervention compared to before the intervention in the control group and increased in the experimental group. There was a significant difference between the mean scores of self-esteem in the experimental and control groups immediately after the intervention. Also, the mean score of self-esteem decreased two weeks after the intervention compared to immediately after the intervention in the control group and increased in the experimental group, and a significant difference was observed between the control and experimental groups. This means that providing psychiatric nursing counseling to patients receiving electroconvulsive therapy, their self-esteem increases. Kim et al. (2019) conducted a study using reality therapy techniques on self-esteem and internal stigma of schizophrenic patients. The results of the study confirmed the improvement of self-esteem of the intervention group compared to the control group [31]. The results of the present study are in line with the study of Kim et al. (2019). Perhaps the reasons for this alignment can be interpreted as counseling increasing the power of internal control and increasing the mentally ill's cognitive abilities, which leads to improved self-esteem. In a clinical trial, Savasan et al. (2017) examined the effect of a tidal model-based psychiatric approach on compliance and self-esteem in alcohol-dependent individuals. The results showed an increase in self-esteem after the intervention. But this increase was not enough to be significantly different from the control group [32]. Perhaps the differences between the results of this study and our study are the differences in the study population and the different counseling patterns. Mejías et al. (2019) studied the effect of group psychotherapy on depressive and anxiety symptoms, self-esteem, and social adjustment in students with depressive and anxiety disorders. The results showed a significant difference in reducing the symptoms of anxiety and depression, improving self-esteem, and social adjustment after the intervention compared to before [33]. Despite the differences between the study population and the intervention, the results are consistent with the present study.
The present study results showed that before the intervention, the mean score of health-promoting behaviors in the control group was higher than the experimental group. There was a significant difference between the mean scores of health-promoting behaviors in the experimental and control groups before the intervention. After the intervention, the mean score of health-promoting behaviors decreased compared to before the intervention in the control group and also in the experimental group. But the reduction rate was less than the control group. There was a significant difference between the mean scores of health-promoting behaviors in the experimental and control groups after the intervention. The reason for the decrease in the mean score of health-promoting behaviors in both groups may be related to the complications related to electroconvulsive therapy and the patient's hospitalization, and the resulting limitations. Participants in the study received electroshock during sampling. However, considering that the decrease in the score of health-promoting behaviors in the experimental group was much lower than the control group, it means that psychiatric nursing counseling to patients admitted to the psychiatric wards of Farshchian Hospital affected their health-promoting behaviors and its decline.
 Blomqvist et al. (2019) conducted a study aiming to investigate the effect of individual lifestyle interventions on the health of people with psychotic disorders in outpatient services. In this quasi-experimental study, multiple nursing interventions were presented, and biomedical and clinical measures, self-reported health status, disease symptoms, and health behaviors were examined. The results showed significant changes in physical activity, HbA1c, and waist size. In general, the results showed that lifestyle intervention for people with severe mental illness could be helpful [9]. Bartels et al. (2018) conducted a study on the health consequences of evidence-based lifestyle interventions for overweight and obese adults with severe mental illness. Weight and fitness outcomes were assessed for 122 overweight or obese adults with severe mental illness after 12 months of intervention. The results showed that the intervention group lost more weight than the control group; this difference was significant. But the difference in reducing the risk of cardiovascular disease and physical fitness was not significant [34]. In the Naslund et al. (2016) study, the intervention was performed on patients with schizophrenia and mood disorders over 12 months. The results showed that after 12 months, the samples had a significant weight reduction, but the difference in body mass index (BMI) between the groups was not significant.
 
 

Psychiatric counseling increased self-esteem and prevented a decline in health-promoting behaviors. Therefore, this method can be used in educational programs and nursing care for patients with mental disorders.
 
 

This article is taken from the research project approved by the Research Council of Hamadan University of Medical Sciences and Health Services in 2017, with project number 9604202514. Also, this project has been registered and approved by the Research Ethics Committee with the ethical code IR.UMSHA.REC.13960.265 and in the Iranian Clinical Trial Registration Center with the code IRCT2017061933378N3. The authors consider it necessary to express their gratitude to the Vice-Chancellor for Research and the Faculty of Nursing of Hamadan University of Medical Sciences, the staff of Sina Farshchian Hospital, and the patients participating in this study.
 
 

The authors declared no conflict of interest.