Effectiveness of Nurse-Led Education and Telehealth on Mental Health in Chronic Disease in Saudi Arabia: A Systematic Review

Introduction: depression, anxiety, and chronic pain are highly prevalent among ambulatory patients and significantly impair their quality of life. Nurse-Led Education (NLE) and Telehealth (TH) interventions have emerged as promising strategies to address mental health challenges in outpatient settings. However, evidence comparing the effectiveness of these two approaches remains inconclusive, especially in culturally sensitive contexts like Saudi Arabia. Objective: to systematically review and compare the effectiveness of NLE and TH interventions in improving mental health outcomes—depression, anxiety, and pain—among ambulatory patients, and to explore the mediating role of anxiety. Method: a systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar from 2010 to 2024. The review adhered to PRISMA guidelines. Eligible studies included randomized controlled trials, quasi-experimental designs, and systematic reviews evaluating NLE or TH interventions for adult outpatient populations. Outcomes of interest included depression (measured by PHQ-9), anxiety (STAI), and pain (VAS). Risk of bias was assessed using the Cochrane RoB tool and ROBINS-I. Data synthesis was narrative due to heterogeneity in study designs. Results: of 1124 records identified, 21 studies met inclusion criteria. Telehealth interventions were associated with significantly greater reductions in depression and pain scores compared to NLE. Anxiety was effectively managed by both interventions, with comparable outcomes. Several studies demonstrated that anxiety served as a key mediator in the relationship between intervention type and improvements in depression and pain. Cultural context, digital access, and patient preferences significantly influenced intervention effectiveness. Conclusion: both NLE and TH interventions are effective in improving mental health outcomes in ambulatory patients. Telehealth offers greater flexibility and impact on depression and pain, while NLE provides culturally grounded peer support, particularly valuable in collectivist societies. The choice of intervention should be informed by patient needs, technological access, and cultural acceptability.