INDEPENDENCE - Impact Of Nursing Diagnoses EPidemiology iN aDdiction and mENtal health serviCEs: a prospective study protocol

BACKGROUND: Mental health and substance use disorders are associated with complex care needs that often extend beyond psychiatric diagnoses. Nursing diagnoses (NDs) provide a standardized framework to describe human responses to health conditions and may improve the representation of patient complexity. However, evidence regarding NDs’ epidemiology and longitudinal evolution in community mental health and addiction services remains limited. AIM: The INDEPENDENCE study will aim to describe the epidemiological profile of NDs among individuals receiving care from community mental health and/or addiction services. METHODS: INDEPENDENCE will have a prospective longitudinal cohort study design. All adults consecutively admitted in community mental health and addiction services in Trieste (Italy) will be followed for six months. NDs will be assigned according to the NANDA-I taxonomy following structured nursing assessment and agreement between at least two trained nurses. Assessments will be performed at enrollment and repeated after three and six months. The primary outcome will be the epidemiological characterization of NDs at admission (frequency, number and distribution). The changes in NDs prevalence and distribution over time and the clinical, sociodemographic, and organizational predictors of NDs persistence or resolution will be explored as secondary outcomes. Descriptive statistics and multivariable regression models will be used. CONCLUSIONS: The study will provide longitudinal evidence on NDs in mental health and addiction services and may support implementation of standardized nursing languages, nursing workforce planning, and service development. ETHICS: The protocol was approved by the Regional Ethics Committee of Friuli Venezia Giulia (Prot. 0050044/P/GEN/ARCS dated December 19, 2025)