BackgroundThoracolumbar compression fractures frequently coexist with depression, creating a self-reinforcing cycle of pain and psychological distress. Conventional nursing care offers limited psychological support for this comorbid population.MethodsThis quasi-experimental, descriptive study with a non-concurrent historical control enrolled 60 patients with comorbid depression and thoracolumbar compression fracture at a tertiary center in China. The control group (n = 30, February 2019 to March 2021) received conventional nursing, while the research group (n = 30, April 2021 to April 2023) received a comprehensive intervention incorporating psychological counseling, environmental optimization, individualized pain management, health education, structured rehabilitation, and daily living support. Outcomes included depression (SDS), anxiety (SAS), sleep quality (PSQI), pain (VAS), coping styles (SCSQ), and nursing satisfaction, assessed at admission and discharge.ResultsBaseline scores were comparable between groups. Post-nursing, the research group showed significantly lower depression (56.83 vs. 70.17, p < 0.001, d = 1.64), anxiety (54.30 vs. 67.50, p < 0.001, d = 1.69), sleep disturbance (7.83 vs. 12.47, p < 0.001, d = 1.70), and pain scores (3.17 vs. 4.93, p < 0.001, d = 1.50). Positive coping was significantly higher (21.53 vs. 16.07, d = 1.35) and negative coping significantly lower (7.83 vs. 11.27, d = 1.36) in the research group (both p < 0.001). Nursing satisfaction was 96.67% versus 66.67% (p = 0.003). All comparisons survived Holm-Bonferroni correction.ConclusionComprehensive nursing significantly improved psychological status, sleep, pain, and coping in patients with comorbid depression and thoracolumbar compression fracture. The non-randomized design and small sample size limit the strength of these conclusions. Larger prospective randomized trials are needed to confirm these findings.