Effects of Depression on Heart Failure Self-Care

KENNETH E. Freedland, JUDITH A. SKALA, BRIAN C. STEINMEYER, ROBERT M. CARNEY, MICHAEL W. RICH

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background: Depression has been identified as a barrier to effective heart failure self-care, but recent studies suggest that the relationship between depression and self-care is more complex than was previously believed. This study was designed to clarify the relationship between depression and self-care in hospitalized patients with HF. Methods and Results: During hospitalization with a confirmed clinical diagnosis of HF, 400 patients completed a structured interview to diagnose Diagnostic and Statistical Manual, 5th edition (DSM-5) depressive disorders, the Patient Health Questionnaire (PHQ-9) depression questionnaire, the Self-Care of Heart Failure Index (SCHFI), and several psychosocial questionnaires. Multivariable models were fitted to each SCHFI scale; separate models were run with DSM-5 disorders and PHQ-9 depression scores. Higher PHQ-9 depression scores were independently associated with lower (worse) scores on the SCHFI Maintenance (P < .05), Management (P < .01), and Confidence (P < .01) scales. No independent associations with DSM-5 depressive disorders were detected. Measures of perceived stress, anxiety, and low perceived social support were also significantly associated with poor HF self-care. Conclusions: Patients with a combination of psychosocial problems, including symptoms of depression, stress, anxiety, and inadequate social support, may be more likely than other patients to display difficulties with HF self-care that can increase their risk for hospitalization. Research is needed on “broad-spectrum” psychosocial interventions for patients with HF self-care deficits.

Original languageEnglish
Pages (from-to)522-532
Number of pages11
JournalJournal of cardiac failure
Volume27
Issue number5
DOIs
StatePublished - May 2021

Keywords

  • Depression
  • depressive disorders
  • heart failure
  • self-care

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