Background: Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Resilience, defined as a dynamic process of positively responding to adversity, could protect against depressive symptoms in cardiac disease. No systematic review has been conducted on the relationship between these variables in this population. Objective: The aim of this review was to explore the association between psychological resilience and depressive symptoms in adults with cardiac disease. Methods: Seven databases (PubMed, EMBASE, CINAHL, PsycInfo, Web of Science, SCOPUS, and Cochrane) were searched from inception to December 2019 using the search terms "cardiac disease," "depressive symptoms," "depression," and "resilience." Inclusion criteria dictated that studies reported original research on the association between resilience and depressive symptoms in adults with a cardiac disease broadly defined. Quality ratings were performed by 2 independent raters. Results: We identified 13 studies for final review. Study sample sizes ranged from 30 to 1022 participants, average age ranged from 52 to 72 years, and all studies had majority male participants (64%-100%). Resilience and depressive symptoms were inversely related in 10 of 13 studies. The 3 studies with poor-quality sampling techniques or significant loss to follow-up found no relationship. Conclusions: Resilience seems to protect against depression in adults with cardiac disease. Gaps in the literature include poor understanding of the direction of causality. Methods of promoting resilience need to be identified and studied.

Despite the high prevalence of depression in HF, little is known about how depression affects symptom perception processes of monitoring, detection, and evaluation. If depression impairs symptom perception, it may delay care-seeking. Aim: To explore how depression influences HF symptom perception. Methods: We enrolled a purposive sample of patients with an unplanned HF hospitalization in this convergent mixed-methods study. Semi-structured in-person interviews were used to explore how patients monitored, detected, and evaluated symptoms prior to hospitalization. HF symptom monitoring, physical symptom presence/severity, and symptom evaluation were measured using the Self-care HF Index, the HF Somatic Perception Scale, and the Illness Perception Scale, respectively. Depression was measured using the Patient Health Questionnaire (PHQ8); score≥10 indicates moderate/severe depression. Qualitative data were analyzed using content analysis to yield categories of symptom type, detection time, and barriers/facilitators for symptom monitoring, detection, and evaluation. To integrate the data, qualitative data were quantified by assigning binary values (e.g. immediacy of symptom detection). Pearson’s correlation and Chi 2 were used to analyze associations. Results: A sample of 40 patients (age 62±13 years, 50% female, 55% White, median HF duration 6 years, 75% NYHA III-IV, 58% PHQ8≥10) was enrolled. There was no significant association between depression and HF symptom monitoring, but moderate/severe depression was described as a barrier to symptom monitoring ("When I get into my depression days, I won't get on the scale, or I just won't do anything."). Depressed patients appeared to detect symptoms more rapidly (p=0.051). More depressed patients reported greater physical symptom severity (r=0.44, p=0.005), but the number of symptoms was not associated with depression. More depressed patients had stronger belief in negative consequences of HF (r=0.46, p=0.003), more negative emotional responses to HF (r=0.60, p<0.001), and less perceived control over HF (r= -0.35, p=0.028). Conclusion: Depressed patients may have difficulties in symptom monitoring, but not in symptom detection. Depression negatively influences symptom evaluation.

Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Psychological resilience may protect against depressive symptoms, but benefits are not yet conclusive. We conducted a systematic review to examine the association between resilience and depressive symptoms in adults with cardiac disease. Seven databases were searched from inception to December 2019 using the search terms “cardiac disease,” “depressive symptoms,” “depression,” and “resilience.” The 623 articles identified were narrowed through title, abstract and full-text review leaving 13 studies for final analysis. Resilience and depressive symptoms were inversely related in 10 of 13 studies. The three studies with poor quality sampling techniques or significant loss to follow-up found null results. The major gap identified in the literature was poor understanding of the longitudinal pattern between resilience and depressive symptoms. If the direction of causality functions as expected in longitudinal research, optimizing resilience could help attenuate depressive symptoms.

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