Background Providing care often causes negative reactions and psychological distress in family caregivers of patients with heart failure. How these 2 constructs are related has not been fully explored. Objective The aims of this study were to describe caregiver reactions to caregiving and psychological distress and to determine the associations between caregiver reactions to caregiving and psychological distress in family caregivers of patients with heart failure. Methods In this secondary analysis of a cross-sectional study, the sample included 231 patients and their family caregivers. The Chinese version of the Hospital Anxiety and Depression Scale was used to assess psychological distress (ie, symptoms of anxiety and depression), and the Caregiver Reaction Assessment was used to measure both negative and positive caregiver reactions to caregiving, including financial problems, impact on schedule, health problems, lack of family support, and self-esteem. Results Of the participants, 15.2% and 25.5% of caregivers reported symptoms of depression and anxiety, respectively. Impact on schedule was the most common caregiver reaction, followed by financial problems. Impact on schedule was related to both the caregivers' symptoms of depression (odds ratio [OR], 1.705; P = .001) and anxiety (OR, 1.306; P = .035), whereas financial problems were only related to symptoms of anxiety (OR, 1.273; P = .011). Conclusions The findings suggest that interventions for reducing the negative impact on schedule of caregiving and helping to solve the caregivers' financial concerns might help to relieve their symptoms of depression and anxiety.

Aims The decline of nutritional status and depressive symptoms are pandemic in heart failure patients and functional status may play a pivotal role between these. This study aimed to determine whether nutritional status is associated with depressive symptoms and whether functional status mediates this relationship in heart failure patients. Design This was a secondary analysis of a cross‐sectional study. Methods The data were collected from November 2015–April 2016. Heart failure patients (N = 254) being hospitalized were included in this secondary analysis. The Depression Sub‐Scale of the Hospital Anxiety and Depression Scale and the Duke Activity Status Index were used to assess patients' depressive symptoms and functional status. The nutritional status of patients was calculated using the Geriatric Nutritional Risk Index. Results In this study, the average scores of depressive symptoms, nutritional status and functional status were 4.91 (SD 3.12), 102.38 (SD 6.57) and 20.58 (SD 8.96) respectively. Out of the 254 patients, 46 patients (18.1%) had significant depressive symptoms (the score of Depression Sub‐Scale of the Hospital Anxiety and Depression Scale ≥ 8) and 55 (21.7%) suffered from malnutrition (the score of Geriatric Nutritional Risk Index ≤ 98). In the multiple regression analyses, nutritional status was negatively associated with depressive symptoms (β = −0.142, p = .02) and functional status mediated the relationship between nutritional status and depressive symptoms. Conclusions Many patients with heart failure have malnutrition and depressive symptoms. Functional status plays a mediating role in the relationship between nutritional status and depressive symptoms. Impact To relieve depressive symptoms in patients with heart failure, it is of importance to improve the functional status, especially for those with poor nutritional status.

Aims Depressive symptoms are common in patients with heart failure, and are associated with adverse outcomes in this group. This study examined depressive symptoms and associated determinants in patients with heart failure based on the hopelessness theory of depression. Methods and results In this cross-sectional study, a total of 282 patients with heart failure were recruited from three cardiovascular units of a university hospital. Symptom burden, optimism, maladaptive cognitive emotion regulation strategies, hopelessness, and depressive symptoms were assessed using self-report questionnaires. A path analysis model was established to evaluate the direct and indirect effects. The prevalence of depressive symptoms was 13.8% in the patients. Symptom burden had the greatest direct effect on depressive symptoms (β = 0.406; P < 0.001), optimism affected depressive symptoms both directly and indirectly with hopelessness as the mediator (direct: β = -0.360; P = 0.001; indirect: β = -0.169; P < 0.001), and maladaptive cognitive emotion regulation strategies only had an indirect effect on depressive symptoms with hopelessness as the mediator (β = 0.035; P < 0.001). Conclusions In patients with heart failure, symptom burden, decreased optimism, and hopelessness contribute to depressive symptoms directly. What’s more, decreased optimism and maladaptive cognitive emotion regulation strategies lead to depressive symptoms indirectly via hopelessness. Accordingly, interventions aimed at decreasing symptom burden, enhancing optimism, and reducing the use of maladaptive cognitive emotion regulation strategies while declining hopelessness, may be conducive to relieving depressive symptoms in patients with heart failure.