Family Context Influences Psychological Outcomes of Depressive Symptoms and Emotional Quality of Life in Patients With Heart Failure

Abstract

Background Although family influences in heart failure (HF) care are considered important, little evidence is available regarding relationships between the family context and specific outcomes for patients with HF. Objective To examine the relationships of patient perceptions of family functioning, autonomy support, and perceived criticism, as well as their family member’s (FM) HF knowledge with patient outcomes of depressive symptoms and HF quality of life (QOL). Methods Participants (n = 117) with HF were enrolled in a family partnership intervention study. Self-report questionnaires measuring the HF patient’s perceptions of family context and the FM’s knowledge were analyzed relative to the HF patient’s outcomes using correlations and sequential multivariate regression analyses. Only pre-intervention, baseline data are reported here. Results Age, ethnicity, Charlson comorbidity index, global family functioning and FM’s HF knowledge accounted for 37.8 % (p < .001) of the variance in patient’s depressive symptoms. An additional moderating effect of ethnicity on the association between global family functioning and patient’s depressive symptoms was significant (change R2 = .06, p = .001) resulting in a final model that accounted 43.3% of depressive symptom variance. Age, ethnicity, global family functioning and autonomy support accounted for 24.9% (p < .001) of the variance in emotional HF QOL. An additional moderating effect of ethnicity on the association between global family functioning and patient’s emotional HF QOL was significant (change R2 = .05, p = .009) resulting in a final model that accounted for 28.9% of emotional QOL variance. Conclusions This study underscores the importance of the patient’s perspective on family functioning and autonomy support, along with FM’s HF knowledge, on HF patient outcomes moderated by ethnicity. Future interventions could target the modifiable patient-family context relationships for improving depressive symptoms and QOL in HF patients. These findings point to the need for greater family assessment to identify those at risk for worse outcomes and to guide family focused interventions.

Randomized Clinical Trial of an Integrated Self-Care Intervention for Persons With Heart Failure and Diabetes: Quality of Life and Physical Functioning Outcomes

“…47–49 The decline in quality of life associated with an additional condition in people with multiple chronic conditions was less for older people than for younger people. 11 Younger age was also related to increased attrition which may have stemmed from lower QOL, or the greater life demands in this age group competing with study activities.…”

Family partnership and education interventions to reduce dietary sodium by patients with heart failure differ by family functioning

“…It is not surprising that higher depressive symptoms were associated with lower adherence to a low Na diet, as prior studies have shown poor self-care adherence in those with higher depressive symptoms. 15,25 This was specifically demonstrated in the poor family functioning strata, and likely reflects the increased vulnerability for poor dietary adherence that depressive symptoms add when the family context is not ideal. Likewise, research has shown that in general women with HF tend to be more adherent to a lower Na diet than do men.…”

“…family functioning) on response to two types of patient and family interventions. Because good family functioning has been linked to better patient outcomes, 15 we were interested to know if adding more information, communication support and problem solving was useful for those experiencing better and worse family contexts. When examining the response (per the 24-hour urine sodium results) to the two types of patient and family interventions compared with UC by good and poor family functioning scores, we found that those HF patients with poor family functioning scores benefited from the more intense family focused intervention than those with reported good family functioning scores.…”

“…The well-established 21-item Beck Depression Inventory II (BDI-II) was used to measure patient depressive symptoms. 14,15 The BDI-II assesses feelings of sadness, guilt, self-criticism, tearfulness, and feelings of cynicism or negativity. The items are on a scale from 0–3, representing the degree in which the symptoms were experienced in the past 2 weeks.…”

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

“…46,47 Several studies have shown that caregiver self-esteem, optimism, and anxiety are associated with outcomes for patients with CVD (eg, depressive symptoms, quality of life). [46][47][48] Our analysis does not quantify emotional or health burden, job loss, life changes, healthcare use, or out-of-pocket costs incurred by informal caregivers. Frequently referred to as spillover effects, 49 limited research exists on the economic spillover effects on CVD caregivers.…”