Perceived social support predicted quality of life in patients with heart failure, but the effect is mediated by depressive symptoms
Depressive symptoms and inadequate social support are well-known independent predictors of increased mortality and morbidity in heart failure (HF). However, it is unclear how depressive symptoms and social support interact to influence quality of life. Thus, the purpose of this study was to determine the nature of the relationships (direct, mediator, and moderator) among depressive symptoms, social support, and quality of life in patients with HF.
We performed a secondary data analysis that included 362 patients with HF who completed the measures of depressive symptoms (the Beck Depression Inventory-II), perceived social support (the Multidimensional Scale of Perceived Social Support), and quality of life (the Minnesota Living with Heart Failure Questionnaire) instruments. The direct, mediator, and moderator effects of both depressive symptoms and social support on quality of life were tested using multiple regressions and 2 × 2 ANCOVA.
Less social support and greater depressive symptoms independently predicted poorer quality of life. The relationship between social support and quality of life was mediated by depressive symptoms. Neither social support nor depressive symptoms moderated quality of life.
Promotion of social support will improve quality of life only when depressive symptoms are also effectively managed.
KeywordsQuality of life Depressive symptoms Perceived social support Mediator Moderator Heart failure
The Multidimensional Scale of Perceived Social Support
The New York Heart Association
The Beck Depression Inventory-II
The Minnesota Living with Heart Failure Questionnaire
The Duke Activity Status Index
The authors would like to thank all staff in the Research and Intervention for Cardiopulmonary Health (RICH) Heart Program and all participants in the RICH Heart Program. Authors received from Grant/Financial support (1) NIH/NINR 3R01 009280 (Moser, D. K., PI); (2) NIH/NINR 5R01 008567 (Lennie, T. A., PI); (3) AACN Phillips Medical Research Award (Moser, D.K., PI; Chung, M.L., co-PI); (4) NIH/NIH M01RR02602 (University of Kentucky Center for Clinical and Translational Science); (5) NIH/NINR 1P20NR010679 (Moser, D.K., PI and P-20 Center Director).
- 9.Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology, 48(8), 1527–1537.PubMedCrossRefGoogle Scholar
- 11.Lichtman, J. H., Bigger, J. T., Jr., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lesperance, F., Mark, D. B., Sheps, D. S., Taylor, C. B., & Froelicher, E. S. (2008). Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association (Vol. 118, pp. 1768–1775).Google Scholar
- 12.Song, E. K., Moser, D. K., Frazier, S. K., Heo, S., Chung, M. L., & Lennie, T. A. (2010). Depressive symptoms affect the relationship of N-terminal pro B-type natriuretic peptide to cardiac event-free survival in patients with heart failure. Journal of Cardiac Failure, 16(7), 572–578.PubMedCrossRefGoogle Scholar
- 17.Beck, A. T., Brown, G., & Steer, R. A. (1996). Beck depression inventory II manual. San Antonio, TX: The Psychological Corporation.Google Scholar
- 19.Rector, T. S., & Cohn, J. N. (1992). Assessment of patient outcome with the Minnesota living with heart failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. American Heart Journal, 124(4), 1017–1025.PubMedCrossRefGoogle Scholar
- 23.Chung, M. L., Moser, D. K., Lennie, T. A., & Rayens, M. K. (2009). The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using actor-partner interdependence model. Journal of Psychosomatic Research, 67(1), 29–35.PubMedCrossRefGoogle Scholar
- 27.Alonso, J., Permanyer-Miralda, G., Cascant, P., Brotons, C., Prieto, L., & Soler-Soler, J. (1997). Measuring functional status of chronic coronary patients. Reliability, validity and responsiveness to clinical change of the reduced version of the duke activity status index (DASI). European Heart Journal, 18(3), 414–419.PubMedCrossRefGoogle Scholar
- 28.Parissis, J. T., Nikolaou, M., Farmakis, D., Bistola, V., Paraskevaidis, I. A., Adamopoulos, S., et al. (2008). Clinical and prognostic implications of self-rating depression scales and plasma B-type natriuretic peptide in hospitalised patients with chronic heart failure. Heart, 94(5), 585–589.PubMedCrossRefGoogle Scholar
- 31.de Leon, C. F., Grady, K. L., Eaton, C., Rucker-Whitaker, C., Janssen, I., Calvin, J., et al. (2009). Quality of life in a diverse population of patients with heart failure: Baseline findings from the heart failure adherence and retention trial (hart). Journal of Cardiopulmonary Rehabilitation and Prevention, 29(3), 171–178.PubMedGoogle Scholar
- 32.Jiang, W., Alexander, J., Christopher, E., Kuchibhatla, M., Gaulden, L. H., Cuffe, M. S., et al. (2001). Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Archives of Internal Medicine, 161(15), 1849–1856.PubMedCrossRefGoogle Scholar
- 33.Ariyo, A. A., Haan, M., Tangen, C. M., Rutledge, J. C., Cushman, M., Dobs, A., et al. (2000). Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group. Circulation, 102(15), 1773–1779.PubMedCrossRefGoogle Scholar
- 35.Gottlieb, S. S., Kop, W. J., Thomas, S. A., Katzen, S., Vesely, M. R., Greenberg, N., et al. (2007). A double-blind placebo-controlled pilot study of controlled-release paroxetine on depression and quality of life in chronic heart failure. American Heart Journal, 153(5), 868–873.PubMedCrossRefGoogle Scholar
- 36.Lesperance, F., Frasure-Smith, N., Laliberte, M. A., White, M., Lafontaine, S., Calderone, A., et al. (2003). An open-label study of nefazodone treatment of major depression in patients with congestive heart failure. Canadian Journal of Psychiatry, 48(10), 695–701.Google Scholar
- 41.Mendes de Leon, C. F., Czajkowski, S. M., Freedland, K. E., Bang, H., Powell, L. H., Wu, C., et al. (2006). The effect of a psychosocial intervention and quality of life after acute myocardial infarction: The enhancing recovery in coronary heart disease (ENRICHD) clinical trial. Journal of Cardiopulmonary Rehabilitation, 26(1), 9–13.; quiz 14–15.PubMedCrossRefGoogle Scholar
- 42.Berkman, L. F., Blumenthal, J., Burg, M., Carney, R. M., Catellier, D., Cowan, M. J., et al. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The enhancing recovery in coronary heart disease patients (ENRICHD) randomized trial. JAMA, 289(23), 3106–3116.PubMedCrossRefGoogle Scholar