The Impact of Self-Efficacy and Depression on Self-Care in Patients with Heart Failure: An Integrative Review

Abstract

[2]. There are 6.5 million patients living with HF in Eu-rope [3,4] and 5.1 million in the USA [5]. The most recent European data (ESC-HF pilot study) demonstrate that 12-month all-cause mortality rates for hospitalized and stable/ambulatory HF patients were 17% and 7%, respectively, and the 12-month hospitalization rates were 44% and 32%, respectively [6]. Encouraging self-care and self-efficacy [7-13] and treating depression [7,12,14,15] have all identified as key factors for lowering mortality rates. Patients with HF are more prone to depression, with a reported prevalence between 9% and 60% [16-18], compared with 5% to 10% in the normal population in Europe [19]. The World Health Organization defines depression as a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt, low self-worth, disturbed sleep and appetite, tiredness, and poor concentration [20]. Recent results from the OPERA-HF study [21] show that moderate to severe depression is associated with a 5-fold increased risk of all-cause mortality in patients with HF. Patients who were not depressed had an 80% lower mortality risk [21]. Self-efficacy has been associated with adverse outcomes and has been considered a reasonable proxy for predicting HF hospitalization [22]. Lower baseline self-efficacy is associated with worse cardiac function and increased risk for HF hospitalization. The concept of self-efficacy is based on Bandura's social cognitive theory [13]. The self-efficacy theory of depression focuses on Abstract Background: Although the importance of self-efficacy and depression are mapped out in previous research; there is a lack of clarity about associations between self-efficacy and depression to self-care, and potential implications for nursing care. The purpose of this review was to identify the association between self-efficacy and depression and how it affects self-care in the HF population.