ISQUA16-1476RESILIENCE AND DEPRESSION SYNERGICALLY AFFECT SELF-CARE MAINTENANCE OF HEART FAILURE

Abstract

Objectives: Due to an aging population and improved survival from acute cardiac events, the prevalence of heart failure (HF) is rising worldwide. HF places a tremendous burden on patients, their families, the community, and the health care system. Inadequate self-care is common in HF, which often leads to acute exacerbations and hospitalizations. Guidelines on HF stress the importance of self-care behaviors, such as adhering to medications, following a low-sodium diet, exercising, and monitoring symptoms in the treatment of HF. The positive effect of resilience and negative effect of depression on self-care behaviors are well understood. Little is known, however, on possible synergic effects of depression and resilience on self-care confidence and self-care maintenance in this population. Methods: A total of 203 patients with HF were enrolled. Information regarding demographic data, body mass index (BMI), comorbidities, exercise habits, depressive symptoms, psychological resilience, self-care confidence, and self-care maintenance were obtained. The burden of comorbidities was estimated by calculating the Charlson Comorbidity Index (CCI). Depressive symptoms were measured using the Beck Depression Inventory II (BDI-II). The Resilience Scale (RS) was used to determine the degree of psychological resilience. The Self Care of Heart Failure Index (SCHFI) was used to gauge the participants' levels of self-care confidence and self-care maintenance. Hierarchical multiple regressions models were developed to estimate the predictor role played by resilience and depression and the moderating effect of resilience on the relationship between depression and self-care confidence/maintenance. Results: Hierarchical multiple regression revealed that both RS (B = 0.33, SE = 0.06, p < 0.001) and BDI-II scores (B = -0.75, SE = 0.23, p < 0.001) independently predicted the level of self-care confidence after adjustment of demographic variables, CCI, and BMI. In terms of self-care maintenance, RS scores (B = 0.15, SE = 0.05, p < 0.001) but not BDI-II scores (B = -0.29, SE = 0.17, p = 0.10) were found to be an independent predictor after adjustment of demographic variables, CCI, and BMI. Moreover, resilience and depression exerted a synergic effect on self-care maintenance as the resilience × depression interaction effect on self-care maintenance was statistically significant (B = 0.02, SE = 0.01, p < 0.001). Conclusion: Resilience enhances both self-care confidence and self-care maintenance in patients with HF whereas depression negatively affects self-care confidence. Resilience and depression act synergically on self-care maintenance. Thus, treatments targeting the enhancement of psychological resilience might mitigate the negative effects of depression on self-care maintenance of HF to optimize the outcomes of self-management strategies.