HFSA: Depressed Spouse Affects HF Patient, Too
By Todd Neale, Senior Staff Writer, September 22, 2011
Today Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that for patients with heart failure, their quality of life suffers most when both they and their caregivers are depressed.
Note that the next lowest physical and mental quality of life scores occurred when only the patient was depressed.
Review
BOSTON -- Heart failure patients' quality of life suffers most when both they and their caregivers are depressed, researchers found.
In a study of 91 patient-caregiver pairs, a patient's physical and mental quality of life scores were lowest when both the patient and his or her caregiver were depressed (P<0.05), according to Misook Chung, PhD, RN, of the University of Kentucky in Lexington.
The next lowest scores occurred when only the patient was depressed, she reported at the Heart Failure Society of America meeting here.
In this study, nearly three-quarters of the caregivers were spouses, and 76% of them were women.
From the caregiver's perspective, quality of life scores were similarly low when both the patient and the caregiver were depressed and when the caregiver was the only one who was depressed.
The findings indicate that healthcare professionals in a heart failure program should be focusing on both the patient's and the caregiver's well-being, which is not generally done, Chung said.
"Because caregivers are hidden patients, too, and a lot of caregivers of heart failure patients have stress, especially emotional stress. And they also have a lot of comorbidity because they are burdened," she said. "So I think the dyadic approach must be done."
Previous studies have shown that up to three-quarters of patients with heart failure report at least some depressive symptoms; up to 35% of those report high levels.
But depression is common among the caregivers as well, with studies indicating that 23% to 47% of spouses of patients of heart failure have mild-to-moderate depressive symptoms.
To explore the impact of depression in both the patient and the caregiver, Chung and her colleagues assessed depression, quality of life, and family function among 91 patient-caregiver dyads in Kentucky.
The caregivers were an average of 5.4 years younger than the patients with heart failure (56.7 versus 62.1, P<0.001). About half of all caregivers and patients had less than a high school education and most were white.
Nearly one-third of caregivers had at least one comorbidity, but information documenting comorbidities was missing for 23% of caregivers, so the rate could have been higher. Also, 30.8% of caregivers worked full or part-time outside the home.
All of the participants underwent screening with the Beck Depression Inventory, the McMaster Family Assessment Device, and the Short Form-36 to measure levels of depressive symptoms, family function, and quality of life, respectively.
Overall, 30% of patients and 25% of caregivers had at least mild depressive symptoms. On average, the level of depressive symptoms was higher in the patients (P=0.011).
The caregivers and patients gave similar scores on all three subscales of family function -- problem solving ability, communication, and general family function.
Physical quality of life scores were lower in the patients, although scores on mental quality of life were similar in the two groups.
On a scale of 0 (poor) to 100 (best), when neither party was depressed, patients reported a score of 34.6 compared with 26.0 when both were depressed (P<0.001). Scores for caregivers were 45.5 and 39.8, respectively (P<0.001).
In general, family function and quality of life were harmed most when both the patient and caregiver were depressed and least when neither was depressed.
For example, on a scale of 1 (healthy function) to 4 (unhealthy function), the general family function when neither party was depressed was 1.8 from both the patient and caregiver's perspective. When both parties were depressed, the scores rose to 2.3 and 2.4 for patient and caregiver, respectively (P=0.001 and P=0.05).
Chung said that she and her colleagues are conducting a pilot study among 38 dyads to see whether an intervention targeting both patients with heart failure and their caregivers can improve outcomes for both compared with usual care. The intervention involves cognitive behavioral therapy and the teaching of self-management skills.