Predictors of Depressive Symptoms among Patients with Heart Failure in Jordan. A Cross-Sectional Study
DOI:
https://doi.org/10.35516/jmj.v59i5.2483Keywords:
Depression, Heart Failure, Jordan, PredictorsAbstract
Background and aim: Heart failure (HF) is a serious health problem in developed and developing countries. The prevalence of depressive symptoms (DS) among patients with HF is high and it might reach up to more than 96%. Depressive symptoms among patients with HF are associated with worse outcomes including recurrent admissions and poor quality of life. Identifying predictors of DS can help in controlling these factors and thereafter these DS leading to better outcomes for this population. This study aimed to identify the most important predictors of DS among patients with HF.
Materials and methods: A descriptive, cross-sectional correlational design was used with a convenience sample of 300 patients with a confirmed diagnosis of HF recruited from one governmental and one private hospital in Amman, Jordan. Depressive symptoms were measured using Beck Depression Inventory-II, while sociodemographic and clinical characteristics were collected either by patient interviews or medical records reviews. Logistic regression was used to determine the predictors of DS.
Results: 209 males and 91 females participated in this study. As independent predictors of DS, older people, females, higher levels of New York Heart Association, and a history of diabetes and hypertension increased the severity of DS. On the contrary, higher levels of Left Ventricular Ejection Fraction were protective against DS. Every unit increase in Left Ventricular Ejection Fraction decreased DS by 45%.
Conclusion: Identifying patients at risk for developing DS is critical to provide necessary assessment and management for them which might improve the quality of their lives, and prognosis.
References
Pelegrino VM, Dantas RAS, Clark AM. Health-related quality of life determinants in outpatients with heart failure. Rev Latino-Am Enfermagem. 2011; 19:451-457.
AbuRuz ME. Anxiety and depression predicted quality of life among patients with heart failure. J Multidiscip Healthc. 2018; 11:367-373. https://doi.org/10.2147/jmdh.s170327.
Alemoush RA, Al-Dweik G, AbuRuz ME. The effect of persistent anxiety and depressive symptoms on quality of life among patients with heart failure. Appl Nurs Res. 2021; 62:151503. https://doi.org/10.1016/j.apnr.2021.151503.
Uchmanowicz I, Gobbens RJ. The relationship between frailty, anxiety and depression, and health-related quality of life in elderly patients with heart failure. Clin Interv Aging. 2015; 10:1595-1600. https://doi.org/10.2147/cia.s90077.
Alaloul F, AbuRuz ME, Moser DK, Hall LA, Al-Sadi A. Factors associated with quality of life in Arab patients with heart failure. Scand J Caring Sci. 2017; 31(1):104-111.
https://doi.org/10.1111/scs.12324.
Zahid I, Baig MA, Ahmed Gilani J, et al. Frequency and predictors of depression in congestive heart failure. Indian Heart J. 2018; 70 Suppl 3(Suppl 3):S199-s203.
https://doi.org/10.1016/j.ihj.2018.10.410.
Aggelopoulou Z, Fotos NV, Chatziefstratiou AA, Giakoumidakis K, Elefsiniotis I, Brokalaki H. The level of anxiety, depression and quality of life among patients with heart failure in Greece. Appl Nurs Res. 2017; 34:52-56.
https://doi.org/10.1016/j.apnr.2017.01.003.
Tsabedze N, Kinsey JH, Mpanya D, Mogashoa V, Klug E, Manga P. The prevalence of depression, stress and anxiety symptoms in patients with chronic heart failure. Int J Ment Health Syst. 2021; 15(1):44.
https://doi.org/10.1186/s13033-021-00467-x.
Isaksen K, Munk PS, Giske R, Larsen AI. Effects of aerobic interval training on measures of anxiety, depression and quality of life in patients with ischaemic heart failure and an implantable cardioverter defibrillator: A prospective non-randomized trial. J Rehabil Med. 2016; 48(3):300-306. https://doi.org/10.2340/16501977-2043.
Shen BJ, Eisenberg SA, Maeda U, et al. Depression and anxiety predict decline in physical health functioning in patients with heart failure. Ann Behav Med. 2011; 41(3):373-382. https://doi.org/10.1007/s12160-010-9251-z.
Sullivan M, Simon G, Spertus J, Russo J. Depression-related costs in heart failure care. Arch Intern Med. 2002; 162(16):1860-1866. https://doi.org/10.1001/archinte.162.16.1860.
Rumsfeld JS, Havranek E, Masoudi FA, et al. Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol. 2003; 42(10):1811-1817. https://doi.org/10.1016/j.jacc.2003.07.013.
Sherwood A, Blumenthal JA, Trivedi R, et al. Relationship of depression to death or hospitalization in patients with heart failure. Arch Intern Med. 2007; 167(4):367-373. https://doi.org/10.1001/archinte.167.4.367.
Ghaemian A, Mohammadpour TR, Hosseini SH, Etemadi S. Depression in heart failure patients and the influence of age, gender and severity of depression on heart failure patients. J Teh Univ Heart Ctr. 2007:31-34.
Vaccarino V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol. 2001; 38(1):199-205. https://doi.org/10.1016/s0735-1097(01)01334-1.
Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. 2022; 145(8):e153-e639. https://doi.org/10.1161/cir.0000000000001052.
Bush DE, Ziegelstein RC, Tayback M, et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol. 2001; 88(4):337-341. https://doi.org/10.1016/s0002-9149(01)01675-7.
Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Do depression and anxiety predict recurrent coronary events 12 months after myocardial infarction? Qjm. 2000; 93(11):739-744. https://doi.org/10.1093/qjmed/93.11.739.
Lane D, Ring C, Lip GY, Carroll D. Depression, indirect clinical markers of cardiac disease severity, and mortality following myocardial infarction. Heart. 2005; 91(4):531-532. https://doi.org/10.1136/hrt.2004.036392.
AbuRuz ME, Alaloul F, Al-Dweik G. Depressive symptoms are associated with in-hospital complications following acute myocardial infarction. Appl Nurs Res. 2018; 39:65-70. https://doi.org/10.1016/j.apnr.2017.11.001.
Glaesmer H, Riedel-Heller S, Braehler E, Spangenberg L, Luppa M. Age- and gender-specific prevalence and risk factors for depressive symptoms in the elderly: a population-based study. Int Psychogeriatr. 2011; 23(8):1294-1300. https://doi.org/10.1017/s1041610211000780.
Nolen-Hoeksema S, Ahrens C. Age differences and similarities in the correlates of depressive symptoms. Psychol Aging. 2002; 17(1):116-124. https://doi.org/10.1037//0882-7974.17.1.116.
Richardson RA, Keyes KM, Medina JT, Calvo E. Sociodemographic inequalities in depression among older adults: cross-sectional evidence from 18 countries. Lancet Psychiatry. 2020; 7(8):673-681.
https://doi.org/10.1016/s2215-0366(20)30151-6.
Gottlieb SS, Khatta M, Friedmann E, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol. 2004; 43(9):1542-1549. https://doi.org/10.1016/j.jacc.2003.10.064.
Kao CW, Chen TY, Cheng SM, Lin WS, Friedmann E, Thomas SA. Gender differences in the predictors of depression among patients with heart failure. Eur J Cardiovasc Nurs. 2014; 13(4):320-328. https://doi.org/10.1177/1474515113496493.
Lesman-Leegte I, Jaarsma T, Coyne JC, Hillege HL, Van Veldhuisen DJ, Sanderman R. Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls. J Card Fail. 2009; 15(1):17-23. https://doi.org/10.1016/j.cardfail.2008.09.006.
Delville CL, McDougall G. A systematic review of depression in adults with heart failure: instruments and incidence. Issues Ment Health Nurs. 2008; 29(9):1002-1017. https://doi.org/10.1080/01612840802274867.
van Melle JP, de Jonge P, Ormel J, et al. Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT. Eur Heart J. 2005; 26(24):2650-2656. https://doi.org/10.1093/eurheartj/ehi480.
Bagherian-Sararoudi R, Gilani B, Bahrami Ehsan H, Sanei H. Relationship between left ventricular ejection fraction and depression following myocardial infarction: an original article. ARYA Atheroscler. 2013; 9(1):16-21.
Freedland KE, Carney RM, Steinmeyer BC, Skala JA, Rich MW. Left Ventricular Dysfunction and Depression in Hospitalized Patients with Heart Failure. Psychosom Med. 2021; 83(3):274-282. https://doi.org/10.1097/psy.0000000000000915.
Sherwood A, Blumenthal JA, Hinderliter AL, et al. Worsening depressive symptoms are associated with adverse clinical outcomes in patients with heart failure. J Am Coll Cardiol. 2011; 57(4):418-423. https://doi.org/10.1016/j.jacc.2010.09.031.

