Depressive Symptoms In Patients With Chronic Heart Failure:Influencing Factors And Path Analysis

ObjectivesTo explore the effects of symptom burden,cognitive vulnerability,and hopelessness on depressive symptoms among patients with chronic heart failure(CHF)using the hopelessness theory of depression,in order to provide the basis for formulating effective intervention strategies to alleviate depressive symptoms of patients.MethodsA cross-sectional design was used in this study.A total of 282 patients with CHF were recruited from cardiovascular units of a large hospital in Shandong province from November,2018 to October,2019.The Center Epidemiological Studies of Depression Scale(CES-D),Heart Failure Somatic Perception Scale,Life Orientation Test-Revised,Cognitive Emotion Regulation Questionnaire,and Beck Hopelessness Scale were used to measure depressive symptoms,symptom burden,dispositional optimism,cognitive emotion regulation strategies,and hopelessness of patients.New York Heart Association(NYHA)functional class,Left ventricular ejection fraction(LVEF),comorbidities,and other clinical data were obtained from medical records.SPSS 24.0 software and SPSS Amos 21.0 software were used for data analysis.Statistical description,inter-group difference comparison,correlation analysis,multiple regression analysis,and path analysis were performed.Results1.The mean score for depressive symptoms was(9.01±4.36)in patients with CHF,and 13.8%of the patients reported depressive symptoms(CES-D?16).2.Factors related to depressive symptoms in patients with CHF(1)The relationship between general data characteristics and depressive symptomsPatients who were female,had family monthly income less than ?3000,were unemployed,with NYHA class ?/?,with diagnosis of CHF six months or longer,and were treated with diuretics reported higher scores of depressive symptoms than those who were male,had family monthly income greater or equal to ?3000,were with brain work or retirement,were with NYHA class ?/?,were with diagnosis of CHF less than six months,and were not treated with diuretics(P<0.05 or P<0.01).(2)Symptom burden,cognitive vulnerability,hopelessness and their correlation with depressive symptomsThe mean score for symptom burden was(11.16±7.11),and was positively correlated with depressive symptoms(r=0.578,P<0.001);the mean score for dispositional optimism was(18.42±2.50),and was negatively correlated with depressive symptoms(r=-0.673,P<0.001);the mean score for adaptive cognitive emotion regulation strategy was(44.26±5.18),and was negatively correlated with depressive symptoms(r=-0.161,P<0.01);the mean score for maladaptive cognitive emotion regulation strategy was(42.61±5.96),and was positively correlated with depressive symptoms(r=0.390,P<0.001);the median score for hopelessness was 1[0,2.25],and was positively correlated with depressive symptoms(rs=0.602,P<0.001).3.The effects of symptom burden,cognitive vulnerability,and hopelessness on depressive symptoms(1)Multiple regression of depressive symptomsSymptom burden(?=0.406,P<0.001)and hopelessness(?=0.235,P<0.001)were positively related to depressive symptoms,dispositional optimism(?-0.352,P<0.001)was negatively related to depressive symptoms.Female patients had more depressive symptoms than male(?=-0.104,P<0.01).All these factors explained 65.4%of the variation of depressive symptoms(adjusted R2=0.654).(3)The path analysis of depressive symptoms Symptom burden directly positively affected depressive symptoms of CHF patients(?=0.406,P<0.001);dispositional optimism not only directly negatively affected(?=-0.360,P=0.001)but also indirectly negatively affected depressive symptoms,and the indirect effect size was-0.169(95%CI:-0.263,-0.081);maladaptive cognitive emotion regulation strategy indirectly positively affected depressive symptoms,and the indirect effect size was 0.035(95%CI:0.012,0.068);hopelessness directly positively affected depressive symptoms(?=0.242,P<0.001).The path model fits well(?2=8.245,P=0.083,CFI=0.993,TLI=0.974,GFI=0.990,AGFI=0.950,RMSEA=0.061).Conclusions1.Depressive symptoms were common in patients with CHF,and were more common in female than in male patients.2.Symptom burden,maladaptive cognitive emotion regulation strategy,and hopelessness were positively correlated with depressive symptoms.Dispositional optimism and adaptive cognitive emotion regulation strategy were negatively correlated with depressive symptoms.3.Symptom burden and hopelessness were directly positively associated with depressive symptoms.Dispositional optimism was not only directly but also indirectly negatively associated with depressive symptoms.Maladaptive cognitive emotion regulation strategy indirectly positively associated with depressive symptoms.4.Clinical workers could reduce depressive symptoms in patients with CHF by alleviating symptom burden.They also could enhance dispositional optimism and reduce the use maladaptive cognitive emotion regulation strategy to reduce patients'sense of hopelessness,thereby alleviate depressive symptoms.