Effects of Depression on Heart Failure Self-Care
Effects of Depression on Heart Failure Self-Care
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DOI：
10.1016/j.cardfail.2020.12.015
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发表时间：
2021-05-01
影响因子：
6
通讯作者：
Rich, Michael W.
中科院分区：
文献类型：
--
作者：
Freedland, Kenneth E.;Skala, Judith A.;Rich, Michael W.
背景：抑郁症被认为是有效的心力衰竭自我护理的障碍，但最近的研究表明，抑郁和自我护理之间的关系比以前认为的要复杂得多。本研究旨在阐明心力衰竭住院患者抑郁与自我护理的关系。方法与结果：400例心力衰竭住院患者在住院期间完成了结构化访谈，内容包括诊断与统计手册第5版(DSM-5)抑郁障碍诊断问卷、患者健康问卷(PHQ-9)抑郁问卷、心力衰竭自我护理指数(SCHFI)及多份心理社会问卷。多变量模型适用于每个SCHFI量表；单独的模型运行与DSM-5障碍和PHQ-9抑郁评分。PHQ-9抑郁得分较高与SCHFI维持(P<；.05)、管理(P<；.01)和自信(P<；.01)量表得分较低(较差)独立相关。未检测到与DSM-5抑郁障碍的独立关联。心力衰竭患者的心理社会问题包括抑郁、压力、焦虑和社会支持不足，与其他患者相比，心力衰竭患者更容易表现出自理困难，从而增加他们住院的风险。需要对心力衰竭患者的“广谱”心理社会干预进行研究。
Background: Depression has been identified as a barrier to effective heart failure self-care, but recent studies suggest that the relationship between depression and self-care is more complex than was previously believed. This study was designed to clarify the relationship between depression and self-care in hospitalized patients with HF.Methods and Results: During hospitalization with a confirmed clinical diagnosis of HF, 400 patients completed a structured interview to diagnose Diagnostic and Statistical Manual, 5th edition (DSM-5) depressive disorders, the Patient Health Questionnaire (PHQ-9) depression questionnaire, the Self-Care of Heart Failure Index (SCHFI), and several psychosocial questionnaires. Multivariable models were fitted to each SCHFI scale; separate models were run with DSM-5 disorders and PHQ-9 depression scores. Higher PHQ-9 depression scores were independently associated with lower (worse) scores on the SCHFI Maintenance (P < .05), Management (P < .01), and Confidence (P < .01) scales. No independent associations with DSM-5 depressive disorders were detected. Measures of perceived stress, anxiety, and low perceived social support were also significantly associated with poor HF self-care.Conclusions: Patients with a combination of psychosocial problems, including symptoms of depression, stress, anxiety, and inadequate social support, may be more likely than other patients to display difficulties with HF self-care that can increase their risk for hospitalization. Research is needed on "broad-spectrum" psychosocial interventions for patients with HF self-care deficits.