Depression and self-care maintenance in patients with heart failure: A moderated mediation model of self-care confidence and resilience
Depression and self-care maintenance in patients with heart failure: A moderated mediation model of self-care confidence and resilience
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DOI：
10.1177/1474515116687179
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发表时间：
2017-06-01
影响因子：
2.9
通讯作者：
Tsai, Pei-Shan
中科院分区：
文献类型：
--
作者：
Chang, Ling-Yin;Wu, Shan-Ying;Tsai, Pei-Shan
背景：尽管人们认识到抑郁症状对心力衰竭患者的自理自信和自理维持的负面影响，但对这些关系背后的弹性的调节作用知之甚少。目的：探讨抑郁症状是否通过自理自信影响自理维持，以及这一中介过程是否受到弹性的调节。方法：样本包括201名社区居住的、医学上稳定的超声心动图心力衰竭患者。结果：抑郁症状通过降低自理自信(间接效应：-0.22，95%可信区间：-0.36，-0.11)间接降低了自理维持，这一途径仅对中、高水平的患者有显著意义，而对低水平的患者无显著影响。复原力还调节了抑郁症状对自我护理维持的直接影响，从而使抑郁症状与自我护理维持之间的负关联被高复原力的存在逆转。结论：复原力通过自我护理自信对心力衰竭患者自我护理维持的直接和间接影响而调节抑郁症状的直接和间接影响。当考虑到中到高弹性水平的患者的自我护理信心时，通过针对抑郁症状来改善自我护理维护的努力可能会更有效。
Background: Despite the recognition of the negative effects of depressive symptoms on self-care confidence and self-care maintenance in patients with heart failure, little is known about the moderating role of resilience underlying these relations.Aims: To explore whether depressive symptoms affect self-care maintenance through self-care confidence and whether this mediating process was moderated by resilience.Methods: The sample comprised 201 community-dwelling and medically stable patients with echocardiographically documented heart failure. A moderated mediation model was conducted to test whether self-care confidence mediated the association between depressive symptoms and self-care maintenance, and whether resilience moderated the direct and indirect effects of depressive symptoms after adjustment for covariates.Results: Depressive symptoms reduced self-care maintenance indirectly by decreasing self-care confidence (indirect effect: -0.22, 95% confidence interval: -0.36, -0.11), and this pathway was only significant for patients with moderate and high levels and not with low levels of resilience. Resilience also moderated the direct effects of depressive symptoms on self-care maintenance such that the negative association between depressive symptoms and self-care maintenance was reversed by the existence of high resilience.Conclusions: Resilience moderated the direct and indirect effects of depressive symptoms through self-care confidence on self-care maintenance in heart failure patients. Efforts to improve self-care maintenance by targeting depressive symptoms may be more effective when considering self-care confidence in patients with moderate to high levels of resilience.