The Synergic Effect of Resilience and Depression on Self-Care in Patients with Chronic Heart Failure

Background: Self-care behavior can improve the health and the prognosis in patients with chronic heart failure (CHF). Therefore, self-care behavior has not only been considered as CHF patients clinical care guidelines but also an important part of disease treatment. Both resilience and depression have been found to associate with self-care, however, the synergic effects of resilience and depression on self-care in patients with CHF remains unknown.

Objectives: This study aims to 1) examine the relationships among resilience, depression, and self-care in CHF patients, and 2) determine whether the relationship between resilience and self-care is moderated by severity of depressive symptoms.

Methods: 128 CHF inpatients and outpatients were recruited from Northern Taiwan hospitals. Participants’ resilience, depression, and self-care were assessed using Resilience Scale, Beck Depression Inventory-II, and Self-care of Heart Failure Index, respectively. The multiple regression models were conducted in SAS software version 9.2 to determine the main and synergic effect of resilience and depression on self-care. All models controlled for confounders (i.e. age, gender, marriage state, education, co-morbidities, Body Mass Index, and weekly exercise).

Results: After adjustment for confounders, resilience was positively and significantly associated with both self-care maintenance (p < 0.01) and self-care confidence (p < 0.01). Depression was negatively and significantly associated with self-care confidence (p = 0.02). Furthermore, depression moderated the relationship between resilience and self-care maintenance (b = 0.02; p < 0.05) but not between resilience and self-care confidence (b = -0.00; p = 0.24). Specifically, there is a stronger effect of resilience on self-care maintenance in CHF patients with low depression compared with those with high depression.

Conclusion: Resilience can improve self-care maintenance and self-care confidence in CHF patients. The positive effect of resilience on self-care maintenance also depends on  severity of depressive symptoms. Interventions to improve self-care in CHF patients should consider both the effects of resilience and depression to enhance the effectivity.