Depression, Anxiety, Anger, and Biomarker in Taiwanese People with Heart Failure

Thursday, 2 August 2012: 3:15 PM

Hsing-Mei Chen, PhD, RN1
Shyh-Jnog Wu, PhD2
Chee-Siong Lee, MD3
Hsueh-Wei Yen, MD4
Wen-Hsien Lee, MD5
Hui- Chin Chien, MSN, RN5
(1)School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
(2)Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
(3)Cardiovascular Departemnt, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
(4)Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
(5)Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Learning Objective 1: understand the psychological distress in people with heart failure

Learning Objective 2: know about the relationship between psychological variables and biomarker


Psychological distresses might be caused by the disease severity in people with heart failure. The purpose of this study was to examine the relationship between depression, anxiety, anger, and B-type natriuretic peptide (BNP) in Taiwanese people with heart failure.


A cross-sectional, descriptive, correlational research design was used. A nonprobability sample of 51 participants was recruited from the outpatient department of a medical center located in southern Taiwan. Inclusion criteria were as follows: 1) a diagnosis of HF, with a class of New York Heart Association (NYHA) II or above; 2) age 20 or older; 3) able to communicate either by speaking or writing Mandarin; and 4) willing to participate in this study. Instruments included the Patient Outcome Questionnaire-9 (PHQ-9), Beck Anxiety Inventory (BAI), State-Trait Anger Expression Inventory-2 (STAXI-2), and BNP.


The mean age was 65.94 years old (SD 13.09) in this sample. The mean PHQ-9 score was 5.06 (4.15), the mean BAI score was 5.98 (5.21), the mean STAXI-2 score was 14.55 (5.19), and the average BNP was 377.65 with a median value of 182 ranged from 5 to 2398. Pearson correlation analyses showed that BNP and duration since heart failure diagnosis did not significantly correlate with any psychological variables. However, NYHA classes were significantly correlated with PHQ-9 (r=.31, p<.05), BAI neurophysiological symptoms (r=.39, p<.01), and BAI autonomic symptoms (r=.30, p<.05). PHQ-9 was significantly correlated with all components of STAXI-2 and BAI ranged from r=.35 (p<.05) to r=.69 (p<.001). BAI had lower but significant correlations with STAXI-2 ranged from r=.29 to r=.34.


Though psychological variables did not show correlations with BNP, they did significantly correlate with heart failure severity measured by subjective NYHA functional classes. Further strategies will be designed to help patients cope with their diseases.