Poor Social Support is Associated with Increases in Depression but not Anxiety Over 2 Years in Heart Failure (HF) Outpatients

Monday, 30 July 2012

Erika Friedmann, PhD1
Sue A. Thomas, PhD, RN, FAAN1
Heesook Son, PhD, MPH, RN2
Deborah W. Chapa, PhD, ACNP-BC2
Patricia Gonce Morton, RN, PhD, CRNP, FAAN1
(1)School of Nursing, University of Maryland, Baltimore, MD
(2)School of Nursing, The George Washington University, Washington, DC

Learning Objective 1: state the theoretical basis for research examining psychosocial issues in heart failure

Learning Objective 2: apply information about the importance of considering psychosocial interventions to slow the progression of heart failure in design of research and in clinical practice

Purpose: To examine the contributions of social support and disease severity to longitudinal changes in depression and anxiety of HF outpatients.  Heart failure (HF) is a major health problem in the US  affecting 5.7 million American adults. Within the biopsychosocial model, social and psychological factors are intergrated into cardiac health outcomes.  Psychosocial distress, in particular depression, contributes to poor health outcomes in HF patients. Little is known about the interrelationship among disease severity, social support, and depression.

Methods: Patients (N = 108) enrolled in the Psychosocial Factors Outcome Study (PFOS) in completed the Beck Depression Inventory -II, State Trait Anxiety Inventory, and Social Support Questionnaire-6 at study entry and every 6 months for up to 2 years. 

Results:   At baseline 30% of the patients were depressed and 42% were anxious.  In linear mixed models, social support amount contributed to changes in depression (p=.044) but not anxiety (p=.856).  Patient depression increased over time for those who had lower social support amount at baseline. Disease severity did not predict changes in either depression or anxiety. Overall, depression (p=.132) and anxiety (p=.909) did not change over the 2 years of study.

Conclusion: Depression and anxiety rates remain high over two years in HF outpatients.  Low social support amount affects longitudinal changes in depression in HF outpatients.  ICDs did not alter these relationships. Assessment of HF patients should include depression and social support.  Interventions to enhance social support among HF patients who have low social support may help alleviate the development or worsening of depression.