Predictors of Depression in Older Adults with Heart Failure: An Acceptance and Commitment Therapy-derived Linear Regression Model

Abstract

Background: Depression is a frequently reported phenomenon that negatively affects selfcare and healthcare provided to older adults with heart failure. However, the literature is contradicting about predictors of depression in older adults with heart failure. Purpose: To examine newly introduced variables derived from the acceptance and commitment therapy model (psychological flexibility, impulsivity, perceived stress and perceived control) and selected demographics as predictors of depression in older adults with heart failure. Methods: This study was conducted using a cross-sectional design. Participants with heartfailure (N = 272) were recruited from major regional hospitals during their regular visits to the heart-failure clinics. The following tools were used to collect the data: The Patient Health Questionnaire–9, the Acceptance and Action Questionnaire, the Perceived Stress Scale-10, the Barratt Impulsiveness Scale, the Atlanta Heart Failure Knowledge Test, the New York Heart Association and the Control Attitudes Scale-Revised. Results: Bivariate analysis shows that all bivariate correlations were significant (r = 0.16 to 0.63, p <0.05), except for the correlation between "age with time since diagnosis" and "time since diagnosis with psychological flexibility". The results showed that time since diagnosis, impulsivity, stress, psychological flexibility and heart-failure knowledge significantly predicted depression in elder adults with heart failure. The model explained 49.5% of the variance in depression. Conclusion: An array of psychological and socio-demographic variables explained approximately a half of the variation in depression in elder adults with heart failure. The acceptance and commitment therapy model has been shown to be beneficial in incorporating new variables contributing to depression in older adults with heart failure. Implications for Nursing: The current study offers preliminary evidence of the potential benefit of the acceptance and commitment therapy model-based interventions. Further research should be conducted to minimize the impact of depression in older adults with heart failure. Keywords: Depression, Stress, Perceived control, Impulsivity, Heart failure, Psychological flexibility.