The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using Actor–Partner Interdependence Model

Abstract

Background Depressive symptoms and anxiety are common in heart failure patients as well as their spousal caregivers. However, it is not known whether their emotional distress contributes to their partner's quality of life (QoL). This study examined the effect of patients' and partners' depressive symptoms and anxiety on QoL in patient–spouse dyads using an innovative dyadic analysis technique, the Actor–Partner Interdependence Model (APIM). Method A total of 58 dyads (patient: 43% in males, mean age 62 years, mean ejection fraction 34% ±11, 43% in New York Heart Association III–IV) participated in the study. Depressive symptoms and anxiety were assessed using the Brief Symptom Inventory. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Dyadic data were analyzed using the APIM with distinguishable dyad regression model. In APIM, actor effect is the impact of a person's emotional distress on his/her own QoL. Partner effect is the impact of a person's emotional distress on his/her partner's QoL. Result Depressive symptoms exhibited actor effect of both patients ( P<.001) and spouses ( P<.001) and only partner effect of patients ( P<.05) on QoL. Patients and spouses with higher depressive symptoms had poorer QoL. Patients whose spouses had higher depressive symptoms were more likely to indicate their own QoL was poorer. Anxiety has similar actor and partner effects on QoL as depressive symptoms. Conclusion Interventions to reduce depression and anxiety and to improve patients' QoL should include both patients and spouses.