Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure.

Ting-Yu Chen,Yue-Cune Chang,Shu-Meng Cheng,Chi-Wen Kao,Andrew Soundy

doi:10.1371/journal.pone.0205953

Ting-Yu Chen, Yue-Cune Chang + Show 3 more

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https://doi.org/10.1371/journal.pone.0205953

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Abstract

Uncertainty in illness is regarded as a source of stress in many chronic diseases and is negatively related to health-related quality of life (HRQoL). However, studies on the relationship between uncertainty and HRQoL in patients with heart failure are limited. This study used Mishel’s theory of uncertainty in illness to investigate the mediating role of uncertainty in illness and depressive symptoms between symptom distress and HRQoL in patients with heart failure. This study used a cross-sectional correlation design. Participants were recruited by convenience sampling from outpatient services and medical wards of cardiology departments of a medical center in northern Taiwan. Data were collected for uncertainty, depressive symptoms, symptoms distress of heart failure, and HRQoL using self-report questionnaires. Demographics and clinical characteristics were analyzed with descriptive statistics. The mutual effects of disease characteristics, symptom distress, uncertainty in illness, depressive symptoms and HRQoL, as well as the overall model fitness, were analyzed by with structural equation modeling. We collected 147 qualified questionnaires. The mean score for the Mishel Uncertainty in Illness Scale for patients with heart failure was 73.5 (SD = 18.55); 65.3% of participants had a score of ≧13 on the Beck Depressive Inventory-II, indicating mild depression. Uncertainty, depressive symptoms, and HRQoL were directly related to symptom distress. Symptom distress and depressive symptoms were both mediators between uncertainty and depressive symptoms. Depressive symptoms also mediated emotional support and HRQoL. Uncertainty and depressive symptoms were important factors in the pathway between symptom distress and HRQoL for heart failure patients. We suggest providing heart failure patients with tailored interventions for effective self-management of symptoms based on Mishel’s theory of uncertainty in illness, which could help control disease symptoms, alleviate uncertainty and depression as well as improve HRQoL.

Highlights

Heart failure (HF) is one of the significant global health issues and a serious health condition impacting many developing and developed countries, including Taiwan
A total of 147 HF patients participated in this study from January to June 2012
Most proportion of the participants were in New York Heart Association (NYHA) Class II (32.0%), followed by 31.3% in class III, 7.7% in Class IV and 9.5% in Class I

Summary

Introduction

Heart failure (HF) is one of the significant global health issues and a serious health condition impacting many developing and developed countries, including Taiwan. The total medical costs for treating HF amount to more than US$3.92 billion [1]. The prevalence of HF is 0.4% to 6.0% in Asia, while values 6% was reported from Taiwan [2]. The cost of hospitalization was up to US$ 96 million in patients with HF in Taiwan [2]. The increasing prevalence of HF has resulted in an increased concern for HF as a clinical issue [3]. Due to the advancement of medical care, many HF patients are surviving longer; their prognosis remains poor and the 1-month re-hospitalization rate is approximately 17.1% [4]

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