Relationship between mutuality and depression in patients with chronic heart failure and caregivers in China: An actor-partner interdependence model analysis

Trajectories and Predictors of the Care Needs of Patients With Chronic Heart Failure: Growth Mixture Modeling

BACKGROUND

Research on the care needs of patients with heart failure (HF) has predominantly relied on cross-sectional studies. Consequently, there is limited understanding of how care needs evolve over time within this population.

OBJECTIVES

The aims of this study were to explore the trajectories of care needs in patients with HF 1 year after discharge and analyze the potential factors that can predict these trajectories.

METHODS

A total of 197 patients with HF were recruited and followed at 1, 3, 6, and 12 months postdischarge. Care needs were assessed using the care needs survey questionnaire, and potential factors were selected based on the Andersen Behavioral Model. A growth mixture model was used to identify the trajectories of care needs, whereas logistic regression analyses were used for statistical comparisons.

RESULTS

Three trajectories in the care needs of patients with HF were identified: (1) a mild increase trajectory, (2) a decline trajectory, and (3) a persistently high trajectory. Need factors were the most significant determinants of care needs trajectories, with higher New York Heart Association functional classification, left ventricular ejection fraction less than 40%, and lower self-reported health serving as key predictors of persistently high trajectory. In contrast, only lower self-efficacy and the absence of a spouse as predisposing factors were associated with an increased risk of maintaining persistently high levels of care needs.

CONCLUSION

Care needs after discharge in patients with HF can be characterized by 3 trajectories. Need factors will help clinicians with early identification of patients with persistently high level of care needs.

Experiences of mutuality between Chinese lung cancer patients and family caregivers during chemotherapy: a qualitative study

BACKGROUND

This qualitative study aims to deeply understand the emotional experiences of mutuality relationships between lung cancer patients undergoing chemotherapy and their caregivers, providing insights for developing cancer-related mutuality interventions.

METHODS

Using a qualitative research method with semi-structured interviews, 15 pairs of patients and their caregivers from the Department of Respiratory Medicine at the Affiliated People's Hospital of Xuzhou Medical University were selected as subjects. Data were qualitatively and inductively analyzed using Braun and Clarke's thematic analysis method.

RESULTS

Five themes and fourteen sub-themes were extracted from the experiences and interactions between patients and caregivers: reciprocity and mutual support (support provided by patients to caregivers, support provided by caregivers to patients), challenges (lack of communication, difficulty in adaptation, role changes, economic burdens), change and adaptation (living with the disease, social support), negative outcomes (increased burden on caregivers, disruption of social activities and family relationships), and intervention needs (need for disease knowledge, humanistic care, communication skills).

CONCLUSION

The findings of this study provide healthcare professionals with information on the mutual support and challenges faced by chemotherapy patients and their caregivers in coping with cancer. This information aims to facilitate culturally-based psychological interventions, enhance mutuality, improve quality of life, and promote the entire family's adaptation to the disease.

The Association Between Mutuality and Quality of Life in Adults With Chronic Illnesses and Their Nurses: Actor-Partner Interdependence Model Analysis

AIM

To examine the association between mutuality and quality of life in nurse-patient dyads.

DESIGN

A cross-sectional multi-centre study was conducted.

METHODS

The study was conducted in five tertiary hospitals in Italy. We enrol both inpatients and outpatients with chronic diseases and their nurses with a convenience sampling. One-hundred ninety-two dyads participated to the study. A self-assessment instrument including the Short-Form 12 Health Survey (SF-12), and the Nurse Patient Mutuality in Chronic Illness scale (NPM-CI scale), in the two versions-one for patients and one for nurses, was administered. The effects of nurse-patient mutuality on the physical and mental quality of life of nurses and patients were estimated with a series of actor-partner-interdependence models (APIM).

RESULTS

Patients' and nurses' perceptions of their mutuality were positively correlated. For patient mental quality of life, there was a statistically significant actor effect both for patients, and for nurses. There was also a consistent statistically significant partner effect for patient mental quality of life. There were no statistically significant actor or partner effects for the nurses' and patients' physical quality of life. This construct may be influenced by additional components, further studies are needed.

CONCLUSIONS

Mutuality between nurses and patients in chronic diseases influence both patient and nurse quality of life.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Our results support the importance of taking a dyadic perspective when considering mutuality and quality of life in nurse-patient dyads.

IMPACT

Nurse-patient mutuality is an indicator of a high-quality relationship, which allows shared goals and shared decision-making. Quality of life is one of the most important outcomes for chronic conditions patients and is an indicator of well-being. Quality of life is also an important variable in healthcare professionals' lives. Little is known about the association between mutuality and quality of life in nurse-patient dyads. Mutuality has an actor effect on patient's and nurse's quality of life and has a negative partner effect on patient's quality of life. The understanding of mutuality and interdependence within the dyad, could increase mental quality of life in nurse-patient dyads.

REPORTING METHOD

STROBE checklist for cross-sectional studies was followed in this study.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in the sample of the study.

Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study

BACKGROUND

Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software.

RESULTS

The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18).

CONCLUSIONS

This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Cluster analysis of heart failure patients based on their psychological and physical symptoms and predictive analysis of cluster membership

AIM

Patients with heart failure experience multiple co-occurring symptoms that lower their quality of life and increase hospitalization and mortality rates. So far, no heart failure symptom cluster study recruited patients from community settings or focused on symptoms predicting most clinical outcomes. Considering physical and psychological symptoms together allows understanding how they burden patients in different combinations. Moreover, studies predicting symptom cluster membership using variables other than symptoms are lacking. We aimed to (a) cluster heart failure patients based on physical and psychological symptoms and (b) predict symptom cluster membership using sociodemographic/clinical variables.

DESIGN

Secondary analysis of MOTIVATE-HF trial, which recruited 510 heart failure patients from a hospital, an outpatient and a community setting in Italy.

METHODS

Cluster analysis was performed based on the two scores of the Hospital Anxiety-Depression scale and two scores of the Heart-Failure Somatic Perception Scale predicting most clinical outcomes. ANOVA and chi-square test were used to compare patients' characteristics among clusters. For the predictive analysis, we split the data into a training set and a test set and trained three classification models on the former to predict patients' symptom cluster membership based on 11 clinical/sociodemographic variables. Permutation analysis investigated which variables best predicted cluster membership.

RESULTS

Four clusters were identified based on the intensity and combination of psychological and physical symptoms: mixed distress (high psychological, low physical symptoms), high distress, low distress and moderate distress. Clinical and sociodemographic differences were found among clusters. NYHA-class (New York Heart Association) and sleep quality were the most important variables in predicting symptom cluster membership.

CONCLUSIONS

These results can support the development of tailored symptom management intervention and the investigation of symptom clusters' effect on patient outcomes. The promising results of the predictive analysis suggest that such benefits may be obtained even when direct access to symptoms-related data is absent.

IMPLICATIONS

These results may be particularly useful to clinicians, patients and researchers because they highlight the importance of addressing clusters of symptoms, instead of individual symptoms, to facilitate symptom detection and management. Knowing which variables best predict symptom cluster membership can allow to obtain such benefits even when direct access to symptoms-data is absent.

IMPACT

Four clusters of heart failure patients characterized by different intensity and combination of psychological and physical symptoms were identified. NYHA class and sleep quality appeared important variables in predicting symptom cluster membership.

REPORTING METHOD

The authors have adhered to the EQUATOR guidelines STROBE to report observational cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

Patients were included only for collecting their data.