Abstract 11759: How Do Depressive Symptoms Influence Self-Care Among an Ethnic Minority Population with Heart Failure?
Depression occurs in 25-51% of patients with heart failure (HF). Little is known about how depression influences self-care (i.e. adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. In this mixed methods study, we explored the meaning of depression and how depressive symptoms affect self-care in an ethnic minority population with HF.
Methods: Thirty Black patients (mean age 59.63 ±15 years; 60% Male; 65% NYHA III) participated in in-depth interviews about HF self-care and mood; and completed standardized instruments measuring self-care (SCHFI), depression (PHQ-9), and physical functioning (DASI). Thematic content analysis was used to explore the meaning of depression and elicit themes about how depressive symptoms affect daily self-care practices. Qualitative and quantitative data were integrated in the final analytic phase.
Results: Self-care was very poor in the sample (standardized mean SCHFI maintenance 60.05 ± 18.12; SCHFI management 51.19 ± 18.98; SCHFI confidence 62.64 ±18.16). Few (< 25%) engaged in adequate self-care (=/> 70% on SCHFI subscales). 40% of the sample had evidence of depressive symptoms (PHQ-9≥10; mean 7.59±5.29, range 0 to 22). None were taking medication for depression. There was a significant negative correlation between depression and physical functioning (r=-.418, p=.02). Individuals with depressive symptoms had poorer self-care management (p=.029). In the qualitative data, individuals described depressive mood as “feeling blue” and “a failure”. “Overwhelming” sadness and fatigue influenced self-care. One women described, “when the blues come, I stay in bed and wait for it to pass. I don't do anything ¼ the pills don't work; why take them ¼ some times it doesn't pass ¼ ” For many, spirituality was central to coping with sadness (“I leave it with God”). Few discussed feelings with healthcare providers (“I don't tell them everything”).
Conclusions: Depression in ethnic minority patients with HF may be difficult to assess. Research to develop and test culturally sensitive interventions is critically needed, especially since depression influences self-care and minority populations continue to experience poorer outcomes.
- © 2011 by American Heart Association, Inc.