Skip to main content
Top
Published in: Journal of General Internal Medicine 4/2007

01-04-2007 | Original Article

Spiritual Well-Being and Depression in Patients with Heart Failure

Authors: David B. Bekelman, MD, Sydney M. Dy, MD, Diane M. Becker, ScD, Ilan S. Wittstein, MD, Danetta E. Hendricks, MA, Traci E. Yamashita, MS, Sheldon H. Gottlieb, MD

Published in: Journal of General Internal Medicine | Issue 4/2007

Login to get access

Abstract

Background

In patients with chronic heart failure, depression is common and associated with poor quality of life, more frequent hospitalizations, and higher mortality. Spiritual well-being is an important, modifiable coping resource in patients with terminal cancer and is associated with less depression, but little is known about the role of spiritual well-being in patients with heart failure.

Objective

To identify the relationship between spiritual well-being and depression in patients with heart failure.

Design

Cross-sectional study.

Participants

Sixty patients aged 60 years or older with New York Heart Association class II–IV heart failure.

Measurements

Spiritual well-being was measured using the total scale and 2 subscales (meaning/peace, faith) of the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being scale, depression using the Geriatric Depression Scale—Short Form (GDS-SF).

Results

The median age of participants was 75 years. Nineteen participants (32%) had clinically significant depression (GDS-SF > 4). Greater spiritual well-being was strongly inversely correlated with depression (Spearman’s correlation −0.55, 95% confidence interval −0.70 to −0.35). In particular, greater meaning/peace was strongly associated with less depression (r = −.60, P < .0001), while faith was only modestly associated (r = −.38, P < .01). In a regression analysis accounting for gender, income, and other risk factors for depression (social support, physical symptoms, and health status), greater spiritual well-being continued to be significantly associated with less depression (P = .05). Between the 2 spiritual well-being subscales, only meaning/peace contributed significantly to this effect (P = .02) and accounted for 7% of the variance in depression.

Conclusions

Among outpatients with heart failure, greater spiritual well-being, particularly meaning/peace, was strongly associated with less depression. Enhancement of patients’ sense of spiritual well-being might reduce or prevent depression and thus improve quality of life and other outcomes in this population.
Literature
1.
go back to reference Freedland KE, Rich MW, Skala JA, Carney RM, Davila-Roman VG, Jaffe AS. Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom Med. 2003;65:119–128.PubMedCrossRef Freedland KE, Rich MW, Skala JA, Carney RM, Davila-Roman VG, Jaffe AS. Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom Med. 2003;65:119–128.PubMedCrossRef
2.
go back to reference Vaccarino V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol. 2001;38:199–205.PubMedCrossRef Vaccarino V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol. 2001;38:199–205.PubMedCrossRef
3.
go back to reference Koenig HG. Depression in hospitalized older patients with congestive heart failure. Gen Hosp Psychiatry. 1998;20:29–43.PubMedCrossRef Koenig HG. Depression in hospitalized older patients with congestive heart failure. Gen Hosp Psychiatry. 1998;20:29–43.PubMedCrossRef
4.
go back to reference Sullivan MD, Newton K, Hecht J, Russo JE, Spertus JA. Depression and health status in elderly patients with heart failure: a 6-month prospective study in primary care. Am J Geriatr Cardiol. 2004;13:252–60.PubMedCrossRef Sullivan MD, Newton K, Hecht J, Russo JE, Spertus JA. Depression and health status in elderly patients with heart failure: a 6-month prospective study in primary care. Am J Geriatr Cardiol. 2004;13:252–60.PubMedCrossRef
5.
go back to reference Rumsfeld JS, Havranek E, Masoudi FA, et al. Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol. 2003;42:1811–7.PubMedCrossRef Rumsfeld JS, Havranek E, Masoudi FA, et al. Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol. 2003;42:1811–7.PubMedCrossRef
6.
go back to reference Jiang W, Alexander J, Christopher E, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med. 2001;161:1849–56.PubMedCrossRef Jiang W, Alexander J, Christopher E, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med. 2001;161:1849–56.PubMedCrossRef
7.
go back to reference Sullivan M, Simon G, Spertus J, Russo J. Depression-related costs in heart failure care. Arch Intern Med. 2002;162:1860–6.PubMedCrossRef Sullivan M, Simon G, Spertus J, Russo J. Depression-related costs in heart failure care. Arch Intern Med. 2002;162:1860–6.PubMedCrossRef
8.
go back to reference McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet. 2003;361:1603–7.PubMedCrossRef McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet. 2003;361:1603–7.PubMedCrossRef
9.
go back to reference Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002;43:213–20.PubMedCrossRef Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002;43:213–20.PubMedCrossRef
10.
go back to reference Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003;289:2387–92.PubMedCrossRef Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003;289:2387–92.PubMedCrossRef
11.
go back to reference Jones AM, O’Connell JE, Gray CS. Living and dying with congestive heart failure: addressing the needs of older congestive heart failure patients. Age Ageing. 2003;32:566–8.PubMedCrossRef Jones AM, O’Connell JE, Gray CS. Living and dying with congestive heart failure: addressing the needs of older congestive heart failure patients. Age Ageing. 2003;32:566–8.PubMedCrossRef
12.
go back to reference Westlake C, Dracup K. Role of spirituality in adjustment of patients with advanced heart failure. Prog Cardiovasc Nurs. 2001;16:119–25.PubMedCrossRef Westlake C, Dracup K. Role of spirituality in adjustment of patients with advanced heart failure. Prog Cardiovasc Nurs. 2001;16:119–25.PubMedCrossRef
13.
go back to reference Havranek EP, Spertus JA, Masoudi FA, Jones PG, Rumsfeld JS. Predictors of the onset of depressive symptoms in patients with heart failure. J Am Coll Cardiol. 2004;44:2333–8.PubMedCrossRef Havranek EP, Spertus JA, Masoudi FA, Jones PG, Rumsfeld JS. Predictors of the onset of depressive symptoms in patients with heart failure. J Am Coll Cardiol. 2004;44:2333–8.PubMedCrossRef
14.
15.
go back to reference Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist. 2002;42 Spec No 3:24–33.PubMed Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist. 2002;42 Spec No 3:24–33.PubMed
16.
go back to reference Hauptman PJ, Havranek EP. Integrating palliative care into heart failure care. Arch Intern Med. 2005;165:374–8.PubMedCrossRef Hauptman PJ, Havranek EP. Integrating palliative care into heart failure care. Arch Intern Med. 2005;165:374–8.PubMedCrossRef
17.
go back to reference Pantilat SZ, Steimle AT. Palliative care for patients with heart failure. JAMA. 2004;291:2476–82.PubMedCrossRef Pantilat SZ, Steimle AT. Palliative care for patients with heart failure. JAMA. 2004;291:2476–82.PubMedCrossRef
18.
go back to reference Stevenson LW. Selection and management of candidates for heart transplantation. Curr Opin Cardiol. 1996;11:166–73.PubMedCrossRef Stevenson LW. Selection and management of candidates for heart transplantation. Curr Opin Cardiol. 1996;11:166–73.PubMedCrossRef
19.
go back to reference Yesavage JA. Geriatric depression scale. Psychopharmacol Bull. 1988;24:709–11.PubMed Yesavage JA. Geriatric depression scale. Psychopharmacol Bull. 1988;24:709–11.PubMed
20.
go back to reference Yesavage JA, Sheikh JI. Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;6:165–73.CrossRef Yesavage JA, Sheikh JI. Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;6:165–73.CrossRef
21.
go back to reference Whooley MA, Browner WS. for the Study of Osteoporotic Fractures Research Group. Association between depressive symptoms and mortality in older women. Arch Intern Med. 1998;158:2129–35.PubMedCrossRef Whooley MA, Browner WS. for the Study of Osteoporotic Fractures Research Group. Association between depressive symptoms and mortality in older women. Arch Intern Med. 1998;158:2129–35.PubMedCrossRef
22.
go back to reference Arthur A, Jagger C, Lindesay J, Graham C, Clarke M. Using an annual over-75 health check to screen for depression: validation of the short Geriatric Depression Scale (GDS15) within general practice. Int J Geriatr Psychiatry. 1999;14(6):431–9.PubMedCrossRef Arthur A, Jagger C, Lindesay J, Graham C, Clarke M. Using an annual over-75 health check to screen for depression: validation of the short Geriatric Depression Scale (GDS15) within general practice. Int J Geriatr Psychiatry. 1999;14(6):431–9.PubMedCrossRef
23.
go back to reference Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp). Ann Behav Med. 2002;24:49–58.PubMedCrossRef Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp). Ann Behav Med. 2002;24:49–58.PubMedCrossRef
24.
go back to reference Bekelman DB, Sullivan M. Depression and anxiety in patients with chronic heart failure. In: Beattie J, Goodlin S, eds. Supportive Care of the Cardiac Patient. Oxford: Oxford University Press, In Press. Bekelman DB, Sullivan M. Depression and anxiety in patients with chronic heart failure. In: Beattie J, Goodlin S, eds. Supportive Care of the Cardiac Patient. Oxford: Oxford University Press, In Press.
25.
go back to reference Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35:1245–55.PubMedCrossRef Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35:1245–55.PubMedCrossRef
26.
go back to reference Spertus J, Peterson E, Conard MW, et al. Monitoring clinical changes in patients with heart failure: a comparison of methods. Am Heart J. 2005;150:707–15.PubMedCrossRef Spertus J, Peterson E, Conard MW, et al. Monitoring clinical changes in patients with heart failure: a comparison of methods. Am Heart J. 2005;150:707–15.PubMedCrossRef
27.
go back to reference Heidenreich PA, Spertus JA, Jones PG, et al. Health status identifies heart failure outpatients at risk for hospitalization or death. J Am Coll Cardiol. 2006;47:752–6.PubMedCrossRef Heidenreich PA, Spertus JA, Jones PG, et al. Health status identifies heart failure outpatients at risk for hospitalization or death. J Am Coll Cardiol. 2006;47:752–6.PubMedCrossRef
28.
go back to reference Mitchell PH, Powell L, Blumenthal J, et al. A short social support measure for patients recovering from myocardial infarction: the ENRICHD Social Support Inventory. J Cardiopulm Rehabil. 2003;23:398–403.PubMedCrossRef Mitchell PH, Powell L, Blumenthal J, et al. A short social support measure for patients recovering from myocardial infarction: the ENRICHD Social Support Inventory. J Cardiopulm Rehabil. 2003;23:398–403.PubMedCrossRef
29.
go back to reference Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA. 2003;289:3106–16.PubMedCrossRef Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA. 2003;289:3106–16.PubMedCrossRef
30.
go back to reference Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler HT. The memorial symptom assessment scale short form (MSAS-SF). Cancer. 2000;89:1162–71.PubMedCrossRef Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler HT. The memorial symptom assessment scale short form (MSAS-SF). Cancer. 2000;89:1162–71.PubMedCrossRef
31.
go back to reference Tranmer JE, Heyland D, Dudgeon D, Groll D, Squires-Graham M, Coulson K. Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale. J Pain Symptom Manage. 2003;25:420–9.PubMedCrossRef Tranmer JE, Heyland D, Dudgeon D, Groll D, Squires-Graham M, Coulson K. Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale. J Pain Symptom Manage. 2003;25:420–9.PubMedCrossRef
32.
go back to reference Brown RL, Leonard T, Saunders LA, Papasouliotis O. A two-item conjoint screen for alcohol and other drug problems. J Am Board Fam Pract. 2001;14:95–106.PubMed Brown RL, Leonard T, Saunders LA, Papasouliotis O. A two-item conjoint screen for alcohol and other drug problems. J Am Board Fam Pract. 2001;14:95–106.PubMed
33.
go back to reference Molloy DW, Standish TI. A guide to the standardized Mini-Mental State Examination. Int Psychogeriatr. 1997;9 (Suppl 1):87–94.PubMedCrossRef Molloy DW, Standish TI. A guide to the standardized Mini-Mental State Examination. Int Psychogeriatr. 1997;9 (Suppl 1):87–94.PubMedCrossRef
36.
go back to reference Beery TA, Baas LS, Fowler C, Allen G. Spirituality in persons with heart failure. J Holist Nurs. 2002;20:5–25.PubMedCrossRef Beery TA, Baas LS, Fowler C, Allen G. Spirituality in persons with heart failure. J Holist Nurs. 2002;20:5–25.PubMedCrossRef
37.
go back to reference Murray SA, Kendall M, Boyd K, Worth A, Benton TF. Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med. 2004;18:39–45.PubMedCrossRef Murray SA, Kendall M, Boyd K, Worth A, Benton TF. Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med. 2004;18:39–45.PubMedCrossRef
38.
39.
go back to reference Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology. 1999;8:417–28.PubMedCrossRef Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology. 1999;8:417–28.PubMedCrossRef
40.
go back to reference Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA. “Are you at peace?” One item to probe spiritual concerns at the end of life. Arch Intern Med. 2006;166:101–5.PubMedCrossRef Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA. “Are you at peace?” One item to probe spiritual concerns at the end of life. Arch Intern Med. 2006;166:101–5.PubMedCrossRef
41.
go back to reference Chochinov HM, Cann BJ. Interventions to enhance the spiritual aspects of dying. J Palliat Med. 2005;8(suppl 1):S103–15.PubMed Chochinov HM, Cann BJ. Interventions to enhance the spiritual aspects of dying. J Palliat Med. 2005;8(suppl 1):S103–15.PubMed
42.
go back to reference Levin JS. How religion influences morbidity and health: reflections on natural history, salutogenesis and host resistance. Soc Sci Med. 1996;43(5):849–64.PubMedCrossRef Levin JS. How religion influences morbidity and health: reflections on natural history, salutogenesis and host resistance. Soc Sci Med. 1996;43(5):849–64.PubMedCrossRef
43.
go back to reference Breitbart W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer. 2002;10:272–80.PubMedCrossRef Breitbart W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer. 2002;10:272–80.PubMedCrossRef
44.
go back to reference Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005;23:5520–5.PubMedCrossRef Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005;23:5520–5.PubMedCrossRef
45.
go back to reference Mendes de Leon CF, Czajkowski SM, Freedland KE, Bang H, Powell LH, Wu C, et al. The effect of a psychosocial intervention and quality of life after acute myocardial infarction: the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. J Cardiopulm Rehabil. 2006;26:9–13.PubMedCrossRef Mendes de Leon CF, Czajkowski SM, Freedland KE, Bang H, Powell LH, Wu C, et al. The effect of a psychosocial intervention and quality of life after acute myocardial infarction: the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. J Cardiopulm Rehabil. 2006;26:9–13.PubMedCrossRef
Metadata
Title
Spiritual Well-Being and Depression in Patients with Heart Failure
Authors
David B. Bekelman, MD
Sydney M. Dy, MD
Diane M. Becker, ScD
Ilan S. Wittstein, MD
Danetta E. Hendricks, MA
Traci E. Yamashita, MS
Sheldon H. Gottlieb, MD
Publication date
01-04-2007
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 4/2007
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-006-0044-9

Other articles of this Issue 4/2007

Journal of General Internal Medicine 4/2007 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.