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. 2007 Apr;22(4):470-7.
doi: 10.1007/s11606-006-0044-9.

Spiritual well-being and depression in patients with heart failure

David B Bekelman  1 , Sydney M Dy, Diane M Becker, Ilan S Wittstein, Danetta E Hendricks, Traci E Yamashita, Sheldon H Gottlieb
Affiliations

Spiritual well-being and depression in patients with heart failure

David B Bekelman et al. J Gen Intern Med. 2007 Apr.

Erratum in

  • J Gen Intern Med. 2007 Jul;22(7):1066

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.

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Figures

Figure 1
Figure 1
Spearman correlation coefficients with 95% confidence intervals between the candidate predictors and depression. SWB spiritual well-being, M/P meaning/peace.
Figure 2
Figure 2
Scatter plot with fitted linear regression line showing the depression measure as a function of the faith (Panel A) and meaning/peace (Panel B) subscales of the spiritual well-being measure. Spiritual well-being (SWB) faith scale range, 0–16; SWB meaning/peace scale range, 0–32; Geriatric Depression Scale—Short Form (GDS-SF) scale range 0–15.
Figure 3
Figure 3
Histograms showing the relationship between spiritual well-being meaning/peace and health status on depressive symptoms. Health status was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score and meaning/peace with the meaning/peace subscale of the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being scale. Participants were classified into either “low” or “high” health status if their KCCQ score was below or above the median score of the study population, respectively. Similarly, “low” or “high” meaning/peace denotes meaning/peace scores below or above the population median. GDS-SF, Geriatric Depression Scale—Short Form.
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