How do depressive symptoms influence self-care among an ethnic minority population with heart failure?

Abstract

Objectives: Depression is very common in patients with heart failure (HF). However, little is known about how depression influences self-care (ie, adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. The purpose of this study was to explore the meaning of depression and how depressive symptoms affect self-care in an ethnic minority Black population with HF.

Design: In this mixed methods study, 30 Black patients (mean age 59.63 SD +/- 15 years; 60% male) participated in in-depth interviews about HF self-care and mood; and completed standardized instruments measuring self-care, depression, and physical functioning. 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. Forty percent of the sample had evidence of depressive symptoms (PHQ-9 > or = 10; mean 7.59 +/- 5.29, range 0 to 22). Individuals with depressive symptoms had poorer self-care (P = .029). In the qualitative data, individuals described depressive mood as "feeling blue... like I failed." "Overwhelming" sadness and fatigue influenced self-care and resulted in treatment delays. For many, spirituality was central to coping with sadness. Few discussed depressive feelings with health care providers.

Conclusions: Depression in ethnic minority patients with HF may be difficult to assess. Research to develop and test culturally sensitive interventions is critically needed, since depression influences self-care and minority populations continue to experience poorer outcomes.