Instituto Polibienestar, University of Valencia, Valencia, Spain.
Department of Psychiatry, Massachusetts General Hospital, 125 Nashua Street, Suite 324, Boston, MA, 02114, USA.
BMC Psychol. 2024 Jun 4;12(1):328. doi: 10.1186/s40359-024-01816-4.
Depression affects 20-30% of individuals with heart failure (HF), and it is associated with worse health outcomes independent of disease severity. One potential explanation is the adverse impact of depression on HF patients' adherence to the health behaviors needed to self-manage their condition. The aim of this study is to identify characteristics associated with lower adherence in this population, which could help to recognize individuals at higher risk and eventually tailor health behavior interventions to their needs.
Using data from a randomized, controlled, collaborative care treatment trial in 629 patients with HF and comorbid depression, we performed mixed effects logistic regression analyses to examine the cross-sectional and prospective relationships between medical and psychosocial variables and health behavior adherence, including adherence to medications, a low-sodium diet, and physician appointments.
In cross-sectional analyses, married marital status and higher physical health-related quality of life (HRQoL) were associated with greater overall adherence (compared to married, single Odds Ratio [OR] = 0.46, 95% Confidence Interval [CI] = 0.26-0.80; other OR = 0.60, CI = 0.38-0.94; p = .012. Physical HRQoL OR = 1.02, CI = 1.00-1.04, p = .047). Prospectively, greater levels of social support were associated with improved overall adherence one year later (OR = 1.04, 95% CI = 1.00-1.08, p = .037). Social support, HF symptom severity, race and ethnicity, and age were predictors of specific types of adherence. Neither depression nor optimism was significantly associated with adherence outcomes.
These results provide important preliminary information about risk factors for poor adherence in patients with both HF and depression, which could, in turn, contribute to the development of interventions to promote adherence in this high-risk population.
https://clinicaltrials.gov/ct2/show/NCT02044211 ; registered 1/21/2014.
抑郁症影响 20-30%的心力衰竭（HF）患者，且其与独立于疾病严重程度的更差的健康结果相关。一个潜在的解释是抑郁对 HF 患者坚持自我管理病情所需的健康行为的不利影响。本研究的目的是确定与该人群较低的依从性相关的特征，这有助于识别风险更高的个体，并最终根据他们的需求定制健康行为干预措施。
使用来自 629 例 HF 合并抑郁患者的随机、对照、协作护理治疗试验的数据，我们进行了混合效应逻辑回归分析，以检验医疗和心理社会变量与健康行为依从性（包括药物、低钠饮食和医生预约的依从性）的横断面和前瞻性关系。
在横断面分析中，已婚的婚姻状况和较高的身体健康相关生活质量（HRQoL）与整体依从性较高相关（与已婚、单身相比，比值比[OR] = 0.46，95%置信区间[CI] = 0.26-0.80；其他 OR = 0.60，CI = 0.38-0.94；p = .012。身体 HRQoL OR = 1.02，CI = 1.00-1.04，p = .047）。前瞻性地，更高水平的社会支持与一年后整体依从性的提高相关（OR = 1.04，95% CI = 1.00-1.08，p = .037）。社会支持、HF 症状严重程度、种族和民族以及年龄是特定类型依从性的预测因素。抑郁和乐观均与依从性结果无显著相关性。
这些结果提供了有关 HF 合并抑郁患者依从性差的危险因素的重要初步信息，这反过来又有助于为该高风险人群制定促进依从性的干预措施。
https://clinicaltrials.gov/ct2/show/NCT02044211；注册于 2014 年 1 月 21 日。
