Association between depressive symptoms and quality of life in outpatients and inpatients with heart failure

Tinoco, Juliana de Melo Vellozo Pereira; Souza, Beatriz Paiva e Silva de; Oliveira, Samara Xavier de; Oliveira, Josiana Araujo de; Mesquita, Evandro Tinoco; Cavalcanti, Ana Carla Dantas

doi:10.1590/S1980-220X2019030903686

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2019030903686 copy

Association between depressive symptoms and quality of life in outpatients and inpatients with heart failure

Asociación entre síntomas depresivos y calidad de vida en pacientes ambulatorios y hospitalizados con insuficiencia cardíaca

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze sociodemographic and clinical characteristics, depressive symptoms and quality of life of patients with heart failure and associate quality of life with depressive symptoms.

Method:

A cross-sectional study conducted with outpatients and inpatients. Sociodemographic data were collected and questionnaires were applied to assess quality of life (Minnesota Living with Heart Failure Questionnaire) and depressive symptoms (Beck Depression Inventory).

Results:

The sample consisted of 113 patients. Outpatients were retired (p=0.004), with better education (p=0.034) and higher ventricular ejection fraction (p=0.001). The inpatient group had greater depressive symptoms (18.1±10 vs 14.6±1.3; p=0.036) and lower quality of life (74.1±18.7 vs 40.5±3.4; p<0.001) than the outpatient group. Outpatients with depressive symptom scores from 18 points had worse quality of life scores in 17 of the 21 questions.

Conclusion:

Inpatients had worse depressive symptoms and quality of life, which was more affected in the physical dimension in those with moderate/severe depressive symptoms. Outpatients with more severe depressive symptoms had worse quality of life in all dimensions.

Hearth Failure; Quality of Life; Depression; Nursing Care

Variables	Inpatient group IG (N=55)	Outpatient group OG (N=58)	Total (N=113)	P value
Age	52.1±10.4	70.4±15.0	55.8±13.2	0.156^* * Student's t-test;
Sex
Female	17 (30.9)	28 (48.3)	45 (39.8)	0.083^ Chi-square test; \|Mann-Whitney U test; \|\|Comparison test not performed between groups, as the functional class is affected in episodes of HF decompensation.
Male	38 (69.1)	30 (51.7)	68 (60.2)
Marital status
Single/widowed/divorced	26 (47.2)	30 (51.7)	56 (49.6)	0.708^ Chi-square test; \|Mann-Whitney U test; \|\|Comparison test not performed between groups, as the functional class is affected in episodes of HF decompensation.
Married/common-law marriage	29 (52.7)	28 (48.3)	57 (50.4)
Source of income
Unemployed	13 (23.6)	5 (8.6)	18 (15.9)	0.004^ Chi-square test; \|Mann-Whitney U test; \|\|Comparison test not performed between groups, as the functional class is affected in episodes of HF decompensation.
Formal/informal worker	8 (14.5)	7 (12.1)	15 (13.3)
Pensioner/retired	34 (61.8)	46 (79.3)	80 (70.8)
Education
Illiterate	-	1 (1.7)	1 (0.8)	0.034^ Chi-square test; \|Mann-Whitney U test; \|\|Comparison test not performed between groups, as the functional class is affected in episodes of HF decompensation.
Elementary school	28 (50.9)	18 (31.0)	46 (40.7)
High school	25 (45.4)	27 (46.6)	52 (46.0)
Higher education	2 (3.6)	12 (20.7)	14 (12.3)
Left ventricular ejection fraction, %	38.8±17.1	54.4±16.9	47.2±18.3	0.001
Functional Class, NYHA\|\|
I	-	18 (31.0)	18 (15.9)	-
II	-	33 (56.8)	33 (29.2)
III	41 (74.5)	6 (10.3)	47 (41.6)
IV	14 (25.5)	1 (1.7)	15 (13.3)
Comorbities
Hypertension	44 (80)	47 (81.0)	91 (80.5)	0.539
Diabetes Mellitus	16 (29)	20 (34.4)	36 (31.9)	0.552
Coronary artery disease	20 (36.3)	14 (24.1)	34 (30.1)	0.218
Smoking	10 (18.2)	10 (17.2)	20 (17.7)	0.417^ Chi-square test; \|Mann-Whitney U test; \|\|Comparison test not performed between groups, as the functional class is affected in episodes of HF decompensation.
Alcoholism	8 (14.5)	15 (25.9)	23 (20.4)	0.517^ Chi-square test; \|Mann-Whitney U test; \|\|Comparison test not performed between groups, as the functional class is affected in episodes of HF decompensation.

Variables	Inpatient group IG (N=55)	Outpatient group OG (N=58)	P value
Total QoL score	74.1±18.7	40.5±3.4	p<0.001\|
Patients with depressive symptoms (score ≥18 points)	23 (39.6)	19 (32.7)	0.337
Total DS score	18.1±10.5	14.6±1.3	0.036\|
DS stratification
No depression or mild depression	7 (12.7)	22 (37.9)
Mild to moderate depression	26 (45.5)	19 (32.7)	0.024^ Chi-square test; \|Mann-Whitney U test.
Moderate to severe depression	15 (27.2)	12 (20.7)
Severe depression	7 (12.7)	5 (8.6)

Questions - QoL questionnaire	Inpatient group IG (N=55)			Outpatient group OG (N=58)
Questions - QoL questionnaire	BDI < 18 (N=32)	BDI ≥ 18 (N=23)	p-value^* * Student's t-test; \|Mann-Whitney U test.	BDI < 18 (N=39)	BDI ≥ 18 (N=19)	p-value
1. Causing swelling in your ankles or legs?	0 (0-3.0)	3.0 (0-5.0)	0.083\|	0 (0-3.0)	0 (3.0-5.0)	0.60
2. Making you sit or lie down to rest during the day?	3.9±1.3	4.4±0.8	0.73	1.0 (0-3.0)	3.5 (2.75-5.0)	p>0.001
3. Making your walking about or climbing stairs difficult?	4.2±1.2	4.8±0.9	0.016	2.0 (0-3.0)	4.0 (3.0-5.0)	p>0.001
4. Making your housework difficult?	3.5±1.7	4.3±0.9	0.027	1.0 (0-3.0)	4.0 (3.0-5.0)	p>0.001
5. Making your going places away from home difficult?	4.0±1.3	4.3±1.3	0.408	1.0 (0-3.0)	3.5 (2.0-5.0)	0.001
6. Making your sleeping well at night difficult?	3.9±1.5	4.2±1.1	0.463	0 (0-2.0)	3.0 (2.0-4.25)	0.003
7. Making your relating to or doing things with your friends or family difficult?	3.2±2.1	3.3±2.1	0.475	0	3.0 (0-4.0)	p>0.001
8. Making your working to earn a living difficult?	3.3±2.1	3.9±1.9	0.310	0 (0-3.0)	2.0 (0-5.0)	0.087
9. Making your recreational pastimes, sports or hobbies difficult?	3.0±2.1	4.1±1.4	0.027	0 (0-3.0)	4.0 (0.75-5.0)	0.006
10. Making your sexual activities difficult?	3.0±2.0	3.5±2.0	0.319	1.0 (0-3.0)	4.0 (0-5.0)	0.138
11. Making you eat less the food you like?	4.1±1.3	3.3±1.9	0.082	0 (2.0-5.0)	4.5 (1.0-5.0)	0.022
12. Making you short of breath?	4.5±0.9	4.5±0.8	0.991	1.0 (0-3.0)	4.0 (3.0-5.0)	p>0.001
13. Making you tired, fatigued, or low on energy?	4.4±1.1	4.6±1.1	0.592	2.0 (0-3.0)	4.5 (3.0-5.0)	p>0.001
14. Making you stay in a hospital?	4.2±1.3	4.2±1.4	0.977	0	0 (0-0.25)	0.093
15. Costing you money for medical care?	3.4±1.8	3.5±1.7	0.819	3.0 (0-4.0)	4.5 (2.0-5.0)	0.071
16. Giving you side effects from treatments?	2.0 (0-3.0)	1.0 (0-4.0)	0.859\|	0 (0-2.0)	0 (0-1.0)	0.564
17. Making you feel you are a burden to your family or friends?	3.0 (0-5.0)	3.0 (0-5.0)	0.804\|	0	1.0 (0-5.0)	0.002
18. Making you feel a loss of self-control in your life?	5.0 (4.0-5.0)	5.0-(3.0-5.0)	0.552\|	0	3.0 (0-4.25)	p>0.001
19. Making you worry?	4.1±1.3	4.1±1.5	0.885	2.0 (0-3.0)	5.0 (3.0-5.0)	0.001
20. Making it difficult for you to concentrate or remember things?	1.0 (0-3.0)	3.0 (1.0-5.0)	0.952\|	1.0 (0-3.0)	4.0 (0-5.0)	0.017
21. Making you feel depressed?	2.0(0-3.0)	4.0(1.0-5.0)	0.011\|	0 (0-1.0)	3.5 (0-5.0)	0.001
QoL total score	73.4±18.4	79.6±18.5	0.106	26 (12.0-46.0)	65.5 (54.7-75.2)	p>0.001

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Juliana de Melo Vellozo Pereira Tinoco Av. Marquês do Paraná, 303 - Centro CEP 24220-000 - Niterói, RJ, Brazil juvellozo.uff@gmail.com