Mediating Effects of Depressive Symptoms and Uncertainty on Physical Symptoms and Self-Care in Korean Older Men With Heart Failure

Background: Heart failure is prevalent among aging populations. Given the increasing median age in many countries, sustainably improving self-care behaviors in heart failure patients is crucial. Physical symptoms predict self-care in patients with heart failure, whereas psychological factors such as depressive symptoms and uncertainty negatively affect disease management efficacy.

Purpose: The mediating and indirect effects of depressive symptoms and disease uncertainty regarding the relationship between physical symptoms and self-care behaviors were examined in older South Korean men with heart failure.

Methods: A descriptive correlational survey design was used to collect data from 185 older men with heart failure. Data were obtained from medical records and self-reported questionnaires addressing physical symptoms, depressive symptoms severity (Patient Health Questionnaire-9), illness uncertainty (Mishel Uncertainty in Illness Scale-Community Form), and self-care behaviors (European Heart Failure Self-care Behavior Scale). The mediating effects of depressive symptoms and disease uncertainty were assessed using a bootstrapping method via PROCESS Model 4, a parallel mediation model, in SPSS.

Results: The mean age of the participants was 77.41 (SD = 5.35) years. Half (50.8%) had a diagnosis of New York Heart Association Class II heart failure, and 21.6% had a diagnosis of New York Heart Association Class III/IV heart failure. Self-care behaviors were found to correlate negatively with physical symptoms, depressive symptoms, and uncertainty. Depressive symptoms (B = -0.10, 95% confidence interval [CI] [-0.18, -0.01]) and uncertainty (B = -0.05, 95% CI [-0.09, -0.01]) were found to mediate the relationship between physical symptoms and self-care behaviors.

Conclusions/implications for practice: The findings reveal depressive symptoms and disease uncertainty significantly mediate the relationship between physical symptoms and self-care behaviors in older South Korean men with heart failure. In light of this, cardiovascular nurses should join in targeted educational initiatives tailored to address the unique needs of older men with heart failure that consider psychological factors such as depressive symptoms and uncertainty as well as physical symptom management.