depressive symptoms, family caregivers, heart failure, psychological stress



  1. Chung, Misook L. PhD, RN
  2. Pressler, Susan J. DNS, RN, FAAN
  3. Dunbar, Sandra B. DSN, RN, FAAN
  4. Lennie, Terry A. PhD, RN
  5. Moser, Debra K. DNSc, RN, FAAN


Background: Millions of family members deliver informal care and support to patients with heart failure (HF). Caregivers of patients with HF experience depressive symptoms, but factors associated with depressive symptoms are unknown. The purposes of this study were (1) to examine differences between caregivers with and without depressive symptoms in patients' characteristics and caregivers' functional status, caregiving burden (time devoted to caregiving, difficulty of caregiving tasks, and overall perceived caregiving distress), and perceived control; and (2) to determine predictors of depressive symptoms of caregivers.


Method: A total of 109 caregivers (mean age of 57 years; spousal caregiver, 79%) and patients with HF participated in this study. Depressive symptoms, perceived control, and functional status of both patients and caregivers were assessed using the Beck Depression Inventory II, the Control Attitudes Scale-Revised, and the Duke Activity Status Index, respectively. Caregivers' burden (time and difficulty of caregiving tasks and burden) were assessed using the Oberst Caregiving Burden Scale and the Zarit Burden Interview.


Results: The 27.5% of HF caregivers with depressive symptoms (Beck Depression Inventory II score >=14) had poorer functional status, lower perceived control, and higher perceived caregiving distress; experienced more caregiving difficulty; and spent more time in caregiving tasks than did caregivers without depressive symptoms. Controlling for age and sex in a multiple regression, caregivers' own functional disability (standard [beta] [s[beta]] = -.307, P < .001), perceived control (s[beta] = -.304, P < .001), and caregiver burden (s[beta] = .316, P = .002) explained 45% of the variance in caregivers' depressive symptoms. Patients' New York Heart Association class and functional status did not predict caregivers' depressive symptoms.


Conclusion: Caregivers' poor functional status, overall perception of caregiving distress, and perceived control were associated with depressive symptoms. Depressed caregivers of patients with HF may benefit from interventions that improve caregivers' perceived control, address the caregiving burden, and improve or assist with caregivers' functional status.