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Heart failure, patient-caregiver dyads, mutuality, anxiety and depression



  1. Dellafiore, Federica PhD, RN
  2. Chung, Misook L. PhD, RN, FAAN, FAHA
  3. Alvaro, Rosaria MSN, RN, FESC
  4. Durante, Angela PhD, RN
  5. Colaceci, Sofia PhD
  6. Vellone, Ercole RN, PhD, FESC
  7. Pucciarelli, Gianluca PhD, RN


Background: Heart failure (HF) patient-caregiver dyads experience severe psychological problems, such as anxiety and depression. A variable that has been found to be associated with anxiety and depression in patients and caregivers in severe chronic conditions is mutuality. However, this association has not been explored in HF patient-caregiver dyads to date.


Objective: The aim of this study was to evaluate the associations among mutuality, anxiety, and depression in HF patient-caregiver dyads.


Methods: This was a cross-sectional study. Mutuality, anxiety, and depression in HF patient-caregiver dyads were assessed using the Mutuality Scale (MS) total and 4 dimension scores and the Hospital Anxiety and Depression Scale, respectively. Data were analyzed using the actor-partner interdependence model to examine how mutuality of patients and caregivers was associated with both the patients' own (actor effect) and their partners' anxiety and depression (partner effect).


Results: A sample of 366 dyads of patients with HF (mean age, 72 years; 56% male) and caregivers (mean age, 54 years; 73.3% female) was enrolled. Regarding patient anxiety, we observed only an actor effect between the MS dimension scores of "love and affection" and "reciprocity" and anxiety in patients (B = -1.108, P = .004 and B = -0.826, P = .029, respectively). No actor and partner effects were observed concerning caregiver anxiety. Regarding depression, we observed that only the MS dimension of "love and affection" in patients had both an actor (patient: B = -0.717, P = .032) and a partner (caregiver: B = 0.710, P = .040) effect on depression.


Conclusions: The assessment of MS in HF patient-caregiver dyads is important to formulate interventions aimed at improving anxiety and depression in patients and caregivers.