Thomson P, et al. PLoS One. 2020 Jan 8;15(1):e0227129.
Thomson P, et al., conducted a cross-sectional study to assess levels of emotional symptoms and health-related quality of life between patients with heart failure and their family caregivers; and to estimate if patients’ and caregivers’ emotional symptoms were correlated with their own, along with their partner’s health-related quality of life.
In this study, almost 41 patients-caregiver dyads (78% male patients, aged 68.6 years; and 83% female caregivers, aged 65.8 years) completed each of the 9 dimensions of the Brief Symptom Inventory (BSI) and the Minnesota Living with Heart failure Questionnaire. By using the Actor–Partner Interdependence Model (APIM) for the 6 sub-scales of the Brief Symptom Inventory, dyadic data were assessed. Comparability was observed between the Cronbach’s alpha vs. Derogatis and Melisaratos in their introductory report for the BSI (Table 1).
Table 1: Correlation and collinearity between markers of congestion
The socio-demographics, clinical history, emotional symptoms and health-related QoL of the subjects were included in Table 2. 78% of majority of patients were men and 83% of majority caregivers were women, notably frequent in studies of patients and caregivers. Patients mean age and caregivers mean age was 68.6 years (SD = 10.8) and 65.8 years (SD = 10.6) respectively. Half of the patients were observed in NYHA class I or II; and a left ventricular ejection fraction of less than 29% was observed in 66% of patients. Just 12% of patients were on antidepressants (Table 2).
Table 2: Patients and family caregivers characteristics (n = 41)
No statistically significant differences were observed between the patients’ and caregivers’ emotional symptoms, with the exception of somatisation. Patients showed 1.02 higher scores for somatization as compared to 0.56 with caregivers (p = 0.017), which indicates higher anxiety emerging from perspectives of bodily dysfunction. No statistically significant differences were observed between the patients’ and caregivers’ Health-related QoL (38.27 vs 30.34, p = 0.1, Table 3).
Table 3: Patients and caregivers’ emotional symptoms and health-related QoL (n = 41 dyads)
The associations between every 9 BSI dimensions and health-related QoL were presented in Table 4. Patient hostility slightly showed negative association with their own health-related QoL. Slight positive association was observed between several caregivers’ emotional symptoms with the patients’ health-related QoL. Moderate positive association was observed between caregivers’ health-related QoL with several of their own BSI dimensions. Highly strong inter-correlation was identified between somatisation, interpersonal sensitivity and psychoticism with other BSI items which indicate that they were closely related constructs (Table 4).
Table 4: Correlations coefficients among British Symptom Inventory dimensions and quality of life (n = 41 dyads)
For 6 emotional symptom dimensions such as obsession-compulsion, depression, anxiety, hostility, phobic anxiety and paranoid ideation and health-related QoL, based on the outcome of the correlations dyadic analysis using the APIM was conducted. Statistical significant partner effects of caregivers’ emotional symptoms were observed on the health related QoL of patients (Table 5).
Table 5: Actor and partner effects of emotional symptoms on health-related QoL using the APIM
The APIM model outcomes observed the actor effects of patients’ anxiety and caregivers’ anxiety on their own health-related QoL, and a partner effect of caregiver’s anxiety on the health-related Qol of the patient (Figure 1).
Figure 1: Results for the actor and partner effects of patient’s anxiety and caregiver’s anxiety on health-related quality of life using the MLHFQ, Minnesota Living with Heart Failure Questionnaire; BSI, Brief Symptom Inventory; APIM: Actor-Partner Interdependence Model. *p < .05; **p < .01; ***p < .001
Thus, the findings of this study recommend that patients may be extremely vulnerable to emotional distress such as thoughts, impulses and actions of their caregivers. By targeting specific detrimental emotional symptoms of caregivers, it might be possible to enhance patients’ health-related quality of life.
