title: Depression and disease severity as predictors of health-related quality of life in patients with chronic heart failure--a structural equation modeling approach.
abstract: BACKGROUND
  To examine whether depression and heart failure severity are independent predictors of both the physical and psychologic domains of health-related quality of life (HRQoL) in patients with chronic heart failure.
  
  
  RESULTS
  A sample of 206 outpatients with chronic heart failure (mean age 64 years, 69% male) was evaluated. Depression was measured with the Patient Health Questionnaire and disease-specific HRQoL with the Kansas City Cardiomyopathy Questionnaire. Heart failure severity was assessed with physician ratings of the New York Heart Association (NYHA) functional class. The simultaneous effects of predictor variables on outcomes were estimated using structural equation modeling. Both depression and NYHA functional class independently predicted the physical domain of HRQoL. By contrast, the psychologic domain was only predicted by depression, but not by NYHA functional class.
  
  
  CONCLUSIONS
  Our results suggest that comorbid depression has an independent impact on both physical and psychologic HRQoL in patients with chronic heart failure after controlling for the severity of heart failure symptoms, while heart failure severity only impacts physical HRQoL. Thus, assessment of comorbid depression may help interpreting reduced HRQoL in heart failure patients. Research seems warranted evaluating whether the amelioration of depression may enhance patients' HRQoL in chronic heart failure.
authors.affiliation: Institute of Psychotherapy und Medical Psychology, University of Würzburg, Würzburg, Germany. h.faller@uni-wuerzburg.de
authors.forename: Hermann
authors.initials: H
authors.lastname: Faller
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.forename: Michael
authors.initials: M
authors.lastname: Schuler
authors.forename: Marion
authors.initials: M
authors.lastname: Schowalter
authors.forename: Thomas
authors.initials: T
authors.lastname: Steinbüchel
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Angermann
mesh_terms: D002908:Chronic Disease; D003866:Depressive Disorder / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index