title: Moderating effect of psychosocial factors for dyspnea in Taiwanese and American heart failure patients.
abstract: BACKGROUND
  Dyspnea is the most common and distressing symptom of heart failure (HF). Evidence from empirical studies has shown that multiple factors apart from pathophysiological changes may influence this symptom.
  
  
  OBJECTIVE
  This study explored the moderating effect of psychosocial factors between clinical characteristics and dyspnea in patients with HF. To assess the potential effects of cultural background, this study also compared differences in psychosocial factor moderating effects between HF patients in Taiwan and the United States.
  
  
  METHODS
  We recruited patients with HF from outpatient clinics in Taiwan and the United States. Data were collected at clinics and research centers. Dyspnea was measured using the modified pulmonary function status and dyspnea questionnaire. Psychosocial factors considered were depression, anxiety, perceived control, and perceived social support. These factors were measured using the Brief Symptom Inventory, Revised Control Attitudes Scale, and Multidimensional Scale of Social Support Scale, respectively. Multiple regressions with interaction effect analysis tested the moderator effects across these two groups.
  
  
  RESULTS
  Ninety-seven Taiwanese (mean age = 66.2 ± 12.1 years; 76% male; 28% NYHA [New York Heart Association] III/IV) and 96 American (mean age = 61.6 ± 11.7 years; 74% male; 42% NYHA III/IV) patients participated. In Taiwanese patients, only perceived social support (B = .08, p = .034) moderated the relationship between clinical variables and dyspnea. In American patients, depression (B = .75, p = .028) and anxiety (B = .85, p = .041) were moderators of the relationship between clinical status and dyspnea severity.
  
  
  CONCLUSIONS
  Depression, anxiety, and perceived social support moderated the relationship of clinical characteristics with dyspnea in Taiwanese and American HF patients, respectively. Attention to these psychosocial factors may improve dyspnea status in HF patients. Symptom management should include a focus on patients' psychological distress and social perspectives.
authors: Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC.
authors: Tsuey-Yuan
authors: TY
authors: Huang
authors: Debra K
authors: DK
authors: Moser
authors: Yeu-Sheng
authors: YS
authors: Hsieh
authors: Bih-Shya
authors: BS
authors: Gau
authors: Fu-Tuein
authors: FT
authors: Chiang
authors: Shiow-Li
authors: SL
authors: Hwang
mesh_terms: D005260:Female; D006333:Heart Failure; D006801:Humans; D008297:Male; D013624:Taiwan; D014481:United States