title: Family context influences psychological outcomes of depressive symptoms and emotional quality of life in patients with heart failure.
abstract: BACKGROUND
  Although family influences in heart failure (HF) care are considered important, little evidence is available regarding relationships between the family context and specific outcomes for patients with HF.
  
  
  OBJECTIVE
  The aim of this study was to examine the relationships of patient perceptions of family functioning, autonomy support, and perceived criticism, as well as their family member's (FM) HF knowledge, with patient outcomes of depressive symptoms and HF quality of life (QOL).
  
  
  METHODS
  Participants (n = 117) with HF were enrolled in a family partnership intervention study. Self-report questionnaires measuring the HF patient's perceptions of family context and the FM's knowledge were analyzed relative to the HF patient's outcomes using correlations and sequential multivariate regression analyses. Only preintervention, baseline data are reported here.
  
  
  RESULTS
  Age, ethnicity, Charlson comorbidity index, global family functioning, and FM's HF knowledge accounted for 37.8% (P < .001) of the variance in the patient's depressive symptoms. An additional moderating effect of ethnicity on the association between global family functioning and patient's depressive symptoms was significant (change R2 = 0.06, P = .001), resulting in a final model that accounted for 43.3% of depressive symptom variance. Age, ethnicity, global family functioning, and autonomy support accounted for 24.9% (P < .001) of the variance in emotional HF QOL. An additional moderating effect of ethnicity on the association between global family functioning and patient's emotional HF QOL was significant (change R2 = 0.05, P = .009), resulting in a final model that accounted for 28.9% of emotional QOL variance.
  
  
  CONCLUSIONS
  This study underscores the importance of the patient's perspective on family functioning and autonomy support, along with FM's HF knowledge, on HF patient outcomes moderated by ethnicity. Future interventions could target the modifiable patient-family context relationships for improving depressive symptoms and QOL in HF patients. These findings point to the need for greater family assessment to identify those at risk for worse outcomes and to guide family focused interventions.
authors.affiliation: Kelly D. Stamp, PhD, ANP-C, RN Assistant Professor, School of Nursing, Boston College, Chestnut Hill, Massachusetts. Sandra B. Dunbar, RN, DSN, FAHA, FAAN Charles Howard Candler Professor of Cardiovascular Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Patricia C. Clark, PhD, RN, FAHA, FAAN Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta. Carolyn M. Reilly, PhD, RN, FAHA Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Rebecca A. Gary, PhD, RN, FAHA, FAAN Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Melinda Higgins, PhD Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Nadine Kaslow, PhD Professor, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Stamp
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Clark
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Reilly
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Gary
authors.forename: Melinda
authors.initials: M
authors.lastname: Higgins
authors.forename: Nadine
authors.initials: N
authors.lastname: Kaslow
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003863:Depression / Q000209:etiology*; D004644:Emotions; D005191:Family Characteristics; D005195:Family Relations; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life / Q000523:psychology*; D057566:Self Report; D012944:Social Support; D055815:Young Adult