title: Depressive symptoms and the relationship of inflammation to physical signs and symptoms in heart failure patients.
abstract: BACKGROUND
  Depressive symptoms in patients with heart failure can affect the relationship between physical signs and symptoms and inflammation.
  
  
  OBJECTIVE
  To examine the relationship between soluble tumor necrosis factor receptor I and physical signs and symptoms and the effects of depressive symptoms on this relationship in patients with heart failure.
  
  
  METHODS
  Data on physical signs and symptoms (Symptom Status Questionnaire-Heart Failure), depressive symptoms (Beck Depression Inventory-II), and levels of the receptor (blood samples) were collected from 145 patients with heart failure. Data on the receptor were square root transformed to achieve normality. Patients were divided into 2 groups according to their scores for depressive symptoms (nondepressed <14 and depressed ≥14). Hierarchical multiple regression was used to analyze the data.
  
  
  RESULTS
  In the total sample, with controls for covariates, higher levels of the receptor were significantly related to more severe physical signs and symptoms (F = 7.915; P < .001). In subgroup analyses, with controls for covariates, levels of the receptor were significantly related to physical signs and symptoms only in the patients without depression (F = 3.174; P = .005).
  
  
  CONCLUSIONS
  Both depressive symptoms and inflammation should be considered along with physical signs and symptoms in patients with heart failure. Further studies are needed to determine the effects of improvement in inflammation on improvement in physical signs and symptoms, with consideration given to the effects of depressive symptoms.
authors.affiliation: Seongkum Heo is an assistant professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Debra K. Moser is a professor and Gill Chair of Nursing, Rebecca L. Dekker is an assistant professor, and Terry A. Lennie is a professor, University of Kentucky, College of Nursing, Lexington, Kentucky. Susan J. Pressler is a professor, University of Michigan, School of Nursing, Ann Arbor, Michigan, and Sandra B. Dunbar is a professor, Emory University, School of Nursing, Atlanta, Georgia. sheo@uams.edu.
authors.forename: Seongkum
authors.initials: S
authors.lastname: Heo
authors.affiliation: Seongkum Heo is an assistant professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Debra K. Moser is a professor and Gill Chair of Nursing, Rebecca L. Dekker is an assistant professor, and Terry A. Lennie is a professor, University of Kentucky, College of Nursing, Lexington, Kentucky. Susan J. Pressler is a professor, University of Michigan, School of Nursing, Ann Arbor, Michigan, and Sandra B. Dunbar is a professor, Emory University, School of Nursing, Atlanta, Georgia.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: Seongkum Heo is an assistant professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Debra K. Moser is a professor and Gill Chair of Nursing, Rebecca L. Dekker is an assistant professor, and Terry A. Lennie is a professor, University of Kentucky, College of Nursing, Lexington, Kentucky. Susan J. Pressler is a professor, University of Michigan, School of Nursing, Ann Arbor, Michigan, and Sandra B. Dunbar is a professor, Emory University, School of Nursing, Atlanta, Georgia.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pressler
authors.affiliation: Seongkum Heo is an assistant professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Debra K. Moser is a professor and Gill Chair of Nursing, Rebecca L. Dekker is an assistant professor, and Terry A. Lennie is a professor, University of Kentucky, College of Nursing, Lexington, Kentucky. Susan J. Pressler is a professor, University of Michigan, School of Nursing, Ann Arbor, Michigan, and Sandra B. Dunbar is a professor, Emory University, School of Nursing, Atlanta, Georgia.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.affiliation: Seongkum Heo is an assistant professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Debra K. Moser is a professor and Gill Chair of Nursing, Rebecca L. Dekker is an assistant professor, and Terry A. Lennie is a professor, University of Kentucky, College of Nursing, Lexington, Kentucky. Susan J. Pressler is a professor, University of Michigan, School of Nursing, Ann Arbor, Michigan, and Sandra B. Dunbar is a professor, Emory University, School of Nursing, Atlanta, Georgia.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Dekker
authors.affiliation: Seongkum Heo is an assistant professor, University of Arkansas for Medical Sciences, College of Nursing, Little Rock, Arkansas. Debra K. Moser is a professor and Gill Chair of Nursing, Rebecca L. Dekker is an assistant professor, and Terry A. Lennie is a professor, University of Kentucky, College of Nursing, Lexington, Kentucky. Susan J. Pressler is a professor, University of Michigan, School of Nursing, Ann Arbor, Michigan, and Sandra B. Dunbar is a professor, Emory University, School of Nursing, Atlanta, Georgia.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003863:Depression / Q000097:blood*; D004417:Dyspnea / Q000209:etiology; D004487:Edema / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000523:psychology*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood*; D012893:Sleep Wake Disorders / Q000209:etiology; D012944:Social Support
chemical_list: D047888:Receptors, Tumor Necrosis Factor, Type I