title: Resilience mediates the relationship between depression and psychological health status in patients with heart failure: a cross-sectional study.
abstract: BACKGROUND
  Depressive symptoms are linked to increased morbidity and mortality, and impaired health status in patients with heart failure. Elevating resilience may mitigate the negative consequences associated with depressive symptoms. However, the role of resilience in the relationship between depressive symptoms and health status in patients with heart failure remains unknown.
  
  
  OBJECTIVE
  To examine the relationships among depressive symptoms, resilience, and physical and psychological health status in patients with heart failure and to determine whether resilience plays a mediating or moderating role in the relationship between depressive symptoms and physical and psychological health status.
  
  
  METHODS
  Cross-sectional study design.
  
  
  METHODS
  Cardiac outpatient clinics in hospitals in Northern Taiwan.
  
  
  METHODS
  The sample comprised 128 community-dwelling and medically stable patients with echocardiographically documented heart failure.
  
  
  METHODS
  Hierarchical multiple regressions were conducted to determine whether depressive symptoms and resilience are associated with physical and psychological health status. The moderating role of resilience was examined by testing the significance of the interaction between depressive symptoms and resilience. The mediating role of resilience was analyzed using the PROCESS procedure in SPSS.
  
  
  RESULTS
  Depressive symptoms were significantly associated with both physical and psychological health status (both p<.01) in patients with heart failure after adjustment for sociodemographic variables, comorbidities, and the New York Heart Association functional class. Furthermore, resilience mediated the relationship between depressive symptoms and psychological health status (b=-0.05; confidence interval: -0.01, -0.001) but not that between depressive symptoms and physical health status (b=-0.004; confidence interval: -0.003, 0.003).
  
  
  CONCLUSIONS
  Depressive symptoms are risk factors for poor health status in patients with heart failure. However, enhancing resilience may facilitate improving psychological health status in patients with depression and heart failure. Future studies should investigate further the design and feasibility of resilience-focused interventions for patients with depression and heart failure.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
authors.forename: Ju-Chi
authors.initials: JC
authors.lastname: Liu
authors.affiliation: Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan.
authors.forename: Ling-Yin
authors.initials: LY
authors.lastname: Chang
authors.affiliation: Taipei Veterans General Hospital, Taipei 11217, Taiwan.
authors.forename: Shan-Ying
authors.initials: SY
authors.lastname: Wu
authors.affiliation: Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei 110, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan. Electronic address: ptsai@tmu.edu.tw.
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Tsai
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D055500:Resilience, Psychological
keywords: Depressive symptoms; Heart failure; Physical and psychological health status; Resilience