title: Depression and self-care maintenance in patients with heart failure: A moderated mediation model of self-care confidence and resilience.
abstract: Despite the recognition of the negative effects of depressive symptoms on self-care confidence and self-care maintenance in patients with heart failure, little is known about the moderating role of resilience underlying these relations.
  
  
  
  To explore whether depressive symptoms affect self-care maintenance through self-care confidence and whether this mediating process was moderated by resilience.
  
  
  
  The sample comprised 201 community-dwelling and medically stable patients with echocardiographically documented heart failure. A moderated mediation model was conducted to test whether self-care confidence mediated the association between depressive symptoms and self-care maintenance, and whether resilience moderated the direct and indirect effects of depressive symptoms after adjustment for covariates.
  
  
  
  Depressive symptoms reduced self-care maintenance indirectly by decreasing self-care confidence (indirect effect: -0.22, 95% confidence interval: -0.36, -0.11), and this pathway was only significant for patients with moderate and high levels and not with low levels of resilience. Resilience also moderated the direct effects of depressive symptoms on self-care maintenance such that the negative association between depressive symptoms and self-care maintenance was reversed by the existence of high resilience.
  
  
  
  Resilience moderated the direct and indirect effects of depressive symptoms through self-care confidence on self-care maintenance in heart failure patients. Efforts to improve self-care maintenance by targeting depressive symptoms may be more effective when considering self-care confidence in patients with moderate to high levels of resilience.
authors.affiliation: 1 Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
authors.forename: Ling-Yin
authors.initials: LY
authors.lastname: Chang
authors.affiliation: 2 Department of Nursing, Taipei Veterans General Hospital, Taiwan.
authors.forename: Shan-Ying
authors.initials: SY
authors.lastname: Wu
authors.affiliation: 3 General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan.
authors.forename: Chern-En
authors.initials: CE
authors.lastname: Chiang
authors.affiliation: 4 School of Nursing, College of Nursing, Taipei Medical University, Taiwan.|5 Sleep Research Center, Taipei Medical University Hospital, Taiwan.|6 Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taiwan.
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Tsai
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000534:rehabilitation*; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D055500:Resilience, Psychological; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012649:Self Concept
keywords: Heart failure; moderated mediation; resilience; self-care confidence; self-care maintenance