Self-Care, Perceived Social Support, and Health-Related Quality of Life in Patients With Heart Failure

BACKGROUND: Depressive symptoms, anxiety, and inadequate social support are predictors of health-related quality of life (HRQoL) in persons with heart failure, but the prediction of HRQoL is multifaceted, and mechanisms underlying association are unknown. Self-care maintenance may moderate associations among these predictors, which is essential to better heart failure outcomes. OBJECTIVES: To determine whether self-care maintenance moderates the direct and indirect effects of social support on HRQoL through psychological status (i.e., depressive symptoms and anxiety) in persons with heart failure. METHODS: We conducted a secondary analysis using cross-sectional data collected from 167 participants. Participants completed Patient Health Questionnaire-9, Brief Symptom Inventory, Multidimensional Scale of Perceived Social Support, Self-Care of Heart Failure Index version 6.2, and Minnesota Living with Heart Failure Questionnaire for depressive symptoms, anxiety, social support, self-care maintenance, and HRQoL, respectively. PROCESS macro was used for the analysis. RESULTS: Self-care maintenance did not moderate the direct effect of social support on HRQoL. However, self-care maintenance moderated the indirect effect of social support on HRQoL through depressive symptoms and anxiety. The beneficial effect of social support on depressive symptoms and anxiety varied with self-care maintenance, suggesting a dose-response moderation effect. DISCUSSION: Findings suggest that an increment in social support reduces depressive symptoms and anxiety, which further improves HRQoL. This relationship was more profound when the self-care maintenance was at a higher level. Our study emphasizes the need to focus on improving HRQoL by promoting positive social support that can decrease depressive symptoms and anxiety in persons with heart failure-particularly in those with low or moderate levels of self-care maintenance.