The association of social determinants of health and depressive symptoms with quality of life among rural patients with coronary heart disease and heart failure

Background: There are significant health disparities among rural populations, especially in the prevalence and management of coronary heart disease and heart failure. Social determinants of health (SDOH) play a crucial role in these disparities, influencing access to care, mental health, and overall quality of life (QOL). Depressive symptoms, common among rural patients with coronary heart disease and heart failure, may further exacerbate these challenges by mediating the relationship between SDOH and QOL. Objectives: We aimed to examine the association between SDOH and QOL among rural patients with coronary heart disease and heart failure, as well as to determine whether depressive symptoms mediate this relationship. Methods: A cross-sectional analysis (N = 124) was conducted using data from a randomized controlled trial. The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences questionnaire was used to measure SDOH, depressive symptoms were assessed using the Patient Health Questionnaire-9, and QOL was evaluated using Short Form-12. We performed hierarchical multiple regression and mediation analyses. Results: Higher SDOH risk scores were significantly associated with lower QOL (B= -0.319; p < 0.001). Depressive symptoms mediated this relationship (indirect effect: a*b = -0.624, 95 % confidence interval (CI)= [-1.045, -0.273]), suggesting that individuals with higher SDOH risk had worse depressive symptoms, which in turn led to lower QOL. Conclusion: The SDOH were associated with QOL in rural patients with coronary heart disease and heart failure, and depressive symptoms mediated this relationship. Findings highlight the need for targeted interventions addressing both social determinants and mental health to improve QOL.