The Mediator Effects of Depressive Symptoms on the Relationship between Family Functioning and Quality of Life in Caregivers of Patients with Heart Failure

Linda Clements, Susan K. Frazier, Debra K. Moser, Terry A. Lennie, Misook L. Chung

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Caregivers of patients with heart failure (HF) report depressive symptoms and poor quality of life (QOL) related to caregiving and poor family functioning, placing them at risk for poor health. Objectives: The purpose of this study was to examine the effect of depressive symptoms on the relationship between family functioning and quality of life in the HF caregiver. Methods: A sample of 92 HF caregivers were enrolled from an ambulatory clinic at a large academic medical center. A mediation analysis was used to analyze data obtained from the Family Assessment Device (FAD), the Patient Health Questionaire-9 (PHQ-9), and the Short Form-12 Health Survey Version 2 (SF-12v2). Results: Depressive symptoms were found to be a significant mediator in the relationship between family functioning and caregiver quality of life. Conclusions: The results of this study suggest that interventions targeting caregiver depression and family functioning could be effective in enhancing HF caregivers’ physical and mental QOL.

Original languageEnglish
Pages (from-to)737-744
Number of pages8
JournalHeart and Lung
Issue number6
StatePublished - Nov 1 2020

Bibliographical note

Funding Information:
This was a secondary analysis of cross-sectional data from a longitudinal observational study designed to determine the impact of caregiver's emotional distress on their QOL, rehospitalization and mortality of patients with HF. 4 , 30 The parent study included patients with stable HF and their self-reported family caregivers recruited from the outpatient cardiology clinic of two community hospitals and an academic medical center in Kentucky. Caregivers were considered for the study if they were the primary caregiver of an outpatient with a confirmed diagnosis of HF, and were excluded from recruitment in this study if they were < than age 21, and/or had a cognitive impairment or major co-morbidity such as HF, dementia, Alzheimer's disease, cancer or other terminal illnesses. When caregivers met eligibility inclusion criteria they were provided with information about the study and if agreeable to be in the study they provided signed consent and were enrolled in the study. In this study, data from the Family Assessment Device (FAD), the Patient Health Questionnaire (PHQ-9) and the Short Form -12 Health Survey Version 2 (SF-12v2) administered only once to each caregiver at baseline was used for analysis. In the parent study 155 patient-caregiver dyads completed the baseline assessment. 4 However, in this article, we included 92 caregivers who had no missing data on the main variables at baseline in this study. This study received ethical approval from the Institutional Review Board (IRB#05-0212-P3G) of the academic medical center where the study was conducted. This work was supported by the National Institutes of Health. (NIH/NINR K23 NR 010011, NIH/NINR P20 NR 010679)

Publisher Copyright:
© 2020


  • caregiver
  • depressive symptoms
  • family functioning
  • heart failure
  • quality of life

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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