Depression, mutuality, and self-care behaviors in patients with heart failure and their caregivers: An actor-partner interdependence model extended to mediation

Abstract

Background: Mutuality may serve as a protective factor against depression for both patients with heart failure (HF) and their caregivers. Mutuality, a sense of positive interaction, is associated with better self-care for HF patients and for lower levels of depression. The mechanism linking mutuality to improved self-care and lowered depression is unclear.

Objectives: To examine whether mutuality, the quality of interactions between HF dyads, functions as a mediator in the association between depression and self-care behaviors.

Methods: A cross-sectional study was conducted among 202 HF dyads from two university-affiliated tertiary hospitals in Seoul, South Korea. Dyadic data were analyzed by the actor-partner interdependence model extended to mediation analysis. We tested whether depression influenced HF self-care behaviors and caregiver contributions through mutuality. Mutuality, measured via self-reported perceptions from both dyad members, was assessed as a potential mediator at both individual and dyadic levels.

Results: Patients' depression had significant direct effects (actor effects) on their own self-care behaviors (β = -0.61, 95 % confidence interval (CI) = -1.22 to -0.12) and caregivers' contribution to self-care behaviors (partner effects) (β = -0.92, 95 % CI = -1.65 to -0.19). Patients' mutuality mediated the association between patients' depression and self-care behaviors (β = -0.27, 95 % CI = -0.57 to -0.07). Caregivers' mutuality mediated the relationship between caregivers' depression and contribution to self-care behaviors (β = -0.26, 95 % CI = -0.61 to -0.01).

Conclusion: Mutuality may serve as a protective factor against depression in HF dyads. The relationship quality in HF dyads should be assessed, with psychosocial interventions implemented to enhance dyadic self-care behaviors.