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.