The Effect of Psychosocial Fcators on the Association between Clinical Characteristics and Dyspnea in Patients with Heart Failure
Date Issued
2008
Date
2008
Author(s)
Huang, Tsuey-Yuan
Abstract
Introduction: One of the most common and distressing symptoms of heart failure (HF) is dyspnea. Although psychosocial factors likely contribute to dyspnea, only clinical characteristics have been studied in HF. It is necessary to identify all factors influencing dyspnea so that effective symptom management interventions can be developed.pecific Aims: To determine whether psychosocial factors moderate the relationship between clinical characteristics and dyspnea. Because cultural diversity is increasingly prominent world-wide and not well explored, an additional aim of this study was to compare Taiwanese and American HF patients. ethod: Two groups of HF patients were enrolled: 97 Taiwanese (mean age 66.2±12.1 yrs; 76% male; 28% NYHA III/IV) and 96 American (mean age 61.6 ± 11.7 yrs; 74% male; 42% NYHA III/IV). Dyspnea and psychosocial variables (i.e., depression, anxiety, perceived control, and perceived social support) were compared between the two groups. Dyspnea was measured using the Modified Pulmonary Function Status and Dyspnea Questionnaire, depression and anxiety using the Brief Symptom Inventory, perceived control using the revised Control Attitudes Scale, and perceived social support using the Perceived Social Support Scale- Revised. Multiple regression with interaction effect analysis and multi-sample LISREL analysis were used to test for a moderator effect and its difference across groups. esult: Dyspnea severity (11.36±13.76 Taiwanese, 12.17±13.57 American, p> .05), depression (0.57±0.70 Taiwanese, 0.58±0.75 American, p> .05), and anxiety (0.48±0.60 Taiwanese, 0.59±0.68 American, p> .05) in both groups were similar. Perceived control (47.59±6.86 Taiwanese, 54.01±6.57 American, p< .05) and perceived social support (44.16±7.72 Taiwanese, 68.32±14.69 American, p< .05) were rated better in Americans compared to Taiwanese HF patients. Perceived control and perceived social support were powerful predictors of dyspnea in both Taiwanese and American patients. Perceived social support moderated the relationship between clinical variables and dyspnea in both groups. The moderator effect between groups are invariant (∆χ2=2.36/df=1, p>.05). onclusion: Perceived control and social support play substantial roles in the dyspnea symptom experience in patients with HF. Attention to perceived control and social support may improve HF patients’ symptom status.
Subjects
Heart failure
Dyspnea
Depression
Anxiety
Perceived control
Perceived social support
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