Background: There is strong evidence to suggest that emotional distress, particularly depression, is common in patients with heart failure (HF). Caregivers of patients with HF play a pivotal role in improving HF patient outcomes; however, these caregivers are at risk for caregiver burden and emotional distress. Objectives: The objectives of this study were to explore potential relationships among patient and caregiver emotional status, uncertainty and caregiver appraisal. For the purposes of this study, emotional distress is defined as the presence of symptoms of anxiety or depression. Methods: Using a longitudinal exploratory design, 48 HF patient-caregiver pairs were recruited. Patients and caregivers completed the Hospital Anxiety and Depression Scale, Mishel Uncertainty in Illness Scale (MUIS) and caregivers also completed the Caregiver Reaction Assessment at baseline, 2 months and 4 months. Results: Patients had advanced HF symptoms and were older than caregivers (mean age 72.6 years, 54% male versus mean age 58.4 years, 54% female). The majority of caregivers were spouses (58%) but many were adult children (42%). There were significant relationships between: a) HF patient and caregiver uncertainty, and b) caregiver emotional distress and caregiver burden. There were no significant relationships between: a) patient and caregiver symptoms of anxiety and depression, b) emotional distress and uncertainty, or c) patient emotional distress and caregiver burden. Over time, there was a trend for a decrease in: a) patient symptoms of depression, b) caregiver symptoms of anxiety, and c) patient and caregiver uncertainty. Conclusions: Contrary to findings in other studies, there was no significant relationship between symptoms of anxiety and depression in patients and their primary caregivers. There was no relationship between emotional distress and uncertainty; however, this is one of the first studies using the MUIS in HF patients and caregivers and further research with this tool is needed. Finally, this study supports findings from other studies suggesting a strong relationship between caregiver emotional distress and caregiver burden.

Doctor of Philosophy (PhD)

Thesis