The effects of emotional distress on quality of life of patients with heart failure and their family caregivers: testing dyadic dynamics using the actor-partner interdependence model

Background: It is vital to examine the impact of emotional distress on quality of life (QoL) at the dyadic level due to interdependent relationships between patients and their caregivers. Although depression and anxiety, common psychological problems, are known to affect individuals partner outcomes in patients with heart failure (HF) and their family caregivers, there is limited knowledge of other emotional symptoms such as hostility or obsessiveness on quality of life (QoL) in HF patient-caregiver dyads. Aims: To compare the levels of emotional symptoms and QoL between patients with HF and family caregivers; and to examine whether patients and family caregivers emotional symptoms were related to their own, and their partners QoL. Methods: A cross-sectional study in which 41 patient-family caregiver dyads completed all 9 dimensions of the Brief Symptom Inventory (sommatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism) and the Minnesota Living with Heart failure Questionnaire for quality of life. Data were analysed using the paired sample t-test and Multilevel modelling regression, the ActorPartner Interdependence Model, with distinguishable dyad regression. Results: Most patients were male (76 %), and caregivers female (81%). Patients were aged 68 years, an average 2.8 years older than the caregivers. Patients had higher scores for somatisation than the caregivers which reflect distress arising from perspectives of bodily dysfunction; other emotional symptoms and QoL were similar. Patients and caregivers phobic anxiety exhibited an actor effect (B = 13.969, p = <0.001; B = 7.798, p = 0.007), and a partner effect (B = -7.077, p = 0.040; B = 6.472, p = 0.049) on QoL, indicating that phobic anxiety influenced the patients and caregivers health in a negative way. Caregivers obsessive-compulsive dimension negatively impacted their own (B = 5.639, p = 0.017, and the patients QoL (B = 5.633, p = 0.017). Patients anxiety, hostility, interpersonal sensitivity and paranoid ideation negatively impacted their own, and the caregivers QoL. Patients somatisation and psychoticism and patients and caregivers depression showed an actor effect on their own QoL. Conclusions: Both patients and caregivers had similar and higher levels of emotional symptoms. Patients and/or caregivers emotional symptoms were variably and negatively associated with QoL. There is a need to develop interventions to target particular emotional responses to improve QoL of the dyads