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Associations Between Self-Care, Caregiver Contribution to Self-Care, and Depressive Symptoms in Patients With Heart Failure: A cross-sectional and correlational study

This cross-sectional study of 200 heart failure patient-caregiver dyads found that higher levels of patient symptom perception and caregiver contribution to symptom perception are significantly associated with lower depressive symptoms in patients, but neither patient self-care nor caregiver involvement was significantly linked to caregiver depressive symptoms.

Original authors: Işıl Şen Kibar, Gizem Şahin Bayındır

Published 2026-10-05

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CC BY 4.0

Original authors: Işıl Şen Kibar, Gizem Şahin Bayındır

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Heart failure is a condition where the heart struggles to pump blood effectively, a chronic struggle that affects millions of people worldwide. Managing this illness requires more than just taking medication; it demands a daily routine of self-care. This involves maintaining a healthy lifestyle, paying close attention to how the body feels, and knowing how to react when symptoms like shortness of breath or swelling appear. For many patients, this responsibility does not fall on them alone. Family members and friends often step in as informal caregivers, helping to monitor health, manage diets, and notice subtle changes in the patient's condition. While it is well known that depression can make it harder for anyone to stick to a health routine, and that caring for a sick relative can be emotionally draining, the specific ways in which a caregiver's help connects to a patient's mood have remained somewhat unclear. Understanding these links is vital because the emotional well-being of both the patient and the caregiver can influence how well the disease is managed and how well the patient feels overall.

Researchers in Turkey set out to untangle these relationships by looking at 200 pairs of heart failure patients and their primary caregivers. The study took place in a hospital in Istanbul, where the team gathered information from patients in their rooms and from their caregivers in a separate education room. They used standard questionnaires to measure three main things: how well the patients were managing their own care, how much the caregivers were helping with that care, and the level of depressive symptoms each person was experiencing. The researchers broke down self-care into specific parts, such as the ability to notice symptoms and the ability to manage daily tasks, to see if certain types of help mattered more than others.

The results revealed a specific and meaningful connection between how symptoms are noticed and how a patient feels emotionally. The study found that when patients were better at recognizing and interpreting changes in their own bodies, they reported fewer symptoms of depression. More importantly, the researchers discovered that when caregivers actively helped with this specific task—helping the patient notice and understand symptoms—the patient's depressive symptoms were lower. This suggests that the act of jointly paying attention to the body's signals provides a sense of control and reduces the uncertainty that often fuels distress. However, the study also found that the overall amount of help a caregiver provided, or their help with general daily tasks, did not have the same clear link to the patient's mood. It was not the quantity of assistance that mattered most, but the quality of the involvement in recognizing the illness itself.

Interestingly, the study showed that these specific interactions did not significantly predict the emotional state of the caregivers themselves. While the patients' mood was tied to how symptoms were perceived, the caregivers' own feelings of depression were not directly linked to how much they helped with self-care tasks. This indicates that the emotional toll on a caregiver may stem from different sources, such as the overall burden of the role or their own support systems, rather than simply the act of helping with daily health routines. The researchers noted that their findings are based on a single snapshot in time, meaning they can show that these things happen together but cannot prove that one causes the other. It is possible that feeling less depressed helps a person notice symptoms better, or that noticing symptoms better helps reduce depression.

In total, the data explained only a small portion of the variations in how depressed the patients felt, suggesting that many other factors, such as the severity of the disease or social support, also play major roles. Nevertheless, the study offers a clear direction for how medical care might evolve. Instead of focusing solely on whether a patient is taking their pills or following a diet, healthcare providers might benefit from looking at how the patient and caregiver work together to understand the illness. By encouraging a partnership where both people are alert to changes in the patient's condition, medical teams may be able to support the emotional health of the patient in a way that goes beyond simple instruction. This approach treats the management of heart failure not just as a set of individual tasks, but as a shared experience where paying attention to the body is a powerful tool for maintaining mental well-being.

Technical Summary: Associations Between Self-Care, Caregiver Contribution, and Depressive Symptoms in Heart Failure

Problem Statement
Heart failure (HF) is a chronic, progressive condition requiring complex self-care behaviors, including maintenance, symptom perception, and management. While self-care is traditionally viewed as an individual patient responsibility, the progressive nature of HF often necessitates informal caregiver involvement. However, the specific mechanisms by which different domains of caregiver contribution (e.g., assisting with symptom recognition vs. general maintenance) relate to the psychological well-being of both patients and caregivers remain unclear. Existing literature often examines these variables in isolation or at a global level, leaving a gap in understanding how specific dyadic interactions—particularly regarding symptom perception—influence depressive symptoms in the patient-caregiver unit.

Methodology
This study employed a cross-sectional and correlational design involving 200 patient-caregiver dyads recruited from a cardiac hospital in Istanbul, Türkiye.

Participants: Patients were diagnosed with HF for at least one year, classified as NYHA functional class II–IV, and had no neurological or terminal diseases. Caregivers were primary, unpaid informal supporters.
Data Collection: Data were collected separately from patients (in hospital rooms) and caregivers (in education rooms) between November 2024 and June 2025.
Instruments:
- Heart Failure Self-Care Index (HFSI): Assessed patient self-care maintenance, symptom perception, and management.
- Caregiver Contribution to Self-Care of Heart Failure Index (CCSC-HF): Assessed caregiver contribution across the same three domains.
- Beck Depression Inventory (BDI): Measured the severity of depressive symptoms in both groups.
Analysis: Multiple linear regression analyses were conducted to examine associations between self-care domains, caregiver contributions, and depressive symptoms. Statistical significance was set at p < .05.

Key Results
The study yielded distinct findings regarding the associations between self-care variables and depressive symptoms for patients versus caregivers:

Patient Depressive Symptoms:
- Symptom Perception: Patient symptom perception was significantly and inversely associated with patient depressive symptoms ( $\beta = -0.213, p = .011$ ).
- Total Self-Care: Total patient self-care was also inversely associated with patient depressive symptoms ( $\beta = -0.177, p = .012$ ).
- Caregiver Contribution: Specifically, caregiver contribution to symptom perception was significantly and inversely associated with patient depressive symptoms ( $\beta = -0.193, p = .027$ ).
- Non-Significant Factors: Caregiver contributions to self-care maintenance and self-care management were not significantly associated with patient depressive symptoms. Total caregiver contribution was also not significantly associated.
- Variance Explained: The regression models explained a modest portion of the variance in patient depressive symptoms, ranging from 3.1% to 4.7% ( $R^2$ ).
Caregiver Depressive Symptoms:
- Neither total patient self-care nor total caregiver contribution to self-care showed a statistically significant association with caregiver depressive symptoms.
- None of the specific subdomains of caregiver contribution (maintenance, perception, management) were significantly associated with caregiver depressive symptoms.

Key Contributions

Domain-Specific Insights: The study demonstrates that the relationship between caregiver involvement and patient psychological well-being is not uniform; it is specifically driven by the caregiver's role in symptom perception rather than general assistance with maintenance or management.
Dyadic Perspective: By analyzing matched dyads, the research highlights that while patient self-care and caregiver involvement in symptom recognition are linked to patient depression, these factors do not directly predict caregiver depression.
Measurement Precision: The findings suggest that global measures of self-care or caregiver contribution may obscure specific, clinically relevant relationships found when analyzing distinct domains like symptom perception.

Significance and Claims
The authors claim that these findings support a shift toward "dyad-sensitive" nursing care in heart failure management. Specifically:

Clinical Implication: Nurses should assess not only whether self-care behaviors are performed but also how patients and caregivers recognize and interpret symptoms. The study suggests that caregiver involvement in symptom perception may reduce patient uncertainty and perceived loss of control, thereby lowering depressive symptom severity.
Modest Causality: The authors explicitly state that due to the cross-sectional design, the direction of causality cannot be established. The relationship between self-care and depression is likely bidirectional (depression may impair self-care, and poor self-care may worsen depression).
Scope of Influence: The paper modestly notes that self-care and caregiver contribution account for only a small proportion of the variance in depressive symptoms, indicating that these are modifiable components within a broader, multidimensional approach to care rather than standalone solutions.
Future Directions: The study calls for longitudinal and intervention studies to clarify the mechanisms of these associations and to determine if targeting shared symptom perception can improve psychological outcomes for both members of the dyad.

Technical Summary: Associations Between Self-Care, Caregiver Contribution, and Depressive Symptoms in Heart Failure

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