Abstract 13443: Influence of Depression on Self-Care Behaviors in Older Adults With Multiple Chronic Conditions: A Multivariate Analysis
Multiple chronic conditions (MCC) are highly prevalent in cardiac patients. People with MCC experience depressive symptoms more frequently than the general population. Self-care has been shown to improve outcomes in a variety of chronic illnesses, but little is known about the influence of depression on these behaviours in MCC. Self-care, is defined as the behaviours adopted to maintain illness stability (self-care maintenance), monitor signs and symptoms (self-care monitoring) and respond to signs and symptoms of an illness exacerbation (self-care management). Our aim was to assess the influence of depression on self-care in MCC patients.
A cross-sectional design was used. Patients were enrolled from community and outpatient settings and included if: ≥65 years, had heart failure, diabetes or chronic obstructive pulmonary disease and another chronic condition; they were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 (PHQ-9) was used to measure depression and Self-Care of Chronic Illness Inventory (SC-CII) was used to measure self-care behaviors (maintenance, monitoring, management). The influence of depression was evaluated with MANOVA, discriminant and regression analysis.
The sample (N=366) was mostly female (54.1%) mean age 76.4 years (± 7.26), and 34.2% had heart failure. Mean PHQ-9 score was 6.7 (± 4.42) and 65.6% of patients scored above the cut-point for depression. MANOVA revealed a significant effect of depression on all self-care dimensions; ∧ = .887, F (3, 362) = 15.308, p < .001. Discriminant analysis revealed a canonical variate that differentiated the two groups; canonical R2 = .11, ∧ = .887, χ2(3, N=366) = 43.295, p = < .001. The maintenance dimension loaded more highly (r = .998) onto the function than the other dimensions. In regression analysis, depression predicted self-care (maintenance, F(1,364) = 810.96, p < .001; monitoring, F(1,364) = 138.07, p < .001; management, F(1,364) = 220.03, p .001).
The results suggest that depression influences all three self-care dimensions in people with MCC. Self-care maintenance behaviours (e.g. physical activity, healthy diet, medication adherence) may be affected more by depression than the other dimensions.