, Volume 22, Issue 4, pp 470-477
Date: 06 Feb 2007

Spiritual Well-Being and Depression in Patients with Heart Failure

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In patients with chronic heart failure, depression is common and associated with poor quality of life, more frequent hospitalizations, and higher mortality. Spiritual well-being is an important, modifiable coping resource in patients with terminal cancer and is associated with less depression, but little is known about the role of spiritual well-being in patients with heart failure.


To identify the relationship between spiritual well-being and depression in patients with heart failure.


Cross-sectional study.


Sixty patients aged 60 years or older with New York Heart Association class II–IV heart failure.


Spiritual well-being was measured using the total scale and 2 subscales (meaning/peace, faith) of the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being scale, depression using the Geriatric Depression Scale—Short Form (GDS-SF).


The median age of participants was 75 years. Nineteen participants (32%) had clinically significant depression (GDS-SF > 4). Greater spiritual well-being was strongly inversely correlated with depression (Spearman’s correlation −0.55, 95% confidence interval −0.70 to −0.35). In particular, greater meaning/peace was strongly associated with less depression (r = −.60, P < .0001), while faith was only modestly associated (r = −.38, P < .01). In a regression analysis accounting for gender, income, and other risk factors for depression (social support, physical symptoms, and health status), greater spiritual well-being continued to be significantly associated with less depression (P = .05). Between the 2 spiritual well-being subscales, only meaning/peace contributed significantly to this effect (P = .02) and accounted for 7% of the variance in depression.


Among outpatients with heart failure, greater spiritual well-being, particularly meaning/peace, was strongly associated with less depression. Enhancement of patients’ sense of spiritual well-being might reduce or prevent depression and thus improve quality of life and other outcomes in this population.

The study was funded by the Johns Hopkins Center for Complementary and Alternative Medicine; Johns Hopkins General Clinical Research Center; and the National Center for Complimentary and Alternative Medicine, NIH. None of these funders had a role in study design, data collection, analyses, interpretation, report writing, or decision to submit paper for publication.
This study was presented at the 52nd Annual Meeting of the Academy of Psychosomatic Medicine, November 17, 2005, Santa Ana Pueblo, NM; The Annual Assembly of the American Academy of Hospice and Palliative Medicine & Hospice and Palliative Nurses Association, February 9, 2006, Nashville, TN; the 29th Society of General Internal Medicine Annual Meeting, April 26–29, 2006, Los Angeles, CA; and the 7th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, May 7–9, 2006, Washington, DC.
An erratum to this article can be found at http://dx.doi.org/10.1007/s11606-007-0174-8