Journal of General Internal Medicine

, Volume 22, Issue 4, pp 470–477 | Cite as

Spiritual Well-Being and Depression in Patients with Heart Failure

  • David B. BekelmanEmail author
  • Sydney M. Dy
  • Diane M. Becker
  • Ilan S. Wittstein
  • Danetta E. Hendricks
  • Traci E. Yamashita
  • Sheldon H. Gottlieb
Original Article



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.


heart failure spirituality depression palliative care 



The authors wish to thank the seriously ill patients in the study for their participation.

Potential Financial Conflicts of Interest

None disclosed


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • David B. Bekelman
    • 1
    Email author
  • Sydney M. Dy
    • 2
  • Diane M. Becker
    • 3
  • Ilan S. Wittstein
    • 4
  • Danetta E. Hendricks
    • 2
  • Traci E. Yamashita
    • 1
  • Sheldon H. Gottlieb
    • 5
  1. 1.Department of Medicine, Division of General Internal MedicineUniversity of Colorado at Denver and Health Sciences CenterDenverUSA
  2. 2.Department of Health Policy & Management, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  3. 3.Division of Internal MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Johns Hopkins HospitalBaltimoreUSA
  5. 5.Johns Hopkins Bayview Medical CenterBaltimoreUSA

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