Ethics code: IR.AJUMS.REC.1398.342


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1- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
2- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran , kourosh1685@gmail.com
3- Student Research Committee, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4- Department of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5- School of Nursing, Institute of Health and Management, Sydney Campus, Australia
Abstract:   (42 Views)
Background: Heart failure (HF) is a chronic condition requiring effective self-care to improve clinical outcomes and quality of life. Psychological factors such as anxiety and depression, as well as religious attitudes, may influence self-care behaviors, but evidence remains inconsistent. Thus, this study aimed to examine the relationships among self-care, religious attitudes, anxiety, and depression among patients with HF.
Methods: This cross-sectional study involved recruiting 114 HF patients through convenience sampling at two educational hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences in Iran in 2023. Participants completed a demographic questionnaire, the European Self-Care Behavior Questionnaire (ESCBQ), the Hospital Anxiety and Depression Scale (HADS), and a Religious Attitude Questionnaire. Data were analyzed using SPSS v.22 running t-tests, one-way ANOVA, Chi-square tests, Pearson correlations, and multiple and simple regression analyses.
Results: Participants had a mean age of 55.47±13.90 years, and hypertension was the most common comorbidity (15.8%). The mean self-care score was 38.92 ± 7.86 (moderate level; higher scores indicate poorer self-care). Their anxiety (9.83±4.22) and depression (9.61±4.75) were at moderate levels, while their religious attitudes averaged 69.05 ± 10.08. Self-care behaviors were significantly negatively correlated with both anxiety and depression (p<0.05), but not with religious attitude. Multiple regression analysis revealed anxiety as the only independent predictor of self-care (β=0.50, p<0.001).
Conclusion: Anxiety is a key determinant of self-care in patients with HF, whereas depression has an indirect effect, and religious attitudes show no significant influence. Interventions focusing on anxiety reduction and psychological support may prove effective in enhancing self-care behaviors and improving clinical outcomes in this population.
     
Type of study: Original Article | Subject: Psychology and Psychiatry

References
1. Baradaranfard F, Babaee S, Boroumand S, Mosleh S, Jafari F, Binaee N. The Relationship Between Quality of Life and Cardiovascular Self-Efficacy in Patients with Heart Failure: A Descriptive Correlation Study. Jundishapur J Chronic Dis Care. 2018;7(4):e68431. [View at Publisher] [DOI] [Google Scholar]
2. Ran J, Zhou P, Wang J, Zhao X , Huang Y, Zhou Q , et al. Global, regional, and national burden of heart failure and its underlying causes, 1990-2021: results from the global burden of disease study 2021. Biomark Res. 2025;13(1):16. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Shahim B, Kapelios CJ, Savarese G, Lund LH. Global Public Health Burden of Heart Failure: An Updated Review. Card Fail Rev. 2023;9:e11. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Darvish M, Shakoor A, Feyz L, Schaap J , van Mieghem NM , de Boer RA ,et al. Heart failure: assessment of the global economic burden. Eur Heart J. 2025;46(31):3069-78. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. WHO. Cardiovascular diseases (CVDs). World Health Organization. 2025. [View at Publisher]
6. Janjani M, Ghadampour E, Hojati M. The Role of Self-care , Resilience and Despair on depression in the elderly with Heart Diseases. Aging Psychol. 2018;3(3):181-8. [View at Publisher] [Google Scholar]
7. Harris KM, Jacoby DL, Lampert R, Soucier RJ, Burg MM. Psychological stress in heart failure: a potentially actionable disease modifier. Heart Fail Rev. 2021;26(3):561-75. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Moradi M, Doostkami M, Behnamfar N, Rafiemanesh H, Behzadmehr R. Global Prevalence of Depression among Heart Failure Patients: A Systematic Review and Meta-Analysis. Curr Probl Cardiol. 2022;47(6):100848. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Bekele F, Tafese L, Demsash AW, Tesfaye H, Labata BG, Fekadu G. Adherence to self-care practices and associated factors among heart failure patients in Ethiopia: A systematic review and meta-analysis. PLoS One. 2023;18(8):e0288824. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Zeighami Mohammadi S, Farmani P, Danesh E. Correlation Between Type D Personality and Medication Adherence in Patients with Systolic Heart Failure. J Res Dev Nurs Midwifery. 2017;14(2):57-64. [View at Publisher] [DOI] [Google Scholar]
11. Hoch CR, George G, Matura LA. The Relationship Between Fatigue and Self-care in Adults With Heart Failure: A Scoping Review. J Cardiovasc Nurs. 2026;41(3):182-93. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Aghakhani N, Sanaie K, Baghaei R, Khademvatan K. the impact of educational- supportive self-care package on anxiety, depression and stress in myocardial infarction patients hospitalized in shahid gholipour hospital, boukan, iran, 2016. Nurs Midwifery J. 2017;15(4):281-91. [View at Publisher] [Google Scholar]
13. Riegel B, Dickson VV, Faulkner KM. The Situation-Specific Theory of Heart Failure Self-Care: Revised and Updated. J Cardiovasc Nurs. 2016;31(3):226-35. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Lee KS, Lennie TA, Yoon JY, Wu JR, Moser DK. Living Arrangements Modify the Relationship Between Depressive Symptoms and Self-care in Patients With Heart Failure. J Cardiovasc Nurs. 2017;32(2):171.-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Wang Z, Tocchi C, Chyun D, Kim K, Cong X, Starkweather A. The association between psychological factors and self-care in patients with heart failure: an integrative review. Eur J Cardiovasc Nurs. 2023;22(6):553-61. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Kutcher AM, Byon H Do, Esquivel JH. Depression, Anxiety, and Resilience. J Cardiovasc Nurs. 2024;39(3):E72-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Ebadi A, Moradian ST, Feyzi F, Asiabi M. Comparison of hospital anxiety and depression among patients with coronary artery disease based on proposed treatment. Iran J Crit CARE Nurs. 2011;4(2):97-102. [View at Publisher] [Google Scholar]
18. Celano CM, Huffman JC. Depression and cardiac disease: a review. Cardiol Rev. 2011;19(3):130-42. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Rajan S, McKee M, Rangarajan S, Bangdiwala Sh, Rosengren A, Gupta R, et al. Association of Symptoms of Depression with Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries. JAMA Psychiatry. 2020;77(10):1052-63 . [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Taghadosi M, Rohollah F, Aghajani M, Raygan F. Effect of cognitive therapy on mental health in patients with heart failure. Feyz. J Kashan Univ Med Sci. 2014;18(1):52-9. [View at Publisher] [Google Scholar]
21. Mbakwem A, Aina F, Amadi C. Expert Opinion-Depression in Patients with Heart Failure: Is Enough Being Done? Card Fail Rev. 2016;2(2):110-2. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Ghanbari S, Bahadorimonfared A. Self-care from the Perspective of Islam. J Pizhūhish dar dīn va salāmat. 2020;6(2):1-6. [View at Publisher] [Google Scholar]
23. Nourisaeed A, Salari A, Nourisaeed A, Rouhi Balasi L, Moaddab F, Akbari B. Comparison of religious attitudes in patients with coronary artery disease and healthy people. Iran J Nurs Res. 2015;10(3):18-25.l [View at Publisher]
24. Jaarsma T, Cameron J, Riegel B, Stromberg A. Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update. Curr Heart Fail Rep. 2017;14(2):71-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Ghanbari S, Bahadorimonfared A. Self-care from the Perspective of Islam. gums-hnmj. 2020;6(2):1-6. [View at Publisher] [Google Scholar]
26. Shojaei F, Asemi S, Najaf Yarandi A, Hosseini F. Self- care behaviors in patients with heart failure. payeshj. 2009;8(4):361-9. [Google Scholar]
27. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70. [View at Publisher] [DOI] [Google Scholar]
28. Zarea K, Maghsoudi S, Dashtebozorgi B, Hghighizadeh MH, Javadi M. The Impact of Peplau's Therapeutic Communication Model on Anxiety and Depression in Patients Candidate for Coronary Artery Bypass. Clin Pract Epidemiol Ment Health. 2014;10:159-65. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Stark R, Glock CY. American Piety: The Nature of Religious Commitment. Vol 29. University of California Press; 1968. . [View at Publisher] [DOI] [Google Scholar]
30. Serajzadeh S, Pouyafar M. Religion and social order: A study of the relationship between religiosity and feelings of anomie and perversion among a sample of students. J Fac Lit Humanit (Kharazmi Univ. 2009;16(63):71-105.
31. Nourisaeed A, Salari A, Nourisaeed A, Rouhi Balasi L, Moaddab F, Akbari B. Comparison of religious attitudes in patients with coronary artery disease and healthy people. Iran J Nurs Res. 2015;10(3):18-25. [View at paplisher]
32. Tian F, Chen S, Lan X, Zhang R x, Zhu C Y, Chen Y. Factors influencing self-care behaviours in patients with heart failure: A mixed-methods systematic review. Hear Lung. 2026;75:304-12. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. Bagheri-Saweh MI, Lotfi A, Salawati Ghasemi S. Self-care behaviors and related factors in chronic heart failure patients. Int J Biomed Public Heal. 2018;1(1):42-7. [DOI] [Google Scholar]
34. Zeighami Mohamadi S, Alhani F, Shakoor M, Farmani P, Fahidi F, Mohseni B,et al. Self-care behaviors in patients with systolic heart failure. J Nurs Midwifery Sci. 2015;2(1):46-54. [View at Publisher] [Google Scholar]
35. Chang LY, Wu SY, Chiang CE, Tsai PS. Depression and self-care maintenance in patients with heart failure: A moderated mediation model of self-care confidence and resilience. Eur J Cardiovasc Nurs. 2017;16(5):435-44. [View at Publisher] [DOI] [PMID] [Google Scholar]
36. Bagheri saweh MI, Ashketorab T. The Study of Self-care behaviors and its related factors in patients with congestive heart failure hospitalized in cardiology wards of Tohid Hospital in Sanandaj city. Sci J Nursing, Midwifery Paramed Fac. 2016;1(3):1-11. [View at Publisher] [DOI] [Google Scholar]
37. Radwańska E, Szwamel K, Lepsy E, Żurek A, Jerzy Gurowiec P, Krok D, et al. Relationship between the level of spirituality and quality of life or psychological well-being in elderly patients hospitalised for heart failure. Med Stud. 2024;40(2):124-42. [View at Publisher] [DOI] [Google Scholar]
38. Amini M, Gheibizadeh M, Kalboland MM, Sharhani A. Investigating the predictive role of spiritual health, social support, and quality of life in self-care behaviors among heart failure patients. J Educ Health Promot. 2023;12(1):438. [View at Publisher] [DOI] [PMID] [Google Scholar]
39. Carrillo A, Belnap BH, Rothenberger SD, Feldman R, Rollman BL, Celano CM. Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial. BMC Psychol. 2024;12(1):328. [View at Publisher] [DOI] [PMID] [Google Scholar]
40. Freedland KE, Skala JA, Steinmeyer BC, Carney RM, MW. Effects of Depression on Heart Failure Self-Care. J Card Fail. 2021;27(5):522-32. [View at Publisher] [DOI] [PMID] [Google Scholar]

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