Real-World observations on levels of demoralization, dignity-related distress and resilience in patients with heart failure
P Severino, A Maraone, E Prevete, A Bonucci, F S Bersani, T Accinni, F Moccia, A D'Amato, S Prosperi, C Segato, F Ferranti, C Cestie', C D Vizza, M PasquiniAbstract
Introduction
Dignity-related distress is a condition of existential suffering experienced when an individual perceives their dignity as compromised, a frequent condition in severe medical illness and consultation–liaison psychiatry. The association between depressive spectrum disorders and cardiovascular conditions is known, however evidence regarding psychopathological features, demoralization, dignity-related distress and resilience levels in patients with heart failure (HF) remains limited.
Purpose
The present study aims to assess psychopathological characteristics, the prevalence of demoralization syndrome, and levels of resilience and dignity-related distress, as well as their correlations with cardiac disease, in a sample of patients diagnosed with HF.
Methods
175 patients with HF were enrolled, the mean age was 73 years and the mean left ventricular ejection fraction was 39.9%. Participants exhibited various types of heart diseases, mainly ischemic (N=78), followed by valvular, dilated hypokinetic, and other etiologies. HF severity was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the New York Heart Association (NYHA) functional classification. Psychopathological assessment was conducted through a structured clinical interview by an experienced clinical psychiatrist. Levels of demoralization (Demoralization Index [DI]), resilience (Brief Resilience Scale [BRS]) and dignity-related distress (Patient Dignity Inventory [PDI]) were assesed through self-administered questionnaires.
Results
HF was predominantly classified as NYHA class II and III, with KCCQ impairment levels mainly in the poor-to-fair and fair-to-good ranges. 114 participants did not meet criteria for any psychiatric disorder, a minority presented with anxiety spectrum disorders (N = 9; 5 %), depressive disorders (N = 22; 12.6%), adjustment disorders (N = 21; 12%), and other mood disorders (N = 6; 3%). Demoralization syndrome was identified in 45 patients (25.7%). Most participants exhibited low (N = 43; 24.6%) or moderate (N = 98; 56%) levels of resilience. KCCQ scores were inversely correlated with resilience levels (p = .000) and directly correlated with demoralization dimensions—Loss of Meaning and Purpose (p = .001), Helplessness (p = .000), Disheartenment (p = .000), and Sense of Failure (p = .026)—as well as with dignity-related distress dimensions—Symptom Distress (p = .000), Existential Distress (p = .000), and Dependency (p = .000). Direct correlations emerged between several PDI dimensions and demoralization levels. Inverse correlations were observed with resilience levels.
Conclusions
These findings highlight the importance of consultation–liaison psychiatry in cardiology and support integrating psychotherapy with pharmacological treatment. Addressing resilience and dignity-related distress appears crucial, as these factors significantly influence cardiac outcomes and demoralization levels in patients with HF.