The role of gratitude in spiritual well-being in asymptomatic heart failure patients.
Open accessAbstract
Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p<0.01), less depressed mood (r=-.41, p<0.01), less fatigue (r=-.46, p<0.01), and better self-efficacy to maintain cardiac function (r=.42, p<0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p<0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, p<.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, p<.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value.
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Claims the paper makes
0 of 4 cited sources checked · 0 supported · 0 flagged
- Finding
Spiritual wellbeing was related to the same outcomes except the inflammatory index.
“Spiritual wellbeing was related to each of these as well, with the exception of the inflammatory index.”
Quote in the paperNot yet classified - Finding
The authors conclude that gratitude and spiritual wellbeing are key positive factors to consider in this population.
“Gratitude and spiritual wellbeing are key positive factors to consider in this population.”
Quote in the paperNot yet classified - Finding
In stage B asymptomatic heart failure patients, gratitude was related to better mood and sleep, more self-efficacy, and lower fatigue and inflammation.
“In stage B asymptomatic HF patients, we found that gratitude was related to better mood and sleep, more self-efficacy, and lower fatigue and inflammation.”
Quote in the paperNot yet classified - Finding
The paper concludes that efforts to increase gratitude may be a treatment for improving wellbeing in heart failure patients and may have clinical value.
“Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients’ lives and be of potential clinical value.”
Quote in the paperNot yet classified - Finding
Patients expressing more gratitude also had lower levels of the inflammatory biomarker index.
“Patients expressing more gratitude also had lower levels of the inflammatory biomarker index (p<0.05).”
Quote in the paperNot yet classified
- Finding
Gratitude fully mediated the relationship between spiritual wellbeing and sleep quality.
“Step 4 of the analyses revealed that, when controlling for trait gratitude (GQ-6), spiritual wellbeing (FACIT-SP12) no longer remained a significant predictor of subjective sleep quality (PSQI) (R2 = .11, β =-.167, t(167)=1.89, p=.06), indicating that the beneficial effect of spirituality on sleep exerts its effect through gratitude.”
Quote in the paperNot yet classified - Finding
Gratitude partially mediated the relationship between spiritual wellbeing and fatigue.
“Although the c1 path remains significant, the Sobel test of the indirect or mediated pathway was also significant (z=−3.85, SE=.18, p<.001), providing evidence to suggest that gratitude partially mediates the relationship between spiritual wellbeing and fatigue.”
Quote in the paperNot yet classified - Finding
Correlational analyses showed that gratitude was associated with better sleep, less depressed mood, less fatigue, and better self-efficacy to maintain cardiac function.
“Gratitude was associated with better sleep (p<0.01), less depressed mood (p<0.01), less fatigue (p<0.01), and better self-efficacy to maintain cardiac function (p<0.01).”
Quote in the paperNot yet classified - Finding
Gratitude partially mediated the relationship between spiritual wellbeing and cardiac-specific self-efficacy.
“Again though, the Sobel test of the indirect or mediated pathway was also significant (z=2.91, SE=.04, p=.003), suggesting that gratitude partially mediates the relationship between spirituality and cardiac-specific self-efficacy.”
Quote in the paperNot yet classified - Finding
Spiritual wellbeing was associated with better sleep, less depressed mood, less fatigue, and better self-efficacy to maintain cardiac function.
“Spiritual wellbeing was associated with better sleep p<0.01), less depressed mood (p<0.01), less fatigue (p<0.01), and better self-efficacy to maintain cardiac function (p<0.01)”
Quote in the paperNot yet classified - Finding
There was no relationship between spiritual wellbeing and the inflammatory index, so gratitude did not mediate spirituality's association with inflammation.
“In our mediation analyses examining inflammation, there was no relationship between spiritual wellbeing and the inflammatory index (R2 = .01, β=−1.02, t(140)=−1.21, p=23).”
Quote in the paperNot yet classified - Finding
Gratitude fully mediated the relationship between spiritual wellbeing and depressed mood.
“Step 4 indicated that when controlling for trait gratitude (GQ-6), the relationship between spiritual wellbeing (FACIT-SP12) and depressed mood (BDI) is no longer significant (R2 = .23, β =-.384, t(156)=−1.663, p=.10), indicating that gratitude fully mediates the relationship between spiritual wellbeing and depressed mood.”
Quote in the paperNot yet classified - Method
The sample included 186 men and women with asymptomatic Stage B heart failure diagnosed for at least 3 months.
“The sample consisted of 186 men and women with AHA/ACC classification Stage B HF with a diagnosis for at least 3 months.”
Quote in the paperNot yet classified - Method
The study assessed depression, sleep quality, fatigue, self-efficacy, and inflammatory biomarkers as outcomes or correlates.
“Symptoms of depression were assessed with the 21-item Beck Depression Inventory (BDI-1a) where scores ≥10 indicate possible clinical depression (Beck, 1978).”
Quote in the paperNot yet classified0 of 1 sources checked- cites Beck, 1978
Not checked in the free run.
- Method
The study aimed to examine associations between spiritual wellbeing, gratitude, and physical and mental health in stage B heart failure patients, and to test gratitude as a possible pathway linking spirituality to health benefits.
“The purpose of this study therefore was to examine associations between spiritual wellbeing, gratitude, and physical and mental health in stage B HF patients and to examine a potential pathway (i.e., gratitude) through which spiritual wellbeing may promote physical and mental health benefits.”
Quote in the paperNot yet classified - Method
Spiritual wellbeing was measured with the FACITsp12, a 12-item scale designed to measure spiritual wellbeing over the past week.
“The FACITsp12 is a 12-item scale designed to measure the extent to which patients experienced spiritual wellbeing over the past week.”
Quote in the paperNot yet classified0 of 1 sources checked- cites Peterman, Fitchett, Brady, Hernandez, & Cella, 2002
Not checked in the free run.
- Method
Gratitude was measured with the GQ-6, a six-item self-administered scale designed to assess trait gratitude.
“The GQ-6 is a psychometrically sound self-administered 6-item scale designed to measure trait gratitude.”
Quote in the paperNot yet classified0 of 2 sources checked- cites Froh et al., 2011
Not checked in the free run.
- cites McCullough et al., 2002
Not checked in the free run.
Statistics that don’t add up
Each reported p-value recomputed from its test statistic and degrees of freedom.
Inconsistent p-value: t(158)=3.087, p < .001
MinorThe paper reports p < .001 here; recomputing from the test statistic and its degrees of freedom gives p = .002 (two-tailed). The check cannot tell whether the statistic or the p-value is the misprint.
Reported p < .001 · recomputed p = .002
“t(158)=3.087, p<.001”
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Doesn’t add upt(158) = 3.087reported p < .001 · recomputed p = .002
“t(158)=3.087, p < .001”
- Consistentt(166) = -3.82reported p < .001 · recomputed p < .001
“t(166)=−3.82, p < .001”
- Consistentt(169) = 8.58reported p < .001 · recomputed p < .001
“t(169)=8.58, p < .001”
- Consistentt(167) = -2.42reported p = .02 · recomputed p = .017
“t(167)=−2.42, p = .02”
- Consistentt(167) = 1.89reported p = .06 · recomputed p = .060
“t(167)=1.89, p = .06”
- Consistentt(157) = -4.765reported p < .001 · recomputed p < .001
“t(157)=−4.765, p < .001”
- Consistentt(158) = -4.536reported p < .001 · recomputed p < .001
“t(158)=−4.536, p < .001”
- Consistentt(156) = -1.663reported p = .1 · recomputed p = .098
“t(156)=−1.663, p = .10”
- Consistentt(163) = -7.342reported p < .001 · recomputed p < .001
“t(163)=−7.342, p < .001”
- Consistentt(162) = -4.318reported p < .001 · recomputed p < .001
“t(162)=−4.318, p < .001”
- Consistentt(162) = -4.02reported p < .001 · recomputed p < .001
“t(162)=−4.020, p < .001”
- Consistentt(159) = 6.453reported p < .001 · recomputed p < .001
“t(159)=6.453, p < .001”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Self-efficacy mediation reports an impossible t-statistic/β pair
MajorThe reported Step 3 and Step 4 values for self-efficacy are inconsistent: the t-statistics are about 3, but the stated coefficients differ by only 0.058, which is not enough to support the reported shift in significance pattern. The text also has a malformed parenthesis that makes the reported Step 4 value ambiguous.
Reported 3.087 · recomputed 0.058
“In Step 3, there was evidence of a relationship between trait gratitude (GQ-6) and self-efficacy to maintain cardiac function (CSEQ-mf) when controlling for spiritual wellbeing (FACIT-SP12), (R2 = .25, β=.256, t(158))=3.10, p=.002. In Step 4, the relationship between spiritual wellbeing (FACIT-sp12) and self-efficacy to maintain cardiac function (CSEQ-mf) remains significant when controlling for our hypothesized mediator, gratitude (GQ-6 (R2 = .25, β =.314, t(158)=3.087, p<.001).”
Sleep regression's coefficient and t statistic have opposite signs
MinorA coefficient and its t statistic must have the same sign because the standard error is positive. The sleep model reports a negative coefficient but a positive t statistic.
“β =-.167”
“t(167)=1.89”
Self-efficacy p values reverse the ordering of their t statistics
MinorBoth tests report 158 degrees of freedom. The smaller absolute t statistic, 3.087, cannot have p<.001 when the larger one, 3.10, has p=.002.
“t(158))=3.10, p=.002”
“t(158)=3.087, p<.001”
Inflammatory factor explains a different percentage of variance
MinorThe index lists five biomarkers. An eigenvalue of 3.23 therefore accounts for 64.6% of their total variance, not 53.8%.
Reported 53.8 · recomputed 64.6
“The resultant factor score Eigenvalue was 3.23, accounting for 53.8% of inflammatory variance.”
Inflammation regression's beta conflicts with its R-squared
MinorFor a simple regression, the square of a standardized beta equals R-squared. The reported beta would imply an R-squared of 1.0404, rather than .01.
Reported 0.01 · recomputed 1.0404
“there was no relationship between spiritual wellbeing and the inflammatory index (R2 = .01, β=−1.02, t(140)=−1.21, p=23).”
Depressed-mood coefficients use different degrees of freedom for the same model
MinorSteps 3 and 4 describe the two coefficients in the model containing both gratitude and spiritual wellbeing as predictors of depressed mood. Their reported t statistics have different degrees of freedom, 158 and 156.
“trait gratitude (GQ-6) was related to depressed mood (BDI) when controlling for spiritual wellbeing (FACIT-SP12) (R2 = .23, β =−3.84, t(158)=−4.536, p<.001).”
“when controlling for trait gratitude (GQ-6), the relationship between spiritual wellbeing (FACIT-SP12) and depressed mood (BDI) is no longer significant (R2 = .23, β =-.384, t(156)=−1.663, p=.10)”
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Chronic heart failure: time to recognise this major public health problem
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Alosco, M. L., Spitznagel, M. B., van Dulmen, M. H. M., Raz, N., Cohen, R. A., Sweet, L. H., Colbert, L. H., Josephson, R., Hughes, J. W., Rosneck, J., et al. (2013) · Journal of Aging and Health · doi:10.1177/0898264312474039 · Cited by 15 · see citing works
Personal Characteristics Predictive of Depressive Symptoms in Hispanics with Heart Failure
Sin, M. (2012) · Issues in Mental Health Nursing · doi:10.3109/01612840.2012.687438 · Cited by 12 · see citing works
Neuroimmune Mechanisms of Depression in Heart Failure
Jiménez, J. A., & Mills, P. J. (2012) · Methods in molecular biology · doi:10.1007/978-1-62703-071-7_9 · Cited by 7 · see citing works
Self-citationProgression and management of chronic heart failure.
Viganego, F., & Jemtel, T. H. L. (2007) · PubMed · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Sirois, F. M., & Wood, A. M. (2017) · Health Psychology · doi:10.1037/hea0000436 · Cited by 93 · see citing works
Self-citationGratitude at the End of Life: A Promising Lead for Palliative Care
Althaus, B., Borasio, G. D., & Bernard, M. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0027 · Cited by 36 · see citing works
Franceschi, L., Small, N., Goldsby, T., Goldsby, M., Padamada, S., Ziegler, M. G., & Mills, P. J. (2024) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130241278970 · Cited by 3 · see citing works
“63,64 Given those fi ndings, coupled with studies showing an association of gratitude with well-being in at-risk women, 65 we included the GQ-6 to examine if the sur fi ng intervention might increase trait gratitude.”
BackgroundInfluentialSelf-citation
- Authors
- Mills, P. J., Redwine, L., Wilson, K., Pung, M. A., Chinh, K., Greenberg, B. H., Lunde, O., Maisel, A., Raisinghani, A., Wood, A., & Chopra, D.
- Affiliations
- University of California San Diego (US)
- University of Stirling (GB)
- ORCID
- Venue
- Spirituality in Clinical Practice
- Published
- 2015-03
- Volume
- 2
- Issue
- 1
- Pages
- 5-17
- ISSN
- 2326-4500 (ISSN-L)
- 2326-4519
- PMC
- PMC4507265
- OpenAlex
- W2135076712
- Cited by
- 132
- References
- 67
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 10 · 2023: 8 · 2022: 16 · 2021: 12 · 2020: 20 · 2019: 10 · 2018: 12 · 2017: 10 · 2016: 9 · 2015: 3
- FWCI
- 14.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Spirituality in Clinical Practice (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (HL-073355, HL-096784, and 1UL1RR031980-01)
- Greater Good Science Center
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- gratitude, spiritual well-being, asymptomatic heart failure, sleep quality, depressive mood, fatigue, inflammation, inflammatory markers, mediation, spirituality and health
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read (extract-v1) on 2026-09-24.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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