Evaluating emotional distress and health-related quality of life in patients with heart failure and their family caregivers: Testing dyadic dynamics using the Actor-Partner Interdependence Model
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PURPOSE: 1) To compare levels of emotional symptoms and health-related quality of life between patients with heart failure and their family caregivers; and 2) to examine whether patients' and caregivers' emotional symptoms were associated with their own, as well as their partner's health-related quality of life. METHOD: In this cross-sectional study, 41 patients-caregiver dyads (78% male patients, aged 68.6 years; and 83% female caregivers, aged 65.8 years) completed all nine dimensions of the Brief Symptom Inventory and the Minnesota Living with Heart failure Questionnaire. Dyadic data were analysed for 6 sub-scales of the Brief Symptom Inventory, using the Actor-Partner Interdependence Model. RESULTS: There were no statistically significant differences in emotional symptoms and health-related quality of life between patients with heart failure and their caregivers. Patients' and caregivers' emotional symptoms were associated with their own health-related quality of life. Caregivers' anxiety, phobic anxiety, obsession-compulsion, depression and hostility negatively influenced their partner's (i.e. the patient's) health-related quality of life. There were no partner effects of patients' emotional symptoms on the health-related quality of life of caregivers. CONCLUSIONS: The results of this study suggest that patients may be particularly vulnerable to the emotional distress, i.e. thoughts, impulses and actions of their caregivers. It may be possible to improve patients' health-related quality of life by targeting specific detrimental emotional symptoms of caregivers.
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Emotional and behavioral responses of chronic heart failure patients and their family caregivers result in reduced quality of life of both patients and their family caregivers.
“These emotional and behavioral responses affect the other person [37], resulting in a strained dyadic relationship between patients and their FCs [38], poorer physical functioning of patients [39], and reduced QOL of both patients and their FCs [35, 40].”
From Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial (2024) · cites this paper as [35]
The Results (§3.4; page unavailable) associate patients’ and caregivers’ emotional symptoms with their own poorer health-related quality of life, supporting the claim for both groups. The paper does not establish that behavioral responses cause reduced quality of life, and it finds no significant effect of patients’ emotional symptoms on caregivers’ quality of life. (LLM, conf=0.84)
Experimental — accuracy not yet measuredChronic heart failure patients and their family caregivers may experience tensions in the dyadic relationship.
“Consequently, they may experience tensions in the dyadic relationship [34, 35].”
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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Bidwell, J. T., Conway, C. M., Babicheva, V., & Lee, C. S. (2023) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2023.02.017 · Cited by 48 · see citing works
Kim, K.-A., Park, J.-S., Seo, K.-W., Choi, E.-Y., & Ahn, J.-A. (2022) · Medicine · doi:10.1097/md.0000000000030042 · Cited by 28 · see citing works
Uchmanowicz, I., Faulkner, K. M., Vellone, E., Siennicka, A. E., Szczepanowski, R., & Olchowska-Kotala, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19041919 · Cited by 23 · see citing works
Bouchard, K., Gareau, A., Gallant, N. L., Lalande, K. M., Greenman, P. S., Sztajerowska, K., & Tulloch, H. E. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110601 · Cited by 20 · see citing works
Wang, H., Ren, L., Li, T., Pu, L., Huang, X., Wang, S., Song, C., & Liang, Z. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.960953 · Cited by 16 · see citing works
Caregiver Distress and Coronary Artery Disease: Prevalence, Risk, Outcomes, and Management
Bouchard, K., Dans, M., Higdon, G., Quinlan, B., & Tulloch, H. E. (2022) · Current Cardiology Reports · doi:10.1007/s11886-022-01810-5 · Cited by 17 · see citing works
Litzelman, K., & Nassar, N. A. (2022) · Journal of Behavioral Medicine · doi:10.1007/s10865-022-00343-0 · Cited by 10 · see citing works
Autonomic symptoms and associated factors in patients with chronic heart failure
Silva, H. D., Pardaens, S., Vanderheyden, M., SUTTER, J. D., Demeyer, H., Pauw, M. D., Demulier, L., Stautemas, J., & Calders, P. (2021) · Acta cardiologica. Supplementum · doi:10.1080/00015385.2021.2010953 · Cited by 9 · see citing works
Xiong, C., Li, P. W. C., Yu, D. S. F., & Wong, C. W. Y. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105065 · Cited by 9 · see citing works
Kar, M. K., Soleimani, F., Alizadeh, A., & Hajikarimi, M. (2022) · Heart & Lung · doi:10.1016/j.hrtlng.2022.09.014 · Cited by 6 · see citing works
Islam, T., & Zhou, E. (2024) · Advances in management and applied economics · doi:10.47260/amae/1457 · Cited by 5 · see citing works
Bouchard, K., Gareau, A., Greenman, P. S., Lalande, K. M., Sztajerowska, K., & Tulloch, H. E. (2023) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2023.2237564 · Cited by 5 · see citing works
Wiertz, C. M. H., Hemmen, B., Sep, S. J. S., & Verbunt, J. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108221 · Cited by 4 · see citing works
Kim, J., Kim, K. H., Shin, M., Heo, S., Lee, J., Cho, K., & An, M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308515 · Cited by 4 · see citing works
Kim, Y., & Chae, H. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16474 · Cited by 4 · see citing works
The Subjective Component of the Dutch Objective Burden Inventory
Grant, J. S., Graven, L. J., Wang, D., Luttik, M. L., & Azuero, A. (2022) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000899 · Cited by 2 · see citing works
Bouchard, K., Chiarelli, A., Dans, M., & Tulloch, H. E. (2023) · Advances in biochemistry in health and disease · doi:10.1007/978-3-031-39928-2_19 · Cited by 2 · see citing works
Informal Caregivers’ Well-Being at the Transition to Caregiving
Williams, N. A., Hatton‐Bowers, H., Kohel, K., Pillai, S., & Burnfield, J. M. (2020) · Rehabilitation Counseling Bulletin · doi:10.1177/0034355220962186 · Cited by 2 · see citing works
Zhang, X., Ho, G. W. K., & Mak, Y. W. (2024) · PLoS ONE · doi:10.1371/journal.pone.0298178 · Cited by 1 · see citing works
“Consequently, they may experience tensions in the dyadic relationship [34, 35].”
BackgroundPatient and caregiver predictors of caregiver burden: a longitudinal analysis
Thomson, R., Evans, J. M. M., Thomson, P., & Stoddart, K. M. (2025) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2025.0027 · Cited by 1 · see citing works
Self-citationFan, W., 张晓磬, Li, C., Li, L., Wang, L., & Yu, M. (2026) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s600692 · Cited by 1 · see citing works
Aria, R., Archer, N., Baskaran, V., & Shah, B. (2023) · Studies in computational intelligence · doi:10.1007/978-3-031-42112-9_8 · Cited by 1 · see citing works
Shahbazi, K., Solati, K., Taghvaei, M. H., Khaledifar, A., & Nazari, M. S. (2022) · Journal of Shahrekord University of Medical Sciences · doi:10.34172/jsums.2022.09 · Cited by 1 · see citing works
Zhang, X., Leung, D. Y. P., Ho, G. W., & Mak, Y. W. (2023) · Research Square · doi:10.21203/rs.3.rs-2785545/v1
PILE-UP OF FAMILY DEMANDS OF TAIWANESE FAMILY LIVING WITH CHRONIC HEART FAILURE
PENG, S.-Y., Hsiung, P., & Wo, J. (2024) · The Hong Kong Journal of Social Work · doi:10.1142/s0219246224500079
Understanding psychological distress in heart failure dyads
Locatelli, G., & Luciani, M. (2025) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvaf194
Napolitano, D., Bozzetti, M., Cascio, A. L., Longobucco, Y., Magi, C. E., Iovino, P., & Vellone, E. (2026) · Psychiatric Quarterly · doi:10.1007/s11126-026-10290-7 · Cited by 1 · see citing works
Psychological distress among family caregivers of patients with cardiovascular disease
Matsumura, K., Yagi, E., Kakiuchi, Y., Tabuchi, T., Yamada, N., Funauchi, Y., Kakehi, K., Fujita, K., Kawamura, T., Matsuzoe, H., et al. (2026) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_399_25
- Authors
- Thomson, P., Howie, K., Leslie, S. J., Angus, N. J., Andreis, F., Thomson, R., Mohan, A. R. M., Mondoa, C., & Chung, M. L.
- Affiliations
- University of Stirling (GB)
- Raigmore Hospital (GB)
- University of the Highlands and Islands (GB)
- University of Glasgow (GB)
- Forth Valley Royal Hospital (GB)
- University of Kentucky (US)
- Corresponding author
- Thomson, Patricia
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-01-08
- Volume
- 15
- Issue
- 1
- Pages
- e0227129
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6948731
- OpenAlex
- W2998971360
- Cited by
- 28
- References
- 89
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 2 · 2020: 1
- FWCI
- 6.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion, cc-by)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by)
- Funders
- Chest, Heart and Stroke Association Scotland (13/NS/0013)
- Topics
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- heart failure, family caregivers, emotional distress, health-related quality of life, dyadic dynamics, actor-partner interdependence, anxiety, depression, caregiver burden, caregiver-patient relationship
- MeSH terms
- Psychological Distress, Adult, Aged, Aged, 80 and over, Anxiety, Depression, Female, Heart Failure, Hostility, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Quality of Life, Caregivers
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.
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.
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