The association between social determinants of health and outcomes in carepartners of persons with chronic heart failure
Authors: Dunbar S , Butts B , Higgins M K , Herring C H , Spikes T , Gary R A 
Published: November 2023

Abstract

Background
Caregiver burden and strain and adverse psychological outcomes of anxiety and depression are often experienced by care partners (CPs) of persons with heart failure (HF). Greater understanding of the factors associated with these responses is needed to direct interventions. While social determinants of health (SDOH) are known to be related to morbidity and mortality in HF, little is known about their relationships to variables reflecting experiences of CPs of persons with HF.

Purpose
To explore associations between SDOH and psychological/mental health outcomes for CPs of persons with HF who were participating in an intervention study to improve CP outcomes.

Methods
CPs of persons with HF were participants in a randomized controlled trial testing combinations of psychoeducation and exercise interventions. CPs were defined as being engaged with care for the person with HF at least 4 hours a week and were primarily spouses and adult children. Baseline variables and measures were SDOH (demographics, marital status, education, occupation type and working status, income, financial concerns, social support [ESSI]). Mental health variables and measures were anxiety (STAI), depression (CES-D), CP strain, burden and stress (Oberst, Perceived Stress Scale [PSS], STRAIN), and mental health component quality of life (SF-36, MCS). Relationships among SDOH and outcomes were assessed using correlations, chi square, t-tests, ANOVA and Kruskal-Wallace test.

Results
CPs of persons with HF (n=127; 92% women; 58% Black) were included. Higher education was associated with greater mental/emotional strain (r=.21; p=.018). Black CPs had lower STAI scores (p=.04) than White/Asian. CPs expressing financial worry (44%) had higher CES-D (18.9 ± 11 vs 12.8 ± 8 p=.004), STAI (45.1 ± 16 vs 37.6 ± 13 (p=.004) scores, higher Oberst (p=.049), mental strain (p=.003), PSS (p=.001) scores and lower MCS scores (39.5 ± 12 vs 48.3 ± 10; p=&lt;.001) compared to those without financial concerns. More CPs with occupation type coded as managerial/professional had high levels of mental strain than other occupational categories (p&lt;.01). Not surprising, higher ESSI scores were (r=.378; p&lt;.05) related to lower burden, mental strain, depression, anxiety, stress and higher MCS Scores.

Conclusion
SDOH factors of education, race/ethnicity, financial concerns, occupation type and work status are associated with CP mental health status which may intensify CPs mental health stress, whereas social support may attenuate the adverse mental health outcomes related to their caregiving role for the person with HF. Further study should focus on the influence of these stressors and their role in compounding adverse mental health stress to direct CP interventions tailored to the occupation and financial stress and to improve social support. These findings suggest the importance of assessing SDOH in in clinical settings and in studies of interventions to improve outcomes for CPs.