Examining the distinctiveness of the Minnesota Living with Heart Failure Questionnaire from depressive symptoms in patients with heart failure.
8 affiliations
- 1Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan.
- 2Department of Medical-Surgical Nursing, College of Nursing, Taibah University, Madinah, Saudi Arabia.
- 3Department of Community Health Nursing, Faculty of Nursing, Applied Science Private University, Amman, Jordan.
- 4Department of Nursing Administration and Education, Faculty of Nursing, University of Tabuk, Tabuk, Saudi Arabia.
- 5Medical-Surgical Nursing Department, Faculty of Nursing, University of Tabuk, Tabuk, Saudi Arabia.
- 6Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia.
- 7Nursing Division, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. [email protected].
- 8Department of Medical and Surgical Nursing, College of Nursing, Taibah University, Madinah, Saudi Arabia. [email protected].
Abstract
Background
The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is widely used to assess health-related quality of life (HRQOL) in patients with heart failure (HF), but conceptual overlap with depressive symptoms may complicate interpretation of patient-reported outcomes.Objective
To evaluate the discriminant validity of the MLHFQ relative to the Patient Health Questionnaire-9 (PHQ-9) and examine the independent association between depressive symptoms and HRQOL.Methods
This secondary cross-sectional analysis included 306 patients with cardiologist-confirmed HF in Jordan. Exploratory factor analysis examined the underlying structure of the combined MLHFQ and PHQ-9 items, and hierarchical regression analyses evaluated the association between depressive symptoms and HRQOL after adjustment for sociodemographic and clinical characteristics.Results
Five correlated factors emerged from the combined MLHFQ and PHQ-9 analysis, representing physical HRQOL, emotional HRQOL, treatment burden, Somatic Depressive Symptoms, and social role limitations. Partial conceptual overlap was observed primarily for fatigue, sleep disturbance, and selected emotional items, whereas most HF-specific items loaded on distinct HRQOL factors. Item-level correlations between the MLHFQ and PHQ-9 ranged from weak to moderate (r = .01-0.61). After adjustment for sociodemographic and clinical characteristics, depressive symptoms explained an additional 25% of the variance in overall HRQOL, 18% in physical HRQOL, and 31% in emotional HRQOL. In a revised physical HRQOL model excluding overlapping items, depressive symptoms remained independently associated with poorer physical HRQOL, explaining an additional 13% of the variance.Conclusions
Depressive symptoms were strongly associated with perceived HRQOL, particularly within the emotional domain, while the MLHFQ captures broader HF-specific aspects of quality of life that remain distinguishable from depression. These findings support the discriminant validity and clinical usefulness of the MLHFQ while highlighting the importance of concurrent assessment of depressive symptoms when evaluating patient-reported outcomes in HF.Clinical trial number
Not applicable.
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BibTeX
@article{saleh2026examining,
title = {{Examining the distinctiveness of the Minnesota Living with Heart Failure Questionnaire from depressive symptoms in patients with heart failure.}},
author = {Zyad T Saleh and Rami A Elshatarat and Manal A Hamithi and Nisrein Alkhatib and Amal Ali Alharbi and Wesam T Almagharbeh and Amal Ali Alasmari and Halah Almulla and Fatmah A Alamoudi and Adil Abdalla and Mahmoud Abdel Hameed Shahin and Khaled M Al-Sayaghi},
journal = {Health and quality of life outcomes},
year = {2026},
month = aug,
doi = {10.1186/s12955-026-02600-1},
url = {https://europepmc.org/article/MED/42972401},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Examining the distinctiveness of the Minnesota Living with Heart Failure Questionnaire from depressive symptoms in patients with heart failure.
AU - Zyad T Saleh
AU - Rami A Elshatarat
AU - Manal A Hamithi
AU - Nisrein Alkhatib
AU - Amal Ali Alharbi
AU - Wesam T Almagharbeh
AU - Amal Ali Alasmari
AU - Halah Almulla
AU - Fatmah A Alamoudi
AU - Adil Abdalla
AU - Mahmoud Abdel Hameed Shahin
AU - Khaled M Al-Sayaghi
PY - 2026
DA - 2026/08/03
JO - Health and quality of life outcomes
DO - 10.1186/s12955-026-02600-1
UR - https://europepmc.org/article/MED/42972401
AB - Background The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is widely used to assess health-related quality of life (HRQOL) in patients with heart failure (HF), but conceptual overlap with depressive symptoms may complicate interpretation of patient-reported outcomes.Objective To evaluate the discriminant validity of the MLHFQ relative to the Patient Health Questionnaire-9 (PHQ-9) and examine the independent association between depressive symptoms and HRQOL.Methods This secondary cross-sectional analysis included 306 patients with cardiologist-confirmed HF in Jordan. Exploratory factor analysis examined the underlying structure of the combined MLHFQ and PHQ-9 items, and hierarchical regression analyses evaluated the association between depressive symptoms and HRQOL after adjustment for sociodemographic and clinical characteristics.Results Five correlated factors emerged from the combined MLHFQ and PHQ-9 analysis, representing physical HRQOL, emotional HRQOL, treatment burden, Somatic Depressive Symptoms, and social role limitations. Partial conceptual overlap was observed primarily for fatigue, sleep disturbance, and selected emotional items, whereas most HF-specific items loaded on distinct HRQOL factors. Item-level correlations between the MLHFQ and PHQ-9 ranged from weak to moderate (r = .01-0.61). After adjustment for sociodemographic and clinical characteristics, depressive symptoms explained an additional 25% of the variance in overall HRQOL, 18% in physical HRQOL, and 31% in emotional HRQOL. In a revised physical HRQOL model excluding overlapping items, depressive symptoms remained independently associated with poorer physical HRQOL, explaining an additional 13% of the variance.Conclusions Depressive symptoms were strongly associated with perceived HRQOL, particularly within the emotional domain, while the MLHFQ captures broader HF-specific aspects of quality of life that remain distinguishable from depression. These findings support the discriminant validity and clinical usefulness of the MLHFQ while highlighting the importance of concurrent assessment of depressive symptoms when evaluating patient-reported outcomes in HF.Clinical trial number Not applicable.
SN - 1477-7525
ER -