The Role of Gratitude in Spiritual Well-Being in Asymptomatic Heart Failure Patients

Spirituality and gratitude are associated with well-being. 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 between gratitude, spiritual well-being, 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 < .01), less depressed mood (r = −.41, p < .01), less fatigue (r = −.46, p < .01), and better self-efficacy to maintain cardiac function (r = .42, p < .01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r = −.17, p < .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 well-being and sleep quality (z = −2.35, SE = .03, p = .02) and also the relationship between spiritual well-being and depressed mood (z = −4.00, SE = .075, p < .001). Gratitude also partially mediated the relationships between spiritual well-being and fatigue (z = −3.85, SE = .18, p < .001) and between spiritual well-being and self-efficacy (z = 2.91, SE = .04, p = .003). In sum, we report that gratitude and spiritual well-being 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 well-being on these endpoints. Efforts to increase gratitude may be a treatment for improving well-being in HF patients' lives and be of potential clinical value.