Psychological distress is common among patients with heart failure (HF); however, somatic symptoms are also common and may confound its assessment. Understanding the contributions of symptoms to psychological distress may assist in focusing treatment. The purpose of this study was to evaluate differences between HF patients and a non‐HF comparison group on psychological distress (anxiety and depression); the association of anxiety and depression with common somatic symptoms of HF (fatigue, sleep disturbance, dyspnea, and excessive daytime sleepiness); and the extent to which somatic symptoms and HF diagnosis explain psychological distress. In this cross‐sectional study, 61 stable systolic HF outpatients and a comparison group of 57 persons recruited from the community completed the Centers for the Epidemiological Studies of Depression Scale, Profile of Mood States‐Short Form, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Multidimensional Assessment of Fatigue Scale, and the Multidimensional Assessment of Dyspnea Scale. The HF patients scored higher on depression, as measured by the Centers for the Epidemiological Studies of Depression Scale, but not on the other depression or anxiety scales. Group‐related differences in depression were explained by sleep disturbance, fatigue, and excessive daytime sleepiness, after accounting for the effects of age, sex, minority status, comorbidity, and physical function.