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Wang C, Li S, Song Y, Yuan X, Zhu H, Yu B. Prospective association of comorbid hypertension and depressive symptoms with C-reactive protein in older adults. J Affect Disord 2024; 354:286-292. [PMID: 38484887 DOI: 10.1016/j.jad.2024.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/28/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Hypertension and depressive symptoms often occur together in the older population, and each has been separately linked to elevated C-reactive protein (CRP). This study investigated the prospective association between comorbid hypertension and depressive symptoms and high-sensitivity CRP (hs-CRP) in a Chinese older population. METHODS This study used data from 4978 participants aged 50 and above, who took part in two waves (2011 and 2015) of the China Health and Retirement Longitudinal Study (CHARLS). Hypertension, depressive symptoms and hs-CRP were measured. Logistic regressions adjusted for confounding variables were used to examine the association between the baseline comorbidity of hypertension and depressive symptoms and the change in hs-CRP levels. RESULTS Hypertension and depressive symptoms did not show independent associations with an elevated level of hs-CRP. Participants with comorbid hypertension and depressive symptoms were more likely to develop a higher level of hs-CRP at follow-up (OR = 1.39, 95 % CI: 1.12-1.74) even after adjusting for covariates. Sex- and age-stratified analyses indicated that the association between the comorbidity and higher levels of hs-CRP were prone to be observed in women (OR = 1.55, 95 % CI: 1.16-2.08) and older adults (OR = 1.74, 95 % CI: 1.20-2.52). CONCLUSIONS Comorbid hypertension and depressive symptoms is related to a higher risk of elevated hs-CRP levels. This association appears to be more pronounced among women and older adults compared to their counterparts. LIMITATION Depression was self-reported by participants, which might be considered less unreliable than clinical diagnoses.
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Affiliation(s)
- Chengwen Wang
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Shen Li
- Laboratory of Biological Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Yunlong Song
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Xinqiang Yuan
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Hui Zhu
- School of Sociology, Nankai University, Tianjin, China.
| | - Bin Yu
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China; Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
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Zaninotto P, Steptoe A, Shim EJ. CVD incidence and mortality among people with diabetes and/or hypertension: Results from the English longitudinal study of ageing. PLoS One 2024; 19:e0303306. [PMID: 38820248 PMCID: PMC11142434 DOI: 10.1371/journal.pone.0303306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND AIMS Diabetes and/or hypertension are the most common conditions in older people, and also related to higher cardiovascular disease (CVD) incidence and mortality. This study aims to explore the risk of CVD incidence and mortality among older people with diabetes and/or hypertension over a 16 years follow-up period and investigates the role of depression and obesity in these relationships. METHODS 6,855 participants aged 50+ from the English Longitudinal Study of Ageing (ELSA). The main exposure is having diabetes and/or hypertension at baseline (2002/2003) compared to not having, but excluded those with coronary heart disease (CHD) and/or stroke (CVD). Survival models are used for CVD incidence and mortality up to 2018, adjusted for socio-demographic, health, health behaviours, cognitive function, and physical function characteristics. RESULTS 39.3% of people at baseline had diabetes and/or hypertension. The risk of CVD incidence was 1.7 (95%CI: 1.5; 1.9) higher among people with diabetes and/or hypertension compared to those without and was independent of covariates adjustment. People with diabetes and/or hypertension were also 1.3 (95%CI: 1.1; 1.8) times more likely to die from CVD than those without. We did not find evidence for an elevated risk of CVD incidence and mortality among people with obesity nor among those with depression. CONCLUSIONS In order to effectively reduce the risk of CVD incidence and mortality among older people, treatment as well as management of hypertension and diabetes should be routinely considered for older people with diabetes and/or hypertension.
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Affiliation(s)
- Paola Zaninotto
- Department of Epidemiology and Public Health, UCL, London, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, UCL, London, United Kingdom
| | - Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Republic of Korea
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3
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Qiu W, Cai A, Li L, Feng Y. Association of depression trajectories and subsequent hypertension and cardiovascular disease: findings from the CHARLS cohort. J Hypertens 2024; 42:432-440. [PMID: 37937504 DOI: 10.1097/hjh.0000000000003609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Little evidence regarding the associations of longitudinal trajectories of depressive symptoms and incident hypertension and cardiovascular diseases (CVDs). This study aimed to evaluate the relationships between trajectories of depressive symptoms and new-onset hypertension and CVDs among the Chinese middle-aged and older general population. METHODS This prospective cohort study used data from a nationally representative sample aged older than 45 years of Chinese residents recruited for the China Health and Retirement Longitudinal Study (CHARLS). The depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The outcomes of the study were new-onset hypertension and CVDs. RESULTS A total of 6071 participants were included in the final analysis and four trajectories of CES-D-10 were identified, including low-stable, medium-decreasing, medium-increasing, and high-stable trajectories. Until 2018, 1668 (27.5%) and 959 (15.8%) participants were newly diagnosed with hypertension and CVDs, respectively. Compared with participants with a low-stable trajectory, individuals with other three trajectories had a significantly higher risk of hypertension and CVDs. The results remained robust in several sensitivity analyses. The restricted cubic spline (RCS) showed an S-shaped relationship between the mean CES-D-10 score and hypertension/CVDs ( P for nonlinear <0.001). Hypertension partially mediated the association between CES-D-10 and CVDs. CONCLUSION Among Chinese aged older than 45 years' general adults, depressive symptoms were prevalent and associated with higher risks of incident hypertension and CVDs. Depressive symptoms mediated the development of CVDs by promoting hypertension progression. Immediate efforts are needed to improve depression management in China to further prevent CVDs.
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Affiliation(s)
- Weida Qiu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University
| | - Liwen Li
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Yildiz Y, Mutlu E, Arihan O, Yagcioglu AEA, Dikmenoglu Falkmarken NH. Investigation of hemorheological parameters in patients with major depressive disorder. Clin Hemorheol Microcirc 2024:CH232061. [PMID: 38277287 DOI: 10.3233/ch-232061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Hemorheological parameters have been reported to be altered in cardiovascular disease. Major depression has been associated with increased risk of cardiovascular disease. OBJECTIVE Our hypothesis is that hemorheological parameters are disturbed in major depressive disorder. METHODS Major depressive disorder and control groups consisted of 50 subjects. Plasma viscosity, erythrocyte aggregation, erythrocyte deformability, hematological parameters and hematological parameters were examined. RESULTS Plasma viscosity was statistically significantly higher, erythrocyte elongation index at 0.53 Pa and 0.95 Pa was lower, and MCV, MCH, and MCHC values were also lower in the major depression group (P < 0.05). Elongation index and plasma viscosity were correlated with depressive symptomatology. CONCLUSIONS The increased plasma viscosity and decreased elongation index of erythrocytes indicate an unfavorable hemorheological situation in patients with major depressive disorder compared with healthy controls. The results of this study confirm the findings of studies finding a potential threat to cardiovascular health from major depressive disorder. Increased plasma viscosity and decreased erythrocyte elongation index in depressed patients may be risk factors for cardiovascular events and provide data on the causality of the association between depression and cardiovascular disease.
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Affiliation(s)
- Yasemin Yildiz
- Department of Physiology, Health Sciences University, Gülhane Faculty of Medicine, Ankara, Turkey
| | - Emre Mutlu
- Department of Psychiatry, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Okan Arihan
- Department of Physiology, Hacetttepe University, Faculty of Medicine, Ankara, Turkey
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Di Giacomo D, Ranieri J, Guerra F, Cilli E, Sciarra L, Romano S. Cardiovascular risk and biopsychosocial interplay: Association among hypertension, anxiety, and emotional dysregulation-observational study in primary care setting for efficient self-care. Clin Cardiol 2024; 47:e24152. [PMID: 37771169 PMCID: PMC10765995 DOI: 10.1002/clc.24152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Aim of the study was to explore the relationship between emotional dimensions of hypertensive patients and the self-care skills; we tried to draw the psychological aspects could impact the health management in hypertension analyzing the effect of emotional regulation on self-care skills: our scope was to highlight the psychological dynamics into behavioral medicine approach. METHODS In an observational study design, patients were collected. Patients with diagnosis of hypertension were recruited in primary care setting. Inclusion criteria included patients older than 18 years, with known and medically treated primary hypertension undergoing antihypertensive medication. RESULTS Statistical analysis was carried out based on the data of 28 primary hypertensive patients (seven females, 21 males, mean age ± SD: 49.8 ± 7.8 years mean; clinic blood pressure: mean systolic blood pressure: 137.2 ± 13.1 mmHg, mean diastolic blood pressure: 82.1 ± 9.9 mmHg). Mean duration of hypertension in the sample was 13.1 years (±8.2 years). Correlations among the main variables of interest showed a positive and significant relationship between emotional dysregulation indexes, psychological distress, and self-care domains: awareness resulted negatively and significantly correlated to self-efficacy; nonacceptance, goals and impulse indexes seemed positively and significantly correlated to anxiety and depression; finally, stress was correlated positively and significantly to awareness and impulse. CONCLUSIONS Evidencing the role of emotion dysregulation on self-care skills and psychological outcomes, and specifically highlighting the impact of emotion dysregulation on self-care, our findings could inform the development and implementation of psychological interventions aimed at promoting psychological well-being and healthy behavior by focusing on the promotion of emotion regulation strategies, to reduce the risk for co-morbidity and/or severe cardiovascular diseases.
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Affiliation(s)
- Dina Di Giacomo
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Jessica Ranieri
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Federica Guerra
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Eleonora Cilli
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Luigi Sciarra
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
- Di Lorenzo ClinicAvezzanoItaly
| | - Silvio Romano
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
- Heart Failure ClinicASL Avezzano‐SulmonaL'AquilaItaly
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6
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Sheehan KA, Chaput J, Bond V, Alloo J, Bonta M, Soklaridis S, Zhang M, Sockalingam S. Exploring the Impact of ECHO Ontario Integrated Mental and Physical Health on Participants' Approach and Attitude Toward the Care of Patients With Complex Needs. J Acad Consult Liaison Psychiatry 2023; 64:512-520. [PMID: 37536441 DOI: 10.1016/j.jaclp.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To examine how project Extension for Community Healthcare Outcomes-Integrated Mental and Physical Health (ECHO-IMPH) influences the attitudes and approaches of primary care providers and other participants towards patients. METHODS An exploratory qualitative approach was undertaken using semistructured interviews conducted between August 2020 and March 2021. One hundred and sixty-four individuals from two cycles of ECHO-IMPH were invited to participate, and 22 (n = 22) agreed to participate. Data were analyzed using the Braun and Clarke method for thematic analysis. RESULTS Three major themes were identified: 1) enhanced knowledge and skills; 2) changes in attitude and approach; 3) space for reflection and exploration. When participants were asked about areas for improvement, suggestions were focused on the structure of the sessions. Participants identified that ECHO-IMPH helped them to view patients more holistically, which led to greater patient-centered care in their practice. Additionally, skills gained in ECHO-IMPH gave participants the concrete tools needed to have more empathetic interactions with patients with complex needs. CONCLUSIONS ECHO-IMPH created a safe space for participants to reflect on their practice with patients with complex needs. Participants applied newly acquired knowledge and skills to provide more empathetic and patient-centered care for patients with complex needs. Based on the shift in perspectives described by participants, transformative learning theory was proposed as a model for how ECHO-IMPH created change in participants' practice.
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Affiliation(s)
- Kathleen A Sheehan
- University Health Network (UHN), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Jake Chaput
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Victoria Bond
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Javed Alloo
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Ontario College of Family Physicians, Toronto, ON, Canada
| | - Mark Bonta
- University Health Network (UHN), Toronto, ON, Canada
| | | | - Maria Zhang
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Qiu T, Jiang Z, Chen X, Dai Y, Zhao H. Comorbidity of Anxiety and Hypertension: Common Risk Factors and Potential Mechanisms. Int J Hypertens 2023; 2023:9619388. [PMID: 37273529 PMCID: PMC10234733 DOI: 10.1155/2023/9619388] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Anxiety is more common in patients with hypertension, and these two conditions frequently coexist. Recently, more emphasis has been placed on determining etiology in patients with comorbid hypertension and anxiety. This review focuses on the common risk factors and potential mechanisms of comorbid hypertension and anxiety. Firstly, we analyze the common risk factors of comorbid hypertension and anxiety including age, smoking, alcohol abuse, obesity, lead, and traffic noise. The specific mechanisms underlying hypertension and anxiety were subsequently discussed, including interleukin (IL)-6 (IL-6), IL-17, reactive oxygen species (ROS), and gut dysbiosis. Increased IL-6, IL-17, and ROS accelerate the development of hypertension and anxiety. Gut dysbiosis leads to hypertension and anxiety by reducing short-chain fatty acids, vitamin D, and 5-hydroxytryptamine (5-HT), and increasing trimethylamine N-oxide (TAMO) and MYC. These shared risk factors and potential mechanisms may provide an effective strategy for treating and preventing hypertension and comorbid anxiety.
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Affiliation(s)
- Tingting Qiu
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- The Central Hospital of Changsha City, Hengyang Medical School, University of South China, Changsha, Hunan 410000, China
| | - Zhiming Jiang
- Department of Cardiology, The Fourth Hospital of Changsha, Changsha, Hunan 410006, China
| | - Xuancai Chen
- Urinary Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang 421002, China
| | - Yehua Dai
- Nursing College, University of Xiangnan, Chenzhou, Hunan 423000, China
| | - Hong Zhao
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
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8
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Schaare HL, Blöchl M, Kumral D, Uhlig M, Lemcke L, Valk SL, Villringer A. Associations between mental health, blood pressure and the development of hypertension. Nat Commun 2023; 14:1953. [PMID: 37029103 PMCID: PMC10082210 DOI: 10.1038/s41467-023-37579-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/18/2023] [Indexed: 04/09/2023] Open
Abstract
Multiple studies have reported a link between mental health and high blood pressure with mixed or even contradictory findings. Here, we resolve those contradictions and further dissect the cross-sectional and longitudinal relationship between mental health, systolic blood pressure, and hypertension using extensive psychological, medical and neuroimaging data from the UK Biobank. We show that higher systolic blood pressure is associated with fewer depressive symptoms, greater well-being, and lower emotion-related brain activity. Interestingly, impending hypertension is associated with poorer mental health years before HTN is diagnosed. In addition, a stronger baseline association between systolic blood pressure and better mental health was observed in individuals who develop hypertension until follow-up. Overall, our findings offer insights on the complex relationship between mental health, blood pressure, and hypertension, suggesting that-via baroreceptor mechanisms and reinforcement learning-the association of higher blood pressure with better mental health may ultimately contribute to the development of hypertension.
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Affiliation(s)
- H Lina Schaare
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
- Otto-Hahn-Group Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany.
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Maria Blöchl
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute for Psychology, Leipzig University, Leipzig, Germany
| | - Deniz Kumral
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Psychology, Neuropsychology, University of Freiburg, Freiburg, Germany
- Institute of Psychology, Clinical Psychology and Psychotherapy Unit, University of Freiburg, Freiburg, Germany
| | - Marie Uhlig
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Lorenz Lemcke
- Nuclear Magnetic Resonance Unit, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sofie L Valk
- Otto-Hahn-Group Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Berlin, Germany
- Clinic of Cognitive Neurology, Leipzig University, Leipzig, Germany
- Charité University Medicine Berlin, Berlin, Germany
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Kohn JN, Lobo JD, Troyer EA, Wilson KL, Ang G, Walker AL, Pruitt C, Pung MA, Redwine LS, Hong S. Tai chi or health education for older adults with hypertension: effects on mental health and psychological resilience to COVID-19. Aging Ment Health 2023; 27:496-504. [PMID: 35311437 PMCID: PMC9489818 DOI: 10.1080/13607863.2022.2053836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare the effectiveness of 12 weeks of community-based, in-person, group Tai Chi (TC) and Health Education (HAP-E) in improving health and wellbeing in older adults with hypertension and in promoting psychological resilience during COVID-19. METHODS A 12-week randomized controlled trial (RCT) in San Diego County, USA. Self-reported depressive symptoms, anxiety, sleep disturbances, gratitude, resilience, mental and physical health were assessed in-person pre- and post-intervention, and by long-term follow-up surveys during COVID-19. Linear mixed-effects models were used to assess study arm differences over time and logistic regression to identify predictors of positive intervention response. RESULTS Of 182 randomized participants (72.6 ± 7.9 yrs; 72% female), 131 completed the intervention. Modest improvements in health and wellbeing occurred post-intervention in both arms (Cohen's d: TC = 0.38, 95% CI: 0.25-0.51; HAP-E = 0.24, 0.11-0.37), though positive intervention responses were more than twice as likely in TC (OR = 2.29, 1.07-4.57). Younger age, higher anxiety, and poorer mental health at baseline predicted greater odds of response. Small declines in health and wellbeing were reported at the first COVID-19 follow-up, with smaller declines in the TC arm (Cohen's d: TC = -0.15, -0.31-0.00; HAP-E = -0.34, -0.49 to -0.19). Health and wellbeing stabilized at the second COVID-19 follow-up. Most participants (>70%) reported that the interventions benefitted their health and wellbeing during COVID-19. CONCLUSION TC and HAP-E improved health and wellbeing, though TC conferred greater odds of an improved mental health response. Declines in health and wellbeing were observed at pandemic follow-up, with smaller declines in the TC arm, suggesting increased resilience.
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Affiliation(s)
- Jordan N. Kohn
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Emily A. Troyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Kathleen L. Wilson
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Gavrila Ang
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
| | - Amanda L. Walker
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Christopher Pruitt
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Meredith A. Pung
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
| | - Laura S. Redwine
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA 92093
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10
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Said B, Gharawi MO, Dallak FH, Maashi AQ, Hurissi E, Gharawi SO, Tarshi MM, Hayyan AI, Faqihi SA, AlMusawa HI, Hakami GM, Alhazmi AH. Factors Associated with Anxiety During COVID-19 Pandemic and Its Association with Hypertension in Saudi Arabia. Patient Prefer Adherence 2023; 17:905-912. [PMID: 37016675 PMCID: PMC10066885 DOI: 10.2147/ppa.s400168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Patients with chronic diseases such as hypertension (HTN) are considered a vulnerable group, and they are prone to anxiety and other psychological conditions during pandemics. Very few reports discussed factors related to anxiety and how it is associated with HTN during COVID-19 pandemic. In this project, we aimed to identify the prevalence of anxiety among hypertensive patients in Saudi Arabia during the COVID-19 pandemic. Methods A cross-sectional study was conducted, and data were collected using an electronic self-administered pretested questionnaire distributed via trained data collectors. Data were analyzed using t-test and chi-test. Results A total of 2135 participants were enrolled in this study. Anxiety was reported in 5% of all participants and 8% of the hypertensive participants. Older age, marital status, higher body mass index (BMI), smoking, and Khat chewing were strongly associated with anxiety among the general population. In addition, less adherence to medication made participants with HTN significantly more anxious. Conclusion The prevalence of anxiety among hypertensive individuals is higher compared to the general population. Moreover, anxiety is significantly associated with some sociodemographic in the general population, and with less adherence to medications in hypertensive patients. Further studies with data from medical record including more variables are needed to highlight this association.
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Affiliation(s)
- Badria Said
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Afnan Q Maashi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Eman Hurissi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Melia M Tarshi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Suzan A Faqihi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Abdulaziz H Alhazmi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
- Correspondence: Abdulaziz H Alhazmi, Jazan University, Tel +966-7329-5000, Email
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11
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Ramos-Vera C, Barrientos AS, Vallejos-Saldarriaga J, Calizaya-Milla YE, Saintila J. Network Structure of Comorbidity Patterns in U.S. Adults with Depression: A National Study Based on Data from the Behavioral Risk Factor Surveillance System. DEPRESSION RESEARCH AND TREATMENT 2023; 2023:9969532. [PMID: 37096248 PMCID: PMC10122603 DOI: 10.1155/2023/9969532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/26/2023]
Abstract
Background People with depression are at increased risk for comorbidities; however, the clustering of comorbidity patterns in these patients is still unclear. Objective The aim of the study was to identify latent comorbidity patterns and explore the comorbidity network structure that included 12 chronic conditions in adults diagnosed with depressive disorder. Methods A cross-sectional study was conducted based on secondary data from the 2017 behavioral risk factor surveillance system (BRFSS) covering all 50 American states. A sample of 89,209 U.S. participants, 29,079 men and 60,063 women aged 18 years or older, was considered using exploratory graphical analysis (EGA), a statistical graphical model that includes algorithms for grouping and factoring variables in a multivariate system of network relationships. Results The EGA findings show that the network presents 3 latent comorbidity patterns, i.e., that comorbidities are grouped into 3 factors. The first group was composed of 7 comorbidities (obesity, cancer, high blood pressure, high blood cholesterol, arthritis, kidney disease, and diabetes). The second pattern of latent comorbidity included the diagnosis of asthma and respiratory diseases. The last factor grouped 3 conditions (heart attack, coronary heart disease, and stroke). Hypertension reported higher measures of network centrality. Conclusion Associations between chronic conditions were reported; furthermore, they were grouped into 3 latent dimensions of comorbidity and reported network factor loadings. The implementation of care and treatment guidelines and protocols for patients with depressive symptomatology and multimorbidity is suggested.
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Affiliation(s)
- Cristian Ramos-Vera
- Research Area, Faculty of Health Sciences, Universidad César Vallejo, Lima, Peru
| | | | | | - Yaquelin E. Calizaya-Milla
- Research Group for Nutrition and Lifestyle, School of Human Nutrition, Universidad Peruana Unión, Lima, Peru
| | - Jacksaint Saintila
- Research Group for Nutrition and Lifestyle, School of Human Nutrition, Universidad Peruana Unión, Lima, Peru
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Dartey AF, Lasidji BN, Baku E, Worna Lotse C, Kuug AK, Dzansi G. A Descriptive Exploratory Study of the Causes and Effects of Hypertension Among Ghanaian Soldiers and Their Families. SAGE Open Nurs 2022; 8:23779608221129130. [PMID: 36245847 PMCID: PMC9554117 DOI: 10.1177/23779608221129130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The quality of life of any soldier can be affected by a simple diagnosis of Hypertension. Hypertension has not been directly linked to a single cause; however, knowing the associated risks and early diagnosis can help with its management. This study aimed to explore and describe the causes of hypertension among soldiers and its effects on their families. OBJECTIVES To explore and describe the causes of hypertension and its effects on soldiers and their families. METHODS A qualitative technique and an exploratory descriptive design were used in this study. At saturation, a total of 10 soldiers were face-to-face interviewed and gathered data simultaneously transcribed and subjected to a content analytic method of analysis. Participants approved being audio recorded on tape with an audio recording device. RESULTS Effects of hypertension on personal lives of soldiers, effects of hypertension on family life, and effects of hypertension on social life were identified as the causes and risk factors of hypertension among the soldiers. These themes are further expanded by their subthemes in the areas of decreased physical activity including sex life, decrease interaction with family, and isolation from friends. CONCLUSION This study revealed that hypertension does have effects on one's personal life, family life, and social life. Hence, it is recommended that frequent health education on hypertension and its effects should be organized in the various Garrisons by the public health department for all soldiers and their families. Screening programs should be organized for early hypertension detection. Soldiers should be educated on appropriate eating habits, weight and financial management, and reduction in tobacco and alcohol.
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Affiliation(s)
- Anita Fafa Dartey
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
- Anita Fafa Dartey, School of Nursing and Midwifery, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
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| | | | - Elizabeth Baku
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Comfort Worna Lotse
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | | | - Gladys Dzansi
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
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13
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Mental and Body Health: The Association between Psychological Factors, Overweight, and Blood Pressure in Young Adults. J Clin Med 2022; 11:jcm11071999. [PMID: 35407607 PMCID: PMC8999355 DOI: 10.3390/jcm11071999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 02/06/2023] Open
Abstract
Comorbidity between cardiometabolic risk factors and major mental health disorders is a public health concern. The close interconnection between the mental and physical aspects of health precludes considering each condition separately. Accordingly, this study sought to explore the interrelationships between psychological factors, overweight, and blood pressure in young adults. One hundred and forty-five young adults participated in the study and were classified according to two independent characteristics: weight condition (normal weight, overweight) and blood pressure (low blood pressure, high blood pressure). Anxiety, depression, and emotional dysregulation were assessed. The results confirmed certain associations, highlighting how cardiometabolic risk factors, such as blood pressure and body mass index, were associated in different ways with mental health, although an interaction between the variables was not reported. In particular, a relationship between body mass index and depression and between anxiety and blood pressure was detected.
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Wang L, Liu Q, Sun D, Xie J, Lao D, Zhang L. Effects of Combination Treatment in Hypertensive Patients with Depression: A Systematic Review and Meta-Analysis of 27 Randomized Controlled Trials. Ther Clin Risk Manag 2022; 18:197-211. [PMID: 35281776 PMCID: PMC8906860 DOI: 10.2147/tcrm.s347622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension commonly co-exists with depression and is associated with adverse health outcomes. This meta-analysis aimed to examine whether combination treatment can improve the outcomes of patients with comorbid hypertension and depression. Methods We searched for relevant randomized controlled trials (RCTs) published through July 2021 using PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. RCTs on patients with an antihypertensive outcome and data on mean blood pressure differences were extracted for both intervention and control groups. Continuous and dichotomous measures of outcomes were pooled using weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CI) by random or fixed effects. Subgroup and meta-regression analyses were performed to identify any existing heterogeneous sources. Results A total of 27 RCTs with 2606 participants were included. Combination treatment significantly improved systolic blood pressure (SBP) by 11.27 mmHg (WMD = −11.27, 95% CI: −14.12 to −8.43), I2 = 95.4%), diastolic blood pressure (DBP) by 8.21 mmHg (WMD = −8.21, 95% CI: −10.73 to −5.69), I2 = 96.9%), and antihypertensive efficiency by 42% (RR = 1.42, 95% CI: 1.32 to 1.52, I2 = 0.0%) compared with in the control group. Combination treatment improved SBP and DBP levels in patients aged <65 years compared with those in patients aged ≥65 years (p = 0.020 and 0.007, respectively). Conclusion Pooled evidence suggests that combination treatment significantly improves both blood pressure levels and antihypertensive efficiency in hypertensive patients with depression. Elderly patients with comorbid hypertension and depression may require a more collaborative approach to improve their outcome. Registration PROSPERO registration number CRD42020213430. Registered on November 08, 2020.
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Affiliation(s)
- Lin Wang
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Qingqing Liu
- Department of Respiratory and Critical Care Medicine, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Dongsheng Sun
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Jianhong Xie
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Dibo Lao
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Li Zhang
- Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
- Correspondence: Li Zhang, Heart Center, Department of Geriatrics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People’s Republic of China, Tel/Fax +86 571-85893957, Email
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15
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Anxiety, home blood pressure monitoring, and cardiovascular events among older hypertension patients during the COVID-19 pandemic. Hypertens Res 2022; 45:856-865. [PMID: 35064249 PMCID: PMC8778505 DOI: 10.1038/s41440-022-00852-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/23/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023]
Abstract
AbstractThe global coronavirus disease 2019 (COVID-19) pandemic has led to a health crisis. It remains unclear how anxiety affects blood pressure (BP) and cardiovascular risk among older patients with hypertension. In this study, we extracted longitudinal data on home BP monitored via a smartphone-based application in 3724 elderly patients with hypertension from a clinical trial (60–80 years; 240 in Wuhan and 3484 in non-Wuhan areas) to examine changes in morning BP during the COVID-19 outbreak in China. Anxiety was evaluated using Generalized Anxiety Disorder-7 item scores. Changes in morning systolic BP (SBP) were analyzed for five 30-day periods during the pandemic (October 21, 2019 to March 21, 2020), including the pre-epidemic, incubation, developing, outbreak, and plateau periods. Data on cardiovascular events were prospectively collected for one year. A total of 262 individuals (7.0%) reported an increased level of anxiety, and 3462 individuals (93.0%) did not. Patients with anxiety showed higher morning SBP than patients without anxiety, and the between-group differences in SBP change were +1.2 mmHg and +1.7 mmHg during the outbreak and plateau periods (P < 0.05), respectively. The seasonal BP variation in winter among patients with anxiety was suppressed during the pandemic. Anxious patients had higher rates of uncontrolled BP. During the 1-year follow-up period, patients with anxiety had an increased risk of cardiovascular events with a hazard ratio of 2.47 (95% confidence interval, 1.10–5.58; P = 0.03). In summary, COVID-19-related anxiety was associated with a short-term increase in morning SBP among older patients and led to a greater risk of cardiovascular events. (ClinicalTrials. gov number, NCT03015311).
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Calvi A, Fischetti I, Verzicco I, Belvederi Murri M, Zanetidou S, Volpi R, Coghi P, Tedeschi S, Amore M, Cabassi A. Antidepressant Drugs Effects on Blood Pressure. Front Cardiovasc Med 2021; 8:704281. [PMID: 34414219 PMCID: PMC8370473 DOI: 10.3389/fcvm.2021.704281] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Individuals suffering from depressive disorders display a greater incidence of hypertension compared with the general population, despite reports of the association between depression and hypotension. This phenomenon may depend, at least in part, on the use of antidepressant drugs, which may influence blood pressure through different effects on adrenergic and serotoninergic pathways, as well as on histaminergic, dopaminergic, and cholinergic systems. This review summarizes extant literature on the effect of antidepressant drugs on blood pressure. Selective serotonin reuptake inhibitors are characterized by limited effects on autonomic system activity and a lower impact on blood pressure. Thus, they represent the safest class—particularly among elderly and cardiovascular patients. Serotonin–norepinephrine reuptake inhibitors, particularly venlafaxine, carry a greater risk of hypertension, possibly related to greater effects on the sympathetic nervous system. The norepinephrine reuptake inhibitor reboxetine is considered a safe option because of its neutral effects on blood pressure in long-term studies, even if both hypotensive and hypertensive effects are reported. The dopamine–norepinephrine reuptake inhibitor bupropion can lead to blood pressure increases, usually at high doses, but may also cause orthostatic hypotension, especially in patients with cardiovascular diseases. The norepinephrine–serotonin modulators, mirtazapine and mianserin, have minimal effects on blood pressure but may rarely lead to orthostatic hypotension and falls. These adverse effects are also observed with the serotonin-reuptake modulators, nefazodone and trazodone, but seldomly with vortioxetine and vilazodone. Agomelatine, the only melatonergic antidepressant drug, may also have limited effects on blood pressure. Tricyclic antidepressants have been associated with increases in blood pressure, as well as orthostatic hypotension, particularly imipramine. Oral monoamine–oxidase inhibitors, less frequently skin patch formulations, have been associated with orthostatic hypotension or, conversely, with hypertensive crisis due to ingestion of tyramine-containing food (i.e., cheese reaction). Lastly, a hypertensive crisis may complicate antidepressant treatment as a part of the serotonin syndrome, also including neuromuscular, cognitive, and autonomic dysfunctions. Clinicians treating depressive patients should carefully consider their blood pressure status and cardiovascular comorbidities because of the effects of antidepressant drugs on blood pressure profiles and potential interactions with antihypertensive treatments.
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Affiliation(s)
- Anna Calvi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Ilaria Fischetti
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Ignazio Verzicco
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Stamatula Zanetidou
- Research Group on Mental and Physical Health of the Elderly (ARISMA), Bologna, Italy
| | - Riccardo Volpi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Pietro Coghi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Stefano Tedeschi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics, and Infant-Maternal Science, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Aderville Cabassi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
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Depression symptoms as longitudinal predictors of the psychological impact of COVID-19 pandemic in hypertensive patients. Sci Rep 2021; 11:16496. [PMID: 34389793 PMCID: PMC8363734 DOI: 10.1038/s41598-021-96165-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022] Open
Abstract
COVID-19 has brought considerable changes and caused critical psychological responses, especially among frail populations. So far, researchers have explored the predictive effect of diverse factors on pandemic-related psychological distress, but none have focused on the impact of prior depression and anxiety symptomatology adopting an extended (10-year) longitudinal design. 105 patients aged over 60, affected by hypertension who participated in a previous longitudinal study were assessed through a follow-up telephone structured interview. The Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R) were used for assessing depression and anxiety symptoms and the psychological impact of COVID-19, respectively. Multiple linear regression analyses were conducted. At the assessment, participants did not report clinically relevant depression, anxiety, and psychological pandemic-related distress symptoms. However, significant mean differences between baseline and current follow-up evaluations for both depression and anxiety were found, reflecting a decrease in symptomatology over time (p < .001). Baseline depression symptoms (β = 1.483, p = .005) significantly predicted the psychological impact of COVID-19 after 10 years. Conversely, their decrease (β = −1.640, p < .001) and living with others (β = −7.274, p = .041) significantly contributed to lower psychological distress scores. Our findings provide insight into the predisposing influence of depressive symptoms on pandemic-related psychological distress ten years later. Preventive interventions and strategies considering these factors are needed to better pre-empt the severe mental consequences of the pandemic.
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Boesten RH, Geleijnse JM, Kromhout D, Ottenheim NR, Giltay EJ. Depressive symptoms and dispositional optimism in relation to mortality in older post-myocardial infarction patients. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Association of Depression with Uncontrolled Hypertension in Primary Care Setting: A Cross-Sectional Study in Less-Developed Northwest China. Int J Hypertens 2021; 2021:6652228. [PMID: 33854797 PMCID: PMC8019649 DOI: 10.1155/2021/6652228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022] Open
Abstract
Background Hypertensive patients commonly experience comorbid depression, which is closely associated with adverse health outcomes. This study aimed to examine the association between depression and uncontrolled hypertension in primary care setting of Northwest China. Methods We used a stratified multistage random sampling method to obtain 1856 hypertensives subjects aged ≥18 years among primary care setting in Xinjiang, Northwest China, between April and October 2019. Depression was evaluated by Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. We related depression to uncontrolled hypertension, using multiple logistic regression, adjusting for minimally sufficient adjustment set of variables retrieved from a literature-based directed acyclic graphs (DAGs) and optimal adjustment set of variables derived from the least absolute shrinkage and selection operator (LASSO) regression. Results A total of 1,653 (89.1%) patients had uncontrolled hypertension. The prevalence of depression was 14.5% and 7.4% among patients with uncontrolled and controlled hypertension. Depression was associated with 1.12-fold increased odds of uncontrolled hypertension [odds ratio (OR) 2.12, 95% confidence interval (CI): 1.23-3.65]. The association remained significant even after adjusting for the minimal sufficient adjustment sets and the optimal adjustment set of variables. Conclusion Depression is significantly associated with uncontrolled hypertension in primary care setting of northwest China. The integrated management of depression and hypertension in the setting might be warranted.
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Sensoy B, Gunes A, Ari S. Anxiety and depression levels in Covid-19 disease and their relation to hypertension. Clin Exp Hypertens 2020; 43:237-241. [PMID: 33176496 DOI: 10.1080/10641963.2020.1847132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: The study aimed to assess the relation of anxiety and depression levels with hypertension in COVID-19 outbreak. The analysis of the association of selected socio-demographic and clinical parameters on the presence and severity of psychological distress was also performed. Methods: The study involved 91 patients applying with a medical history supportive of COVID-19 infection. According to the hospitalization criteria and diagnostic result of SARS-CoV-2 nucleic acid test certainty of the disease, three groups were created. Patients with positive SARS-CoV-2 nucleic acid test results were consisted of 31 hospitalized subjects. To assess the applicant psychological state, a specially developed questionnaire was used, as the presence and severities of the symptoms were assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Results: Statistically, a significantly higher average level of depression and a higher incidence of anxiety were demonstrated among applicants in the Covid-19 pandemic (% 24 and % 44). Also a higher level of anxiety was demonstrated in hospitalized patients compared with the outpatient group. Different from the presence of depression symptoms, the presence of anxiety symptoms was associated independently with hypertension in our study group OR 2.6 (95% CI, 0.99-6.78) P = .04). Conclusions: In the aftermath of COVID-19 outbreak both anxiety and depression are common psychological disorders. Also, different from the symptoms of depression, the symptoms of anxiety are associated independently with hypertension. The described socio-demographic parameters and clinical characteristics had no impact on the symptoms of depression and anxiety irrespective of hospitalized status in the investigated groups.
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Affiliation(s)
- Baris Sensoy
- Bursa Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic , Bursa, Turkey
| | - Aygül Gunes
- Bursa Yüksek Ihtisas Training and Research Hospital, Neurology Clinic , Bursa, Turkey
| | - Selma Ari
- Bursa Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic , Bursa, Turkey
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Collazos-Perdomo D, Ramirez-Ramos CF, Torres de Galvis MY, Correas-Orozco L, Ramirez-Mendez D, Castilla Agudelo GA, Martinez Cano CA, Gallego C, Saldarriaga C. [Association between major depression and arterial hypertension in a Colombian population]. HIPERTENSION Y RIESGO VASCULAR 2020; 37:162-168. [PMID: 32675035 DOI: 10.1016/j.hipert.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/18/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION A third of hypertensive patients have major depression, a relationship that is associated with a worse prognosis. The objective of the study was to estimate the association between depression and high blood pressure, as well as to establish the possible bidirectionality of the conditions. MATERIALS AND METHODS Retrospective cohort study. People between 18 and 65 years old with high blood pressure, depression or use of medications for their management were included. To analyze the antecedent, a comorbidity model was performed. A bivariate analysis was performed and then a multivariate logistic regression. The association was estimated using the Chi-square test and the odds ratios that were crude and adjusted to the other variables included in the analysis. The Hosmer-Lemeshow test was used to assess the goodness of fit. SPSS® v.21 was used as the statistical package. RESULTS A total of 1,721 people were included in the study. The prevalence of depression in patients with and without hypertension was 17.4 and 12.6%, respectively, with a 43% risk of hypertension in people with depression. In patients with depression, it preceded the diagnosis of hypertension in 64.8% of cases and in hypertensive patients, 22.2% were later diagnosed with depression. The association between high blood pressure and major depression remained significant after adjusting for the other risk factors. CONCLUSIONS Depression was found as a risk factor for high blood pressure, with a 2-way risk relationship between depression and high blood pressure.
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Affiliation(s)
| | - C F Ramirez-Ramos
- Departamento de Cardiología Clínica, Universidad Pontificia Bolivariana y clínica CardioVID, Medellín, Colombia.
| | - M Y Torres de Galvis
- Departamento de Epidemiología y Salud Pública, Grupo de Investigación en Salud Mental, Universidad CES, Medellín, Colombia
| | | | - D Ramirez-Mendez
- Clínica Antioquia y Universidad Surcolombiana, Medellín, Colombia
| | - G A Castilla Agudelo
- Departamento de Medicina Interna, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - C A Martinez Cano
- Departamento de Cardiología Clínica, Universidad Pontificia Bolivariana y clínica CardioVID, Medellín, Colombia
| | - C Gallego
- Departamento de Cardiología Clínica y Cuidado Intensivo Cardiovascular, Universidad Pontificia Bolivariana y clínica CardioVID, Medellín, Colombia
| | - C Saldarriaga
- Departamento de Cardiología y Clínica de Insuficiencia Cardiaca, Universidad Pontificia Bolivariana, Universidad de Antioquia y clínica CardioVID, Medellín, Colombia
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Loeb DF, Monson SP, Lockhart S, Depue C, Ludman E, Nease DE, Binswanger IA, Kline DM, de Gruy FV, Good DG, Bayliss EA. Mixed method evaluation of Relational Team Development (RELATED) to improve team-based care for complex patients with mental illness in primary care. BMC Psychiatry 2019; 19:299. [PMID: 31615460 PMCID: PMC6792180 DOI: 10.1186/s12888-019-2294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with mental illness are frequently treated in primary care, where Primary Care Providers (PCPs) report feeling ill-equipped to manage their care. Team-based models of care improve outcomes for patients with mental illness, but multiple barriers limit adoption. Barriers include practical issues and psychosocial factors associated with the reorganization of care. Practice facilitation can improve implementation, but does not directly address the psychosocial factors or gaps in PCP skills in managing mental illness. To address these gaps, we developed Relational Team Development (RELATED). METHODS RELATED is an implementation strategy combining practice facilitation and psychology clinical supervision methodologies to improve implementation of team-based care. It includes PCP-level clinical coaching and a team-level practice change activity. We performed a preliminary assessment of RELATED with a convergent parallel mixed method study in 2 primary care clinics in an urban Federally Qualified Health Center in Southwest, USA, 2017-2018. Study participants included PCPs, clinic staff, and patient representatives. Clinic staff and patients were recruited for the practice change activity only. Primary outcomes were feasibility and acceptability. Feasibility was assessed as ease of recruitment and implementation. Acceptability was measured in surveys of PCPs and staff and focus groups. We conducted semi-structured focus groups with 3 participant groups in each clinic: PCPs; staff and patients; and leadership. Secondary outcomes were change in pre- post- intervention PCP self-efficacy in mental illness management and team-based care. We conducted qualitative observations to better understand clinic climate. RESULTS We recruited 18 PCPs, 17 staff members, and 3 patient representatives. We ended recruitment early due to over recruitment. Both clinics developed and implemented practice change activities. The mean acceptability score was 3.7 (SD=0.3) on a 4-point Likert scale. PCPs had a statistically significant increase in their mental illness management self-efficacy [change = 0.9, p-value= <.01]. Focus group comments were largely positive, with PCPs requesting additional coaching. CONCLUSIONS RELATED was feasible and highly acceptable. It led to positive changes in PCP self-efficacy in Mental Illness Management. If confirmed as an effective implementation strategy, RELATED has the potential to significantly impact implementation of evidence-based interventions for patients with mental illness in primary care.
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Affiliation(s)
- Danielle F. Loeb
- 0000 0001 0703 675Xgrid.430503.1Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office 1; Mailstop B180; 12631 East 17th Ave., Aurora, CO 80045 USA
| | | | - Steven Lockhart
- 0000 0001 0703 675Xgrid.430503.1Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO USA
| | - Cori Depue
- 0000 0001 0703 675Xgrid.430503.1Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office 1; Mailstop B180; 12631 East 17th Ave., Aurora, CO 80045 USA
| | - Evette Ludman
- 0000 0004 0615 7519grid.488833.cKaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | - Donald E. Nease
- 0000 0001 0703 675Xgrid.430503.1Department of Family Medicine, University of Colorado, Aurora, USA
| | - Ingrid A. Binswanger
- 0000 0000 9957 7758grid.280062.eKaiser Permanente Colorado Institute for Health Research, Aurora, CO USA
| | - Danielle M. Kline
- 0000 0001 0703 675Xgrid.430503.1Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office 1; Mailstop B180; 12631 East 17th Ave., Aurora, CO 80045 USA
| | - Frank V. de Gruy
- 0000 0001 0703 675Xgrid.430503.1Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Dixie G. Good
- 0000 0001 0703 675Xgrid.430503.1Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office 1; Mailstop B180; 12631 East 17th Ave., Aurora, CO 80045 USA
| | - Elizabeth A. Bayliss
- 0000 0000 9957 7758grid.280062.eKaiser Permanente Colorado Institute for Health Research, Aurora, CO USA
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Graham N, Ward J, Mackay D, Pell JP, Cavanagh J, Padmanabhan S, Smith DJ. Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank. BMJ Open 2019; 9:e024433. [PMID: 31575565 PMCID: PMC6797415 DOI: 10.1136/bmjopen-2018-024433] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To assess whether a history of major depressive disorder (MDD) in middle-aged individuals with hypertension influences first-onset cardiovascular disease outcomes. DESIGN Prospective cohort survival analysis using Cox proportional hazards regression with a median follow-up of 63 months (702 902 person-years). Four mutually exclusive groups were compared: hypertension only (n=56 035), MDD only (n=15 098), comorbid hypertension plus MDD (n=12 929) and an unaffected (no hypertension, no MDD) comparison group (n=50 798). SETTING UK Biobank. PARTICIPANTS UK Biobank participants without cardiovascular disease aged 39-70 who completed psychiatric questions relating International Classification of Diseases-10 Revision (ICD-10) diagnostic criteria on a touchscreen questionnaire at baseline interview in 2006-2010 (n=134 860). PRIMARY AND SECONDARY OUTCOME MEASURES First-onset adverse cardiovascular outcomes leading to hospital admission or death (ICD-10 codes I20-I259, I60-69 and G45-G46), adjusted in a stepwise manner for sociodemographic, health and lifestyle features. Secondary analyses were performed looking specifically at stroke outcomes (ICD-10 codes I60-69 and G45-G46) and in gender-separated models. RESULTS Relative to controls, adjusted HRs for adverse cardiovascular outcomes were increased for the hypertension only group (HR 1.36, 95% CI 1.22 to 1.52) and were higher still for the comorbid hypertension plus MDD group (HR 1.66, 95% CI 1.45 to 1.9). HRs for the comorbid hypertension plus MDD group were significantly raised compared with hypertension alone (HR 1.22, 95% CI 1.1 to 1.35). Interaction measured using relative excess risk due to interaction (RERI) and likelihood ratios (LRs) were identified at baseline (RERI 0.563, 95% CI 0.189 to 0.938; LR p=0.0116) but not maintained during the follow-up. LIMITATIONS Possible selection bias in UK Biobank and inability to assess for levels of medication adherence. CONCLUSIONS Comorbid hypertension and MDD conferred greater hazard than hypertension alone for adverse cardiovascular outcomes, although evidence of interaction between hypertension and MDD was inconsistent over time. Future cardiovascular risk prediction tools may benefit from the inclusion of questions about prior history of depressive disorders.
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Affiliation(s)
- Nicholas Graham
- Gartnavel Royal Hopsital, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Joey Ward
- Gartnavel Royal Hopsital, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Daniel Mackay
- 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jonathan Cavanagh
- 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Loeb DF, Kline DM, Kroenke K, Boyd C, Bayliss EA, Ludman E, Dickinson LM, Binswanger IA, Monson SP. Designing the relational team development intervention to improve management of mental health in primary care using iterative stakeholder engagement. BMC FAMILY PRACTICE 2019; 20:124. [PMID: 31492096 PMCID: PMC6728939 DOI: 10.1186/s12875-019-1010-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022]
Abstract
Background Team-based models of care are efficacious in improving outcomes for patients with mental and physical illnesses. However, primary care clinics have been slow to adopt these models. We used iterative stakeholder engagement to develop an intervention to improve the implementation of team-based care for this complex population. Methods We developed the initial framework for Relational Team Development (RELATED) from a qualitative study of Primary Care Providers’ (PCPs’) experiences treating mental illness and a literature review of practice facilitation and psychology clinical supervision. Subsequently, we surveyed 900 Colorado PCPs to identify factors associated with PCP self-efficacy in management of mental illness and team-based care. We then conducted two focus groups for feedback on RELATED. Lastly, we convened an expert panel to refine the intervention. Results We developed RELATED, a two-part intervention delivered by a practice facilitator with a background in clinical psychology. The facilitator observes PCPs during patient visits and provides individualized coaching. Next, the facilitator guides the primary care team through a practice change activity with a focus on relational team dynamics. Conclusion The iterative development of RELATED using stakeholder engagement offers a model for the development of interventions tailored to the needs of these stakeholders. Trial registration Not applicable. Electronic supplementary material The online version of this article (10.1186/s12875-019-1010-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle F Loeb
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Academic Office 1; Mailstop B180; 12631 East 17th Ave, Aurora, CO, 80045, USA.
| | - Danielle M Kline
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Academic Office 1; Mailstop B180; 12631 East 17th Ave, Aurora, CO, 80045, USA
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cynthia Boyd
- John Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Evette Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - L Miriam Dickinson
- Department of Biostatistics & Informatics, Colorado School of Public Health; Department of Family Medicine, University of Colorado, Aurora, CO, USA
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Abstract
UNLABELLED ABSTRACTBackground:Both elevated blood pressure and/or depression increase the risk of cardiovascular disease and mortality. This study in treated elderly hypertensive patients explored the incidence of depression, its association (pre-existing and incident) with mortality and predictors of incident depression. METHODS Data from 6,083 hypertensive patients aged ≥65 years enrolled in the Second Australian National Blood Pressure study were used. Participants were followed for a median of 10.8 years (including 4.1 years in-trial) and classified into: "no depression," "pre-existing" and "incident" depression groups based on either being "diagnosed with depressive disorders" and/or "treated with an anti-depressant drug" at baseline or during in-trial period. Further, we redefined "depression" restricted to presence of both conditions for sensitivity analyses. For the current study, end-points were all-cause and any cardiovascular mortality. RESULTS 313 (5%) participants had pre-existing depression and a further 916 (15%) participants developed depression during the trial period (incidence 4% per annum). Increased (hazard-ratio, 95% confidence-interval) all-cause mortality was observed among those with either pre-existing (1.23, 1.01-1.50; p = 0.03) or incident (1.26, 1.12-1.41; p < 0.001) depression compared to those without. For cardiovascular mortality, a 24% increased risk (1.24, 1.05-1.47; p = 0.01) was observed among those with incident depression. The sensitivity analyses, using the restricted depression definition showed similar associations. Incident depression was associated with being female, aged ≥75 years, being an active smoker at study entry, and developing new diabetes during the study period. CONCLUSIONS This elderly cohort had a high incidence of depression irrespective of their randomised antihypertensive regimen. Both pre-existing and incident depression were associated with increased mortality.
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Yang M, Loeb DF, Sprowell AJ, Trinkley KE. Design and Implementation of a Depression Registry for Primary Care. Am J Med Qual 2018; 34:59-66. [PMID: 30008227 DOI: 10.1177/1062860618787056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Registries are fundamental to the success of population health initiatives to improve care and outcomes for patients, including those with depression. The purpose of this article is to describe the design and clinical implementation of a depression registry as part of a collaborative care for depression intervention at 2 large academic outpatient internal medicine practices. The primary objective of the registry was to identify and track patients with depression and monitor antidepressant therapy. Secondary objectives of the registry were to assist in addressing pay-for-performance and value-based reimbursement metrics for depression screening and remission. The registry design and variables for inclusion in the registry were defined with input from clinicians, institutional leadership, and data analysts. For implementation, specific clinical workflows were established and responsible team roles were designated.
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Affiliation(s)
- Michael Yang
- 1 University of Colorado School of Medicine, Aurora, CO
| | - Danielle F Loeb
- 2 University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, CO
| | | | - Katy E Trinkley
- 2 University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, CO.,3 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
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Loeb DF, Leister E, Ludman E, Binswanger IA, Crane L, Dickinson M, Kline DM, deGruy FV, Nease D, Bayliss EA. Factors associated with physician self-efficacy in mental illness management and team-based care. Gen Hosp Psychiatry 2018; 50:111-118. [PMID: 29156252 PMCID: PMC5842160 DOI: 10.1016/j.genhosppsych.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Danielle F. Loeb
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, USA;
| | - Erin Leister
- Department of Biostatistics & Informatics, Colorado School of Public Health, The Adult and Child Center for Outcomes Research and Delivery Science, Aurora, USA.
| | | | - Ingrid A. Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA; Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, USA
| | - Lori Crane
- The Adult and Child Center for Outcomes Research and Delivery Science, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, USA.
| | - Miriam Dickinson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, USA; Department of Family Medicine, University of Colorado, Aurora, USA.
| | - Danielle M. Kline
- Division of General Internal Medicine, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, USA;
| | | | - Donald Nease
- Department of Family Medicine, University of Colorado, Aurora, USA.
| | - Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA; Department of Family Medicine, University of Colorado, Aurora, CO, USA;
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Brouillette J, Nattel S. A Practical Approach to Avoiding Cardiovascular Adverse Effects of Psychoactive Medications. Can J Cardiol 2017; 33:1577-1586. [DOI: 10.1016/j.cjca.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 12/30/2022] Open
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Psychiatric comorbidities in patients with hypertension--a study of registered diagnoses 2009-2013 in the total population in Stockholm County, Sweden. J Hypertens 2016; 34:414-20; discussion 420. [PMID: 26766563 DOI: 10.1097/hjh.0000000000000824] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the prevalence of concomitant hypertension and psychiatric disorders in the general population, using administrative healthcare data in Stockholm County. DESIGN AND METHOD The study population, included all living persons who resided in Stockholm County 1 January 2011 (N = 2 ,058 ,408). Individuals with a diagnosis of hypertension were identified with data from all consultations in primary care, specialized outpatient care, and inpatient care 2009-2013. As outcome, data were obtained on all consultations because of certain psychiatric diagnoses between 2011 and 2013, including specifically depression, anxiety disorders, bipolar disorder, and schizophrenia. Age-adjusted odd ratios (ORs) with 95% confidence intervals (95% CI) were calculated for men and women with and without hypertension, with individuals without hypertension as referents. RESULTS The age-adjusted ORs for depression in persons with hypertension were 1.293 (95% CI 1.256-1.331,) for men and 1.036 (95% CI 1.013-1.058) for women. The age-adjusted ORs for anxiety in persons with hypertension were 1.279 (95% CI 1.238-1.322) for men and 1.050 (95% CI 1.024-1.076) for women. The OR for bipolar disease were 0.904 (95% CI 0.826-0.990) for men and 0.709 (95% CI 0.656-0.767) for women. For schizophrenia, the ORs were 0.568 (95% CI 0.511-0.632) for men and 0.537 (95% CI 0.478-0.603) for women. CONCLUSION Increased awareness of the risk of depression and anxiety among hypertensive patients is needed to combat hypertension, its complications, and psychiatric suffering in the population. Hypertension is probably underdiagnosed and neglected in individuals with severe psychiatric disorders. We warrant efforts to integrate psychiatric and hypertensive care.
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Association of anxiety and depression with hypertension control: a US multidisciplinary group practice observational study. J Hypertens 2016; 33:2215-22. [PMID: 26259121 DOI: 10.1097/hjh.0000000000000693] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The presence of a mental health disorder with hypertension is associated with higher cardiovascular disease mortality than hypertension alone. Although earlier detection of hypertension has been demonstrated in patients with anxiety and depression, the relationship of mental health disorders to hypertension control is unknown. Our objective was to evaluate rates and predictors of incident hypertension control among patients with anxiety and/or depression compared with patients without either mental health diagnosis. METHODS A 4-year retrospective analysis included 4362 patients, at least 18 years old, who received primary care in a large academic group practice from 2008 to 2011. Patients met The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure criteria and had a hypertension diagnosis. Kaplan-Meier analysis estimated the probability of achieving control for patients with and without anxiety and/or depression. Cox proportional hazard models were fit to identify predictors of time to control. RESULTS Overall, 13% (n = 573) had a baseline diagnosis of anxiety and/or depression. Those with anxiety and/or depression demonstrated more primary care and specialty visits than those without either condition. After adjustment, patients with anxiety and/or depression had faster rates of hypertension control (hazard ratio [HR] 1.22; 1.07-1.39] than patients without either diagnosis. Other associations of faster hypertension control included female gender (HR 1.32; 1.20-1.44), absence of tobacco use (HR 1.17; 1.03-1.33), Medicaid use (HR 1.27; 1.09-1.49), and a higher Adjusted Clinical Group Risk Score (HR 1.13; 1.10-1.17), a measure of healthcare utilization. CONCLUSION Greater healthcare utilization among patients with anxiety and/or depression may contribute to faster hypertension control.
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Loeb DF, Binswanger IA, Candrian C, Bayliss EA. Primary care physician insights into a typology of the complex patient in primary care. Ann Fam Med 2015; 13:451-5. [PMID: 26371266 PMCID: PMC4569453 DOI: 10.1370/afm.1840] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Primary care physicians play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. To inform the clinical application of new models of care for complex patients, we sought to understand how these physicians conceptualize patient complexity and to develop a corresponding typology. METHODS We conducted qualitative in-depth interviews with internal medicine primary care physicians from 5 clinics associated with a university hospital and a community health hospital. We used systematic nonprobabilistic sampling to achieve an even distribution of sex, years in practice, and type of practice. The interviews were analyzed using a team-based participatory general inductive approach. RESULTS The 15 physicians in this study endorsed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had an exacerbating factor-a medical illness, mental illness, socioeconomic challenge, or behavior or trait (or some combination thereof)-that complicated care for chronic medical illnesses. CONCLUSION This perspective of primary care physicians caring for complex patients can help refine models of complexity to design interventions or models of care that improve outcomes for these patients.
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Affiliation(s)
- Danielle F Loeb
- University of Colorado, Division of General Internal Medicine, Aurora, Colorado
| | - Ingrid A Binswanger
- University of Colorado, Division of General Internal Medicine, Aurora, Colorado Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Carey Candrian
- University of Colorado, Division of General Internal Medicine, Aurora, Colorado
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado University of Colorado, Department of Family Medicine, Aurora, Colorado
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Swarbrick M, Rockson L, Pratt C, Yudof J, Nemec P. Perceptions of Overall Health and Recency of Screenings. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2015. [DOI: 10.1080/15487768.2015.1001703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maleki A, Samandari S, Almeida O, Jafarian Kerman SR, Abdolvand M, Aliyari F, Foroughi S. Correlation Between Hypertension, C-Reactive Protein and Serum Uric Acid With Psychological Well-being. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e17205. [PMID: 25237581 PMCID: PMC4166100 DOI: 10.5812/ircmj.17205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 01/28/2014] [Accepted: 03/11/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple population-based human studies have established a strong association between increasing levels of serum C-reactive protein, uric acid and subsequent development of hypertension. OBJECTIVES We aimed to investigate the association between mental well-being with presence of hypertension, hyperuricemia and hs-CRP levels. PATIENTS AND METHODS This was a cross sectional study of 801 individuals aged 35-85 years old in Broujerd, Iran, included by randomized cluster sampling. General Health Questionnaire (GHQ-12) for assessing mental health/distress level, MONICA standard questions for evaluating hypertension history, serum hs-CRP and Serum Uric Acid (SUA) were evaluated Data were analyzed by appropriate statistical test such as chi-square, T-test and correlation. RESULTS One hundred eighty five patients (23.1%) had high distress/minor psychiatric disorders. SUA had significant association with hypertension (r = 0.64, P = 0.034). No significant relation was observed between hs-CRP and hypertension. The correlation between GHQ and hs-CRP was not significant but a weak and negative correlation was found between GHQ and SUA SUA (P = 0.012, r = -0.089). CONCLUSIONS The weak and strong correlation among these parameters indicate that mental wellbeing relays on physical wellness and interact with each other; therefore, controlling hypertension along with uric acid control may effect mental health of any kind of patients.
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Affiliation(s)
- Ali Maleki
- School of Medicine, Lorestan University of Medical Sciences, Khorramabad, IR Iran
- Corresponding Author: Ali Maleki, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, IR Iran. Tel: +98-9161623573, E-mail:
| | - Saeid Samandari
- Psychiatry Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Osvaldo Almeida
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Australia
| | | | - Mahdi Abdolvand
- Azna Health Services Center, Lorestan University of Medical Sciences, Azna, IR Iran
| | - Farshid Aliyari
- Imam Khomeini Hospital, Lorestan University of Medical Sciences, Borujerd, IR Iran
| | - Saeid Foroughi
- School of Nursing, Lorestan University of Medical Sciences, Aligudarz, IR Iran
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Almas A, Patel J, Ghori U, Ali A, Edhi AI, Khan MA. Depression is linked to uncontrolled hypertension: a case–control study from Karachi, Pakistan. J Ment Health 2014; 23:292-6. [DOI: 10.3109/09638237.2014.924047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Loeb D, Sieja A, Corral J, Zehnder NG, Guiton G, Nease DE. Evaluation of the role of training in the implementation of a depression screening and treatment protocol in 2 academic outpatient internal medicine clinics utilizing the electronic medical record. Am J Med Qual 2014; 30:359-66. [PMID: 24829154 DOI: 10.1177/1062860614532681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systematic approaches to depression identification and management are effective though not consistently implemented. The research team implemented a depression protocol, preceded by training, in 2 faculty-resident practices. Medical assistants used the Patient Health Questionnaire (PHQ)-2 for initial screening; providers performed the PHQ-9. These were documented in the electronic medical record. Logistic regression was performed to assess the association of provider type, clinic site, and training attendance with documentation of PHQ-9 after positive PHQ-2s, and with repeat PHQ-9s after positive PHQ-9s. In logistic regression analysis, training attendance was positively associated with documentation of PHQ-9 after a positive PHQ-2 (odds ratio [OR] = 2.4 [confidence interval (CI) = 1.3-4.3]) and repeated documentation of a PHQ-9 after a positive PHQ-9 (OR = 2.5 [CI = 1.1-5.3]). This study describes the successful implementation of a stepped-care approach to depression care. The positive association of training with compliance with protocol procedures indicates the importance of training in the implementation of practice change.
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Affiliation(s)
- Danielle Loeb
- University of Colorado School of Medicine, Division of General Internal Medicine, Department of Internal Medicine, Aurora, CO
| | - Amber Sieja
- University of Colorado School of Medicine, Division of General Internal Medicine, Department of Internal Medicine, Aurora, CO
| | - Janet Corral
- University of Colorado School of Medicine, Department of Internal Medicine, Aurora, CO
| | - Nichole G Zehnder
- University of Colorado School of Medicine, Division of General Internal Medicine, Department of Internal Medicine, Aurora, CO
| | - Gretchen Guiton
- University of Colorado School of Medicine, Dean's Office, Aurora, CO
| | - Donald E Nease
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
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Azadbakht L, Kelishadi R, Saraf-Bank S, Qorbani M, Ardalan G, Heshmat R, Taslimi M, Motlagh ME. The association of birth weight with cardiovascular risk factors and mental problems among Iranian school-aged children: the CASPIAN-III study. Nutrition 2013; 30:150-8. [PMID: 24206820 DOI: 10.1016/j.nut.2013.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 05/10/2013] [Accepted: 06/02/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Both high and low birth weights (HBW and LBW) are risk factors for adulthood diseases. The aim of this study was to investigate the association of birth weight with cardiovascular disease (CVD) risk factors and mental problems among Iranian school-aged children. METHODS This national multicenter study of school-aged children entitled CASPIAN III was conducted among 5528 students in ranging from ages 10 to 18 y. Biochemical indices and anthropometric measurements were collected. Mental health was assessed by questionnaire. To investigate the association between birth weight categories and CVD risk factors and mental problems, multivariate logistic regression was used. RESULTS HBW adolescents were at higher risk for elevated diastolic blood pressure (DBP) (Ptrend < 0.05), low levels of high-density lipoprotein cholesterol (HDL-C) (Ptrend < 0.05), and lower risk for general obesity (Ptrend < 0.05) compared with the LBW category. HBW had no significant association with mental problems (Ptrend > 0.05) compared with LBW adolescents. The results of regression analysis, which considered normal birth weight as the reference group, showed that LBW students had lower risk for overweight and obesity (P < 0.01), as well as higher DBP (P < 0.05) but they were at higher risk for lower levels of HDL-C (P < 0.01). Furthermore, birth-weight categories had a U-shaped relationship with mental problems and sleep disorders (P < 0.05). Risk for confusion was higher among the LBW group (P < 0.05). CONCLUSION Findings from this population-based study revealed a positive relation between birth weight categories and CVD risk factors. Compared with students born with normal weight, those born with HBW and LBW were at higher risk for mental problems, sleep disorders, and confusion.
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Affiliation(s)
- Leila Azadbakht
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Pediatrics Department, Faculty of Medicine and Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sahar Saraf-Bank
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Qorbani
- Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Gelayol Ardalan
- Office of School Health, Health and Medical Education, Tehran, Iran
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Footman K, Roberts B, Tumanov S, McKee M. The comorbidity of hypertension and psychological distress: a study of nine countries in the former Soviet Union. J Public Health (Oxf) 2013; 35:548-57. [PMID: 23480878 DOI: 10.1093/pubmed/fdt019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental health problems in those with physical ailments are often overlooked, especially in the former Soviet Union (fSU) where this comorbidity has received little attention. Our study examines the comorbidity of psychological distress and hypertension in the fSU. METHODS Nationally representative household survey data from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2001 and 2010 were analysed to compare the levels of psychological distress in people with and without self-reported hypertension. Multivariate regression analysed determinants of psychological distress in hypertensive respondents, and prevalence rate ratios were calculated to compare the change in distress between the two groups. RESULTS There were significantly higher levels of psychological distress among hypertensive respondents (9.9%) than in the general population (4.9%), and a significant association between the two conditions [odds ratio (OR) = 2.27 (1.91; 2.70)]. Characteristics associated with distress among hypertensive respondents included residing in Armenia or Kyrgyzstan, being female, over age 50, with a poor economic situation, lower education, poor emotional support and limited access to medical drugs. Levels of distress declined between 2001 and 2010, but at a lesser rate in hypertensive respondents [rate ratio (RR) = 0.85 (0.75; 0.95)] than non-hypertensive respondents [RR = 0.65 (0.56; 0.75)]. CONCLUSIONS There is a significant association between psychological distress and hypertension in the region.
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Affiliation(s)
- Katharine Footman
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Association of treatment modality for depression and burden of comorbid chronic illness in a nationally representative sample in the United States. Gen Hosp Psychiatry 2012; 34:588-97. [PMID: 23089065 PMCID: PMC3479411 DOI: 10.1016/j.genhosppsych.2012.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 07/05/2012] [Accepted: 07/07/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We examined associations between treatment modality for depression and morbidity burden. We hypothesized that patients with higher numbers of co-occurring chronic illness would be more likely to receive recommended treatment for depression with both antidepressant medication and psychotherapy. METHODS Using a retrospective cross-sectional design, we analyzed data on 165,826 people over 16 years from 2004 to 2008. Using a single multinomial logistic regression model, we examined the likelihood of treatment modality for depression: no treatment, psychotherapy alone, medication alone, and psychotherapy and medication. We examined the following predictors of therapy: (a) morbidity burden; (b) five specific chronic conditions individually: diabetes mellitus II, coronary artery disease, congestive heart failure, hypertension, and chronic obstructive pulmonary disease or asthma; and (c) sociodemographic factors. RESULTS The likelihood of any treatment for depression, specifically psychotherapy with medication, increased with the number of co-occurring illnesses. We did not find a clear pattern of association between the five specific conditions and treatment modality, although we identified treatment patterns associated with multiple sociodemographic factors. CONCLUSIONS This study provides insight into the relationship between multimorbidity and treatment modalities which could prove helpful in developing implementation strategies for the dissemination of evidence-based approaches to depression care.
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Which symptoms matter? Self-report and observer discrepancies in repressors and high-anxious women with metastatic breast cancer. J Behav Med 2012; 37:22-36. [PMID: 23085787 DOI: 10.1007/s10865-012-9461-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 10/05/2012] [Indexed: 01/10/2023]
Abstract
Clinicians working with cancer patients listen to them, observe their behavior, and monitor their physiology. How do we proceed when these indicators do not align? Under self-relevant stress, non-cancer repressors respond with high arousal but report low anxiety; the high-anxious report high anxiety but often have lower arousal. This study extends discrepancy research on repressors and the high-anxious to a metastatic breast cancer sample and examines physician rating of coping. Before and during a Trier Social Stress Test (TSST), we assessed affect, autonomic reactivity, and observers coded emotional expression from TSST videotapes. We compared non-extreme (N = 40), low-anxious (N = 16), high-anxious (N = 19), and repressors (N = 19). Despite reported low anxiety, repressors expressed significantly greater Tension or anxiety cues. Despite reported high anxiety, the high-anxious expressed significantly greater Hostile Affect rather than Tension. Physicians rated both groups as coping significantly better than others. Future research might productively study physician-patient interaction in these groups.
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Loeb DF, Bayliss EA, Binswanger IA, Candrian C, deGruy FV. Primary care physician perceptions on caring for complex patients with medical and mental illness. J Gen Intern Med 2012; 27:945-52. [PMID: 22370766 PMCID: PMC3403152 DOI: 10.1007/s11606-012-2005-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 01/13/2012] [Accepted: 01/18/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental illness is common and associated with poor outcomes for co-occurring medical illness. Since primary care physicians manage the treatment of complex patients with both mental and medical illnesses, their perspectives on the care of these patients is vital to improving clinical outcomes. OBJECTIVE To examine physician perceptions of patient, physician and system factors that affect the care of complex patients with mental and medical illness. DESIGN Inductive, participatory, team-based qualitative analysis of transcripts of in-depth semi-structured interviews. PARTICIPANTS Fifteen internal medicine physicians from two university primary care clinics and three community health clinics. RESULTS Participant characteristics were balanced in terms of years in practice, practice site, and gender. Physicians identified contributing factors to the complexity of patient care within the domains of patient, physician and system factors. Physicians identified 1) type of mental illness, 2) acuity of mental illness, and 3) communication styles of individual patients as the principal patient characteristics that affected care. Physicians expressed concern regarding their own lack of medical knowledge, clinical experience, and communication skills in treating mental illness. Further, they discussed tensions between professionalism and emotional responses to patients. Participants expressed great frustration with the healthcare system centered on: 1) lack of mental health resources, 2) fragmentation of care, 3) clinic procedures, and 4) the national healthcare system. CONCLUSIONS Physicians in this study made a compelling case for increased training in the treatment of mental illness and improvements in the delivery of mental health care. Participants expressed a strong desire for increased integration of care through collaboration between primary care providers and mental health specialists. This approach could improve both comfort in treating mental illness and the delivery of care for complex patients.
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Affiliation(s)
- Danielle F Loeb
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Academic Office 1; Mailstop B180; 12631 East 17th Ave., Aurora, CO 80045, USA.
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The contribution of depression to mortality among elderly with self-reported hypertension: analysis using a national representative longitudinal survey. J Hypertens 2012; 29:2084-90. [PMID: 21934532 DOI: 10.1097/hjh.0b013e32834b59ad] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Previous research has suggested that hypertension and depression are two of the important causes of mortality among the elderly. This study aims to test the contribution of depression to mortality among elderly with self-reported hypertension. METHODS This research used data from the Survey of Health and Living Status of the Middle Age and Elderly (SHLS) conducted by the Bureau of Health Promotion, Department of Health in Taiwan. The 1989, 1996, 1999, 2003, and 2007 waves were used. In total, 3736 respondents aged 60 or above were analyzed. Participants were grouped by status of hypertension and depression. The contribution of depression to mortality among elderly with self-reported hypertension was estimated using Cox proportional hazard model. Analyses were separated into younger elderly individuals (<70 years) and older elderly individuals (≥ 70 years). RESULTS In the full model, the hazard ratios for mortality for the groups of not hypertensive/depressed, hypertensive/not depressed, and hypertensive/depressed were 1.12 [95% confidence interval (CI) 0.98-1.28], 1.32 (95% CI 1.19-1.46), and 1.54 (95% CI 1.29-1.83), respectively, compared with the reference group of not hypertensive/not depressed. The pattern remained the similar after separating the participants into the two age groups. However, much higher hazard ratios were observed for the older cohort. CONCLUSION Depression contributes significantly to the hypertension-mortality relationship for the elderly. For the elderly, hypertension should be tackled along with depression in order to reduce the mortality associated with hypertension.
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