The association among hypertension and reduced psychological well-being, anxiety and sleep disturbances: a population study

Psychological distress and its associated factors among people with specific chronic conditions (diabetes and/or hypertension) in the Sidama region of southern Ethiopia: A cross-sectional study

BACKGROUND

The majority of people with long-term, non-communicable medical conditions experience significant psychological anguish. Poor mental health or psychological distress influences low lifestyle decisions that result in obesity, inactivity, and cigarette use as well as poor health literacy and limited access to health promotion activities.

OBJECTIVES

The study's purpose was to measure the prevalence of psychological distress and it's predictors in patients with chronic non-communicable diseases who were being treated in selected hospitals in the Sidama region of southern Ethiopia in 2022.

METHODOLOGY

Institutional based cross-sectional study was carried out using a sample of 844 patients receiving medication for either high blood pressure or diabetes mellitus or both between May1 and August 31, 2022. To gauge psychiatric distress, the Amharic translation and Ethiopian validation of the Kessler 6 scale (K-6) was employed. The analysis was done using binary logistic regression and an odds ratio with the corresponding 95% confidence interval was estimated to measure the strength of the association. P value <0.05 was considered to declare the significance.

RESULT

Patients with diabetic mellitus, hypertension or both had a 49.6% prevalence of psychological distress at selected Sidama hospitals. Age, drug side effects, history medical complications following diabetic mellitus/hypertension, and body mass index of the patient were all significantly linked with psychological distress (P<0.05).

CONCLUSION

According to the results of this study, psychological distress is far more prevalent than it was in past studies in Ethiopia and other African countries. To lessen the problem, all stakeholders must cooperate, but health agencies, policymakers, and NGOs particularly need to put in extra effort. The study also showed a significant association between body mass index, patient age, drug side effects, and history of medical complications following diabetic mellitus /hypertension.

"What do we think?": a qualitative exploratory study of acceptability and experiences of individuals with resistant hypertension after completing a physical exercise program (the EnRICH trial)

PURPOSE

Aerobic exercise training programs decrease blood pressure in individuals with resistant hypertension. However, participants' experiences regarding exercise training participation are unknown and often undervalued. Therefore, participant's experiences and program acceptability of the exercise arm of the EnRicH trial, a randomized clinical trial investigating the effect of a 12-week aerobic exercise training program in individuals with resistant hypertension were analysed.

METHODS

An exploratory qualitative study was conducted with twenty individuals with resistant hypertension (11 males, mean age 58.9 ± 8.9 years), after the exercise program. Four focus group interviews were performed to explore participants' perspectives. The interviews were digitally audio-recorded, transcribed verbatim, and subjected to thematic analysis.

RESULTS

Five themes emerged from the data analyses: 1) main impacts of participating in the exercise program; 2) facilitators of adherence; 3) perceived barriers; 4) perception of the program structure; and 5) global satisfaction with the program. Positive physical and emotional changes were reported, associated with reduced perceived stress and irritability, and decreased blood pressure. Adherence to the exercise program was facilitated by personalized supervision and feedback, the personal commitment to attend the training sessions, and different schedule options. Lack of motivation, peer support, physical health limitations, and difficulty in conciliating schedules were identified as barriers to the maintenance of exercise training after the program.

CONCLUSION

The qualitative analysis demonstrates the acceptability of the program. Peer and health professional's support, commitment to health professionals, and boosting individual-perceived advantages are key-points to promote participants adherence.

The Mediating Role of Rumination and Self-Regulation Between Self-Generated Stress and Psychological Well-Being

In this study, we aimed to examine the relationships between self-generated stress (SGS) and psychological well-being (PWB) and the mediating role of self-critical rumination (SCR) and self-regulation in this relationship. In this direction, the Self-Generated Stress Scale (SGSS) was adapted into Turkish in the first study. In the second study, we tested the mediating role of SCR and self-regulation in the relationship between SGS and PWB in university students. The findings showed that the Self-Generated Stress Scale is a valid and reliable measurement tool for Turkish culture and PWB and self-regulation have partial mediating roles in the relationship between SGS and PWB. These results contribute to a better understanding of the association between SGS and PWB.

Psychological morbidity and substance use among patients with hypertension: a hospital-based cross-sectional survey from South West Ethiopia

BACKGROUND

Psychological morbidity and substance use disorders have been linked to cardiovascular diseases; affecting patients' medical outcome and quality of life. However, little is known about psychological morbidity and substance use among patients with hypertension in Ethiopia. Therefore, we aimed to assess psychological comorbidity and substance use among hypertensive patients in Southwest Ethiopia.

METHODS

A cross-sectional study was conducted among 396 hypertensive patients on follow-up at Jimma University Teaching Hospital in Ethiopia during the study period. Structured questionnaires were used to assess alcohol use, khat chewing and cigarette smoking. Psychological morbidity was assessed using the Kessler-6 scale. Multiple logistic regression analysis was carried out to identify the independent association between outcome and explanatory variables.

RESULTS

The prevalence of psychological morbidity among hypertensive patients was 31.6%. Of the total participants, 31 (7.8%) of them had alcohol use disorders and 79 (19.9%) of them were using khat regularly at the time of the study. Singles were more likely to have psychological morbidity than married participants (AOR = 4.72; 95% CI 1.83, 12.20, p = 0.001), whereas those who were able to 'read and write' were less likely to have psychological morbidity than non-literate ones (AOR = 0.46; 95% CI 0.24, 0.89, p = 0.02). However, no association was seen between psychological morbidity and substance use (khat chewing, alcohol use and cigarette smoking), belief about hypertension, ever discontinuation of medication and lifestyle (exercise, salt consumption).

CONCLUSION

Psychological morbidity and substance use are prevalent among hypertensive patients on follow-up at the hospital. The findings of the study imply that there is a need for further studies to understand the effect of psychological morbidity on the clinical outcomes of hypertensive patients.

Depression, anxiety, stress and demographic determinants of hypertension disease

Background and Objective: Research evidence supports the relationship of psychological and demographic factors with hypertension and these variables are strongest predictors of hypertension which are scarcely studied in Pakistan. The present study was carried out to explore the correlation of depression, anxiety, stress and demographic factors with hypertension.

Method: We used correlation research design and a sample of (N = 237), hypertensive patients (N = 137) and their age matched healthy controls (N = 100) was taken from hospitals. Depression, Anxiety and Stress Scale (DASS) (Lovibond & Lovibond, 1995) was used to assess depression, anxiety and stress.

Results: Results indicated significant positive correlation between depression (χ²_MH = 104.18, p < .001), anxiety (χ²_MH = 78.48, p < .001), stress (χ²_MH = 110.95, p < .001) and overall negative states (χ²_MH = 97.43, p < .001) with hypertension. Depression (OR = 1.44, p < .01), anxiety (OR = 1. 76, p < .01) stress (OR = 1.37, p < .01), job and dependents, working hours and weight turned out as predictors of hypertension.

Conclusion: Hypertension has significant positive relationship with depression, anxiety, stress and with demographic variables. The findings of the present study will contribute in the existing knowledge of health professionals to enhance public awareness regarding the harmful outcomes of depression, anxiety and stress upon human health.

Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies

BACKGROUND

Epidemiological studies have repeatedly investigated the association between anxiety and hypertension. However, the results have been inconsistent. This study aimed to summarize the current evidence from cross-sectional and prospective studies that evaluated this association.

METHODS

Seven common databases were searched for articles published up to November 2014. Cross-sectional and prospective studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratios or hazard ratios, and 95% confidence intervals (CIs) were extracted or calculated by the authors. The pooled odds ratio was calculated separately for cross-sectional and prospective studies using random-effects models. The Q test and I2 statistic was used to assess heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias.

RESULTS

The search yielded 13 cross-sectional studies (n=151,389), and the final pooled odds ratio was 1.18 (95% CI 1.02-1.37; P Q<0.001; I (2)=84.9%). Eight prospective studies with a total sample size of 80,146 and 2,394 hypertension case subjects, and the pooled adjusted hazard ratio was 1.55 (95% CI 1.24-1.94; P Q<0.001; I (2)=84.6%). The meta-regression showed that location, diagnostic criteria for anxiety, age, sex, sample size, year of publication, quality, and years of follow-up (for prospective study) were not sources of heterogeneity.

CONCLUSION

Our results suggest that there is an association between anxiety and increased risk of hypertension. These results support early detection and management of anxiety in hypertensive patients.

State and regional prevalence of sleep disturbance and daytime fatigue

STUDY OBJECTIVES

Social and demographic influences are important for sleep attainment. Geographic location has not been previously explored.

METHODS

Data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) were used (N = 157,319). Participants answered a question on Sleep Disturbance and Daytime Fatigue. Thirty-six states/regions provided data on these items. Prevalence estimates were adjusted for age, sex, ethnoracial group, education, income, employment, general health, healthcare access, and depression. Chi-squared tests were conducted across states and census regions, and pseudo-R(2) values were computed for the effect of state, relative to other predictors. To evaluate potential mediators of census region differences, an analysis of p value change associated with specific covariates and covariate groups was undertaken.

RESULTS

Adjusted prevalence rates of Sleep Disturbance differed across states/regions overall (χ(2) = 412.3, p < 0.0001), as well as separately for men (χ(2) = 139.5, p < 0.0001) and women (χ(2) = 350.0, p < 0.0001), as did rates of Daytime Fatigue overall (χ(2) = 245.7, p < 0.0001), and separately for men (χ(2) = 117.5, p < 0.0001) and women (χ(2) = 181.2, p < 0.0001). Analysis of pseudo-R(2) values revealed that despite these significant findings, state differences were an overall weak predictor, representing 1.30% to 1.73% of the magnitude of the effect of the best predictor (mental health). When Census regions were compared, significant differences were found for Sleep Disturbance (p = 0.002), but after adjustment for covariates, these were no longer significant. Differences existed for Daytime Fatigue in adjusted analyses overall (p < 0.0001), with the West reporting the fewest complaints and the South reporting the most.

CONCLUSIONS

These results demonstrate that reports of sleep related complaints vary across states, independent (at least partially) of factors that influence circadian rhythms (e.g., latitude).

The effect of cognitive behavior therapy-based "forest therapy" program on blood pressure, salivary cortisol level, and quality of life in elderly hypertensive patients

OBJECTIVE

This article aimed to develop the "forest therapy" program, which is a cognitive behavior therapy (CBT)-based intervention program using forest environment, and investigate its effects on blood pressure (BP), salivary cortisol, and quality of life (QoL) measures in patients with hypertension.

METHODS

A total of 56 men and women were enrolled for this study, being referred from local health centers in Republic of Korea, from April to October 2009. They were conveniently assigned to either "forest" group participating in the forest therapy program or control group doing self-monitoring of BP. Measurements of salivary cortisol level and QoL were done at initial visits and at 8-week final visits.

RESULTS

Both groups did not differ significantly in baseline clinical characteristics. The BP change at week 4 and week 8 did not differ between the two groups. Salivary cortisol level reduction was significantly larger and QoL measures improved significantly more in the forest group at week 8 compared with the control group.

CONCLUSIONS

The forest therapy program did not induce prolonged systolic blood pressure (SBP) reduction. However, considering the significant decrease in cortisol level and improvement in QoL measures, this may be a useful model of community hypertension management program.