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K C D, Kaphle HP, Shrestha D, Neupane N. Anxiety and depression among hypertensive patients during the COVID-19 pandemic: A cross-sectional study from Kathmandu Metropolitan, Nepal. PLoS One 2024; 19:e0308048. [PMID: 39074135 DOI: 10.1371/journal.pone.0308048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION The outbreak of a global pandemic like COVID-19 has highlighted significant distress around mental health. The burden of mental health issues like anxiety and depression requires evidence-based intervention, especially in low-income settings like Nepal. The study aims to determine the prevalence of anxiety and depression and the factors associated with it among hypertensive patients. MATERIALS AND METHODS The quantitative cross-sectional study design was used for this study. The study was conducted among 374 samples from selected wards of Kathmandu Metropolitan using a convenience sampling technique. Face-to-face interviews were conducted using a structured interview schedule. A Chi-square test was used to identify the statistical significance between dependent and independent variables. Binary logistic regression analysis was performed to determine the factors associated with anxiety and depression. RESULTS The prevalence of anxiety and depression among hypertensive patients during the COVID-19 pandemic was 27.8% and 24.3% respectively. According to the results of bivariate logistic regression analysis, smoking/tobacco consumption, staying in quarantine, positive COVID-19 test result, history of COVID-19 positive in the family, History of death due to COVID-19 in the family, visiting a hospital during the COVID-19 pandemic appeared as influencing factors of both anxiety and depression. CONCLUSION Our findings suggest that COVID-19 has a substantial effect on the mental health of hypertensive patients. This study highlights the need to develop early intervention and coping strategies among this population to minimize the negative impact of COVID-19 on their mental health and well-being.
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Affiliation(s)
- Dilasha K C
- School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
| | | | - Durga Shrestha
- School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
| | - Nirmala Neupane
- School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
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Wijemunige N, van Baal P, Rannan-Eliya RP, O'Donnell O. Health outcomes and healthcare utilization associated with four undiagnosed chronic conditions: evidence from nationally representative survey data in Sri Lanka. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:45. [PMID: 38983904 PMCID: PMC11228003 DOI: 10.1186/s44263-024-00075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
Background Low awareness of chronic conditions raises the risk of poorer health outcomes and may result in healthcare utilization and spending in response to symptoms of undiagnosed conditions. Little evidence exists, particularly from lower-middle-income countries, on the health and healthcare use of undiagnosed people with an indication of a condition. This study aimed to compare health (physical, mental, and health-related quality of life (HRQoL)) and healthcare (inpatient and outpatient visits and out-of-pocket (OOP) medical spending) outcomes of undiagnosed Sri Lankans with an indication of coronary heart disease (CHD), hypertension, diabetes, and depression with the outcomes of their compatriots who were diagnosed or had no indication of these conditions. Methods This study used a nationally representative survey of Sri Lankan adults to identify people with an indication of CHD, hypertension, diabetes, or depression, and ascertain if they were diagnosed. Outcomes were self-reported measures of physical and mental functioning (12-Item Short Form Survey (SF-12)), HRQoL (EQ-5D-5L), inpatient and outpatient visits, and OOP spending. For each condition, we estimated the mean of each outcome for respondents with (a) no indication, (b) an indication without diagnosis, and (c) a diagnosis. We adjusted the group differences in these means for socio-demographic covariates using ordinary least squares (OLS) regression for physical and mental function, Tobit regression for HRQoL, and a generalized linear model (GLM) for healthcare visits and OOP spending. Results An indication of each of CHD and depression, which are typically symptomatic, was associated with a lower adjusted mean of physical (CHD -2.65, 95% CI -3.66, -1.63; depression -5.78, 95% CI -6.91, -4.64) and mental functioning (CHD -2.25, 95% CI -3.38, -1.12; depression -6.70, 95% CI -7.97, -5.43) and, for CHD, more annual outpatient visits (2.13, 95% CI 0.81, 3.44) compared with no indication of the respective condition. There were no such differences for indications of hypertension and diabetes, which are often asymptomatic. Conclusions Living with undiagnosed CHD and depression was associated with worse health and, for CHD, greater utilization of healthcare. Diagnosis and management of these symptomatic conditions can potentially improve health partly through substitution of effective healthcare for that which primarily responds to symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00075-0.
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Affiliation(s)
- Nilmini Wijemunige
- Institute for Health Policy, Colombo, Sri Lanka
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter van Baal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Owen O'Donnell
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Abate MW, Nigat AB, Tigabu A, Bantie B, Tiruneh CM, Emiru TD, Tibebu NS, Legas G, Belete A, Walle BG, Feleke MG. Depression and its associated factors among adult hypertensive patients attending follow-up in South Gondar zone public hospitals, Ethiopia, 2023. BMC Psychiatry 2024; 24:360. [PMID: 38745187 PMCID: PMC11094849 DOI: 10.1186/s12888-024-05807-y] [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: 11/28/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Depression is the most common public health issue affecting the world's population. Like patients with other chronic medical diseases, hypertensive patients experience many intense emotions which increase their risk for the development of depression. This study aimed to assess the magnitude of depression and its associated factors among hypertensive patients in South Gondar zone governmental hospitals, Northwest Ethiopia, 2023. METHODS An institutional-based cross-sectional study was used in government hospitals of South Gondar Zone. A total of 311 patients were sampled randomly and included in the study. Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Data were analyzed mainly by using descriptive statistics and binary logistics regression. RESULTS A total of 311 patients participated with a 100% response rate. Almost half of the participants were female. The mean age of the respondents was 58.85 years. More than 60% of the respondents had a co-morbid illness. Among participants, 83 (26.7%) of hypertensive patients had depression. Being female, age, uneducated, having poor social support, the presence of co-morbid illness and complications, uncontrolled hypertension, having less than or equal to two dietary regimen and duration of hypertension greater than ten years were significantly associated with depression. CONCLUSION The magnitude of depression was found to be high. This indicated that depression is a common co-morbid illness among hypertensive patients. Healthcare professionals and other stakeholders should consider and diagnose co-morbid diseases like depression among hypertensive patients. It is also better to give particular emphasis to highly vulnerable groups like females, elders, uneducated and those who have poor social support.
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Affiliation(s)
- Moges Wubneh Abate
- Department of Adult Health Nursing, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia.
| | - Adane Birhanu Nigat
- Department of Adult Health Nursing, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Agimasie Tigabu
- Department of Adult Health Nursing, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Chalie Marew Tiruneh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Tigabu Desie Emiru
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Nigusie Selomon Tibebu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Getasew Legas
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Amsalu Belete
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, P.O.Box:272, Debre Tabor, Ethiopia
| | - Belete Gelaw Walle
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Wolayta Sodo University, Wolaita, Ethiopia
| | - Mulualem Gete Feleke
- Department of Adult Health Nursing, College of Health Sciences, Wolayta Sodo University, Wolaita, Ethiopia
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Choong SM, Lee PY, Rashid AA. Prevalence of undiagnosed depression among patients with hypertension: A cross-sectional study of Malaysian primary care perspective. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:10. [PMID: 36992959 PMCID: PMC10042249 DOI: 10.51866/oa.2l4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Introduction This study aimed to determine the prevalence of suspected depression and its associated factors among patients with hypertension in a Malaysian primary care clinic. Method This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9. Results The prevalence of suspected depression was 9.0%. The significant predictors of depression were Indian ethnicity (adjusted odd ratio [AOR]: 2.373; confidence interval [CI]: 1.147-4.907), divorce (AOR: 3.5; CI: 1.243-9.860), singleness (AOR: 2.241; CI: 1.182-4.251), heavy episodic drinking (AOR: 7.343; CI: 2.494-21.624), low physical activity level (AOR: 1.921; CI: 1.0932.274), low fibre intake (AOR: 1.836; CI: 1.061-3.178), uncontrolled blood pressure (AOR: 1.800; CI: 1.134-2.858) and presence of hypertension complications (AOR: 3.263; CI: 2.053-5.185). Conclusion Primary health care providers must screen for depression among patients with hypertension, particularly those within high-risk groups, and implement interventions that address modifiable risk factors.
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Affiliation(s)
- Siaw Mei Choong
- MD (UPM), MMed Family Medicine (UPM) Klinik Kesihatan Pasir Panjang, Taman Pasir Panjang,Port Dickson, Negeri Sembilan, Malaysia.
| | - Ping Yein Lee
- MBBS (UM), DrFamMed (UM) E-Health Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- MBBCh BAO (NUI) (IRL), DrFamMed (UKM) Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
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Denche-Zamorano A, Basilio-Fernández B, Herrera-Guerrero P, Garcia-Gordillo MA, Castillo-Paredes A, Rojo-Ramos J, Gómez-Paniagua S, Barrios-Fernandez S. A Cross-Sectional Study on the Associations between Depression and Anxiety, Medication Use for These Diseases and Physical Activity Level in Spanish People with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1803. [PMID: 36767173 PMCID: PMC9914456 DOI: 10.3390/ijerph20031803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Hypertension (HTN) has a high prevalence in the overall population, affecting people's mental health. Physical Activity (PA) has proven to be an effective tool to improve mental health. This study analyzed the associations between Depression and Anxiety prevalence, medication use for these disorders (antidepressants and anxiolytics) and Physical Activity Level (PAL) in people with HTN. A cross-sectional study was conducted with data from the Spanish National Health Survey 2017 (ENSE2017) with a final sample of 3228 individuals over 15 years of age with HTN who resided in Spain. Data normality was assessed through the Kolmogorov-Smirnov test. Associations between Depression and Anxiety prevalence, antidepressant and anxiolytic use and PAL were studied using a chi-square test. Possible differences between Depression and Anxiety prevalence and medication use according to the PAL were analyzed with a z-test for independent proportions. Depression or Anxiety and antidepressant and anxiolytic use odds ratios (OR) were calculated for every PAL group, taking the "Very Active" group as a reference. Risk factors were evaluated using multiple binary logistic regression. Dependency relationships were found between Depression and Anxiety prevalence, antidepressant and anxiolytic use and PAL (p < 0.001). The Inactive group displayed the highest prevalence and medication use according to their PAL (p < 0.05). Higher ORs for Depression or Anxiety and pharmacological treatments used were also found in the Inactive group compared to the other PAL groups.
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Affiliation(s)
- Angel Denche-Zamorano
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Belinda Basilio-Fernández
- Department of Nursing, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
| | - Pedro Herrera-Guerrero
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | | | - Antonio Castillo-Paredes
- Grupo AFySE, Investigación en Actividad Física y Salud Escolar, Escuela de Pedagogía en Educación Física, Facultad de Educación, Universidad de Las Américas, Santiago 8370040, Chile
| | - Jorge Rojo-Ramos
- Physical Activity for Education, Performance and Health, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | | | - Sabina Barrios-Fernandez
- Occupation, Participation, Sustainability and Quality of Life (Ability Research Group), Nursing and Occupational Therapy College, University of Extremadura, 10003 Caceres, Spain
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Karki P, Shahi PV, Sapkota KP, Bhandari R, Adhikari N, Shrestha B. Depressive symptoms and associated factors among persons with physical disabilities in disability care homes of Kathmandu district, Nepal: A mixed method study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001461. [PMID: 36962869 PMCID: PMC10021957 DOI: 10.1371/journal.pgph.0001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023]
Abstract
Depression is one of the most common mental disorders, affecting 300 million people worldwide and 75% of these occur in low- and middle-income countries. Persons with physical disabilities are vulnerable groups and are more prone to experience depressive symptoms than the general population. This study investigated the prevalence of depressive symptoms and the associated factors among persons with a physical disability. We conducted a concurrent triangulation mixed methods design using Beck's Depression Inventory scale among 162 persons with physical disabilities in the Kathmandu district. In parallel, eight in-depth interviews were conducted with an interview guideline to collect the participants' perceptions and experiences of disability. Both quantitative and qualitative findings were integrated into the results. We found that about 77% of the participants with a physical disability had experienced depressive symptoms. Unemployment status (adjusted odds ratio (AOR) 2.7, 95% confidence interval (CI) 1.0-7.3) and comorbidity (AOR 2.5, 95% CI 1.0-6.0) had a statistically significant association with depressive symptoms. The majority of people with physical disabilities had negative experiences with societal prejudice and coping with their limitations. They were depressed as well as angry over having to stop their careers, education, and possibilities. Nevertheless, they were significantly happier and less sad than in their earlier years of life because of the possibilities, family environment, improved means of subsistence, therapeutic facilities, and supportive atmosphere at disability care homes. The policymakers should focus on preventing comorbidity and providing technical skills to persons with physical disabilities to improve their employment status and promote a healthy lifestyle.
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Affiliation(s)
- Prabin Karki
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prasant Vikram Shahi
- Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Rabindra Bhandari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Nabin Adhikari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Department of Research and Development Division, Dhulikhel Hospital, Dhulikhel, Kavrepalanchowk, Nepal
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Ang CW, Tan MM, Bärnighausen T, Reininghaus U, Reidpath D, Su TT. Mental distress along the cascade of care in managing hypertension. Sci Rep 2022; 12:15910. [PMID: 36151113 PMCID: PMC9508187 DOI: 10.1038/s41598-022-20020-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022] Open
Abstract
Hypertension might be a contributing factor of mental illness. The aim of this study was to investigate the association between different levels of hypertension care and mental distress among hypertensive individuals in Malaysia. We constructed a hypertension care cascade using data of 6531 hypertensive individuals aged ≥ 35 years that were collected as part of the community health survey conducted in 2013 in the South East Asia Community Observatory. We examined the association between the status of hypertension care and mental distress using multiple logistic regressions. Respondents who had not been screened for hypertension and those who had uncontrolled blood pressure (BP) had higher odds of depression, anxiety and, stress compared to those who had been screened and those who had controlled BP, respectively. Respondents who were not taking antihypertensive medication had lower odds of depression and anxiety compared to those who were on medication. There was an association between different levels of hypertension care and mental distress. The application of a hypertension care cascade may help improve the provision of mental health support in primary care clinics. Specific mental health interventions could be provided for patients with particular needs along the cascade.
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Affiliation(s)
- Chiew Way Ang
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Min Min Tan
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,ESRC Centre for Society and Mental Health, King's College London, London, UK.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Reidpath
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia. .,Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany.
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Kohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, Kartha MR, Poudyal A, Singh R, Rai S, Baral PP, McCutchan S, Gronholm PC, Hanlon C, Lempp H, Lund C, Thornicroft G, Gautam K, Jordans MJD. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implement Sci 2022; 17:39. [PMID: 35710491 PMCID: PMC9205129 DOI: 10.1186/s13012-022-01202-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/10/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
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Affiliation(s)
- Brandon A. Kohrt
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington D.C., USA
| | - Elizabeth L. Turner
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Xueqi Wang
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mani Neupane
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Muralikrishnan R. Kartha
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, IOPPN, King’s College London, London, UK
| | - Anubhuti Poudyal
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York, NY USA ,grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Ritika Singh
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Sauharda Rai
- grid.34477.330000000122986657Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA
| | - Phanindra Prasad Baral
- grid.500537.4Non-communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Kathmandu, Nepal
| | - Sabrina McCutchan
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Petra C. Gronholm
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Crick Lund
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Mark J. D. Jordans
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King’s College London, London, UK
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Anxiety and Depression among Hypertensive Adults in Tertiary Care Hospitals of Nepal. PSYCHIATRY JOURNAL 2022; 2022:1098625. [PMID: 35310013 PMCID: PMC8933064 DOI: 10.1155/2022/1098625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/20/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022]
Abstract
Introduction Cooccurrence of hypertension and depression/anxiety increases the chance of cardiovascular mortality and morbidity. Therefore, this study is aimed at assessing the prevalence of anxiety and depression and their association with hypertension among hypertensive adults in a tertiary care hospital in Kathmandu, Nepal. Methods A descriptive cross-sectional study was conducted using a semistructured self-administered questionnaire based on Hamilton Anxiety and Hamilton Depression Rating Scale. The data was entered in EPI Data and analyzed using descriptive and inferential statistics in SPSS version 22. P value < 0.05 was considered statistically significant. Results A total of 260 individuals participated in the study, with a mean age of 42.6 years. About 46% of patients did not have any symptoms of depressed mood, and 73 (28.1%) of the participants experienced feelings of depressed mood only on questioning. Similarly, (151) 58.1% did not have feelings of guilt, and 48 (18.5%) participants who had the feeling of guilt had let people down. Among 260 respondents, most participants ((102) 39.2%) had mild symptoms of anxious mood, followed by (86) 33.1% participants with moderate symptoms. Only (4) 1.5% of participants had severe symptoms. Similarly, the majority of participants ((114) 43.8%) had a mild form of mental and emotional strain, followed by (72) 27.7% with moderate mental and emotional strain while (43) 16.5% had no mental and emotional strain. The occupation and marital status of the hypertensive individual was associated with anxiety and depression (P = ≤0.01). Conclusion In conclusion, anxiety and depression were common among patients with hypertension. Anxiety and depression were linked to some of the patients' sociodemographic and clinical features. This study demonstrates that treating hypertension alone is not enough to improve patients' quality of life; mental illness screening among chronically ill individuals is also required.
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Albasara SA, Haneef MS, Zafar M, Moinuddin KG. Depression and associated risk factors among hypertensive patients in primary health care centers in Dammam, Kingdom of Saudi Arabia. Pan Afr Med J 2021; 38:278. [PMID: 34122705 PMCID: PMC8179995 DOI: 10.11604/pamj.2021.38.278.27133] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/01/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction depression is a common mental illness and Hypertension is a chronic disease and due to the negligence depression is co-morbidity with hypertension. The aim of this study was to determine the prevalence of depression and its associated factor among hypertensive patients in Dammam. Methods it was a cross-sectional study and 342 hypertensive patients were selected from primary health care centers in Dammam, KSA. Beck Depression Inventory scale was used to determine the depression. The logistic regression analysis was used to assess the correlation between depression (dependent) and other variables. The P-value of less than 0.05 has been set to be statistically significant. Results the proportion of depression with various degrees of severity among study participants was 19.6%. After Adjustment of covariates, older age [aOR 3.33, 95% CI 1.22-9.10; p= 0.019,low income [a OR 3.19, 95% CI 1.02-9.11; p= 0.003, illiterate [aOR 3.41, 95% CI 1.09-7.65; p= 0.005], physical inactivity [aOR 2.65, 95% CI 1.21-9.65; p= 0.051], ever smoker [aOR 2.99, 95% CI 1.09-3.77; p= 0.002], long standing hypertension > 3 years [aOR 3.765, 95% CI 1.01-7.10; p= 0.049] were more likely significantly associated with depression among hypertensive patients. Conclusion depression is common among hypertensive patients in our setting. The associated multiple risk factors are older age, low income (< 3000 SR), physical inactivity, long standing hypertension.
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Affiliation(s)
- Sumood Abdulbaqi Albasara
- Department of Public Health, College of Public Health, Imamm Abdul Rehman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad Shafee Haneef
- Department of Public Health, College of Public Health, Imamm Abdul Rehman Bin Faisal University, Dammam, Saudi Arabia
| | - Mubashir Zafar
- Department of Family and Community Medicine, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Khawaja Ghulam Moinuddin
- Department of Family and Community Medicine, College of Medicine, University of Hail, Hail, Saudi Arabia
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11
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Khadoura KJ, Shakibazadeh E, Mansournia MA, Aljeesh Y, Fotouhi A. Undiagnosed Depression among Hypertensive Individuals in Gaza: A Cross-sectional Survey from Palestine. Ethiop J Health Sci 2021; 31:339-348. [PMID: 34158786 PMCID: PMC8188075 DOI: 10.4314/ejhs.v31i2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to estimate the prevalence and to determine the associated factors of undiagnosed depression amongst hypertensive patients (HTNP) at primary health care centers (PHCC) in Gaza. METHODS A cross-sectional survey was conducted including 538 HTNP as a recruitment phase of a clustered randomized controlled trial. Data were collected through face-to-face structured interview, and depression status was assessed by Beck's Depression Inventory (BDI-II). Data were analyzed by STATA version 14 using standard complex survey analyses, accounted for unresponsiveness and clustering approach. Generalized linear regression analysis was performed to assess associations. RESULTS The prevalence of undiagnosed clinical depression was 11.6% (95% confidence interval [CI]: 8.1, 16.3). Moreover, prevalence of 15.4% (95% CI: 10.8, 21.6) was found for mild depression symptoms. We found that non-adherence to antihypertensive medications (AHTNM) (β = 0.9, 95% CI: 0.17, 1.7), having more health-care system support (β = 2.8, 95% CI: 1.6, 3.9) and number of AHTNM (β = 1.5, 95% CI: 0.6, 2.5) remain significantly positively associated with BDI-II score. On the other hand, older age (β = -0.1, 95% CI: -0.2, -0.02), having better social support (β = -6.8, 95% CI: -8.9, -4.7) and having stronger patient-doctor relationship (β = -4.1, 95% CI: -6.9, -1.2) kept significantly negative association. CONCLUSION The prevalence of undiagnosed depression was about one-quarter of all cases; half of them were moderate to severe. Routine screening of depression status should be a part of the care of HTNP in PHCC.
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Affiliation(s)
- Khalid Jamal Khadoura
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
- Department of Nursing, Faculty of Medical Sciences, Israa University-Gaza, Palestine
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Aljeesh
- Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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12
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Boima V, Tetteh J, Yorke E, Archampong T, Mensah G, Biritwum R, Yawson AE. Older adults with hypertension have increased risk of depression compared to their younger counterparts: Evidence from the World Health Organization study of Global Ageing and Adult Health Wave 2 in Ghana. J Affect Disord 2020; 277:329-336. [PMID: 32858314 DOI: 10.1016/j.jad.2020.08.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression and hypertension interact through a complex interplay of social, behavioral and biological factors. Despite the huge burden of hypertension in the African sub-region, very little information exists on depression among hypertensive patients. This study assessed the prevalence and factors associated with depression among young and older adult hypertensive patients in Ghana. METHOD Data from the World Health Organization Study on Global AGEing and Adult Health wave 2 (2014/2015) for Ghana was used. Depression was estimated among participants with blood pressure 140/90mmHg and above. Weighted descriptive statistics and logistic regression with adjusted predictions were carried out. The analysis was performed using Stata 15. RESULT The overall prevalence of depression was 6.3%. Older hypertensive patients had almost twice the prevalence of depression compared with younger patients (8.4% vs 4.5%). The factors which predicted depression among hypertensive patients were educational level, marital status, religion, region of residence, work status, self-rated health (SRH), and unhealthy lifestyle. Participants with no religion were more than 7 times likely to be depressed compared with Christians [aOR(95%CI)=7.52(2.11-26.8)]. Those in the Volta region were more than 8 times likely to be depressed compared to those in the Greater Accra region [aOR(95%CI)=8.58(2.51-29.3)]. CONCLUSION Older adult hypertensive patients were more likely to experience depressive symptoms. Multiple factors predicted depression in both young and old hypertensive patients; thus a comprehensive care package including psychological support for patients with hypertension is essential for optimum clinical management.
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Affiliation(s)
- Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - John Tetteh
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Timothy Archampong
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - George Mensah
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Richard Biritwum
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana.
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13
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Zhang B, Zhang W, Sun X, Ge J, Liu D. Physical Comorbidity and Health Literacy Mediate the Relationship Between Social Support and Depression Among Patients With Hypertension. Front Public Health 2020; 8:304. [PMID: 32850572 PMCID: PMC7419472 DOI: 10.3389/fpubh.2020.00304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/04/2020] [Indexed: 02/05/2023] Open
Abstract
Depression is a common comorbidity among patients with hypertension. Patients with hypertension and depression have worse health outcomes compared to those without depression. The combined effects of social support, physical comorbidity, and health literacy on depression among individuals with hypertension remain unclear. A survey was conducted between December 2017 and May 2018 to investigate the relationships among social support, physical comorbidity, health literacy, and depression in a population of patients with hypertension in rural areas of Sichuan province, China. Multiple linear regression was used to examine factors that influenced depression, and structural equation modeling (SEM) was used to examine the relationships among the four study variables. The mean scores of 549 patients with hypertension were 37.17 ± 6.84 for social support, 14.62 ± 6.26 for health literacy, and 3.56 ± 3.05 for depression; furthermore, 34.2% of participants had physical comorbidity. Gender and per capita annual family income were significantly associated with depression. Physical comorbidity was directly positively related to depression while health literacy was directly negatively related to depression. Social support had an indirect negative association with depression by the mediating effects of health literacy and physical comorbidity. Adequate social support and health literacy, and less physical comorbidity could potentially contribute to reducing depression. The study highlights the importance of social support in maintaining mental health among patients with hypertension. Strategies that target the enhancement of social support and health literacy should be prioritized to relieve depression among patients with hypertension. More attention should be paid to women, low-income individuals, and patients with physical comorbidities.
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Affiliation(s)
- Baiyang Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wenjie Zhang
- The Department of Academic Affairs, West China School of Medicine/ West China Hospital, Sichuan University, Chengdu, China
| | - Xiaxia Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jingjing Ge
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Danping Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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14
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Rajan S, Rathod SD, Luitel NP, Murphy A, Roberts T, Jordans MJD. Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal. BMC Health Serv Res 2020; 20:250. [PMID: 32213188 PMCID: PMC7093962 DOI: 10.1186/s12913-020-05094-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/09/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite attempts to improve universal health coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. METHODS We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. RESULTS We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7-22%, p < 0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p < 0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). CONCLUSIONS In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.
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Affiliation(s)
- Selina Rajan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sujit D. Rathod
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Adrianna Murphy
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK
| | - Tessa Roberts
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF UK
| | - Mark J. D. Jordans
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF UK
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15
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Gebre BB, Deribe B, Abeto M. Magnitude and Associated Factors of Depression Among Hypertensive Patients Attending Treatment Follow Up in Chronic OPD at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Integr Blood Press Control 2020; 13:31-39. [PMID: 32273751 PMCID: PMC7106993 DOI: 10.2147/ibpc.s240015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Hypertension and depression are among the most common public health issues affecting the population around the world. Like patients with other chronic medical conditions, hypertensive patients experience many intense emotions which increase their risk for the development of depression. Globally, depression is the leading cause of disability and 382 million people suffer worldwide. Objective The aim of this study was to assess the magnitude and factors associated with depression among hypertensive patients attending treatment follow up in the chronic OPD at Hawassa University Comprehensive Specialized Hospital (HUCSH) from March to May, 2019. Methods An institutional-based cross-sectional study was conducted with 310 hypertensive patients attending treatment follow up at the chronic Out-Patient Department of HUCSH at Hawassa from March to May, 2019. A validated patient health questionnaire (PHQ−9) was used to assess depression. The data were entered using EPI-data version 3.1 and analyzed in SPSS version 22. Binary logistic regression was used to determine the association of independent variables with dependent variables. Results The magnitude of depression among hypertension (HPN) patients was found to be 73 (24.7%). The independent predictors were sex 2.6 (1.16, 5.83), age 11.2 (2.98, 42), educational status, social support 2.55 (1.09, 5.94), family history of depression 7.12 (1.48, 34.26), hypertension 7.57 (2.67, 21.44), and medication adherence 11.6 (4.23, 31.78). Conclusion The magnitude of depression among HPN patients was high. So, continuous health information dissemination at a different level regarding factors affecting them should be given. Strengthening a referral linkage with a psychiatric unit for psycho-behavioral therapy will bring good clinical outcome. Besides, controlling hypertension was crucial to bring good clinical outcome.
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Affiliation(s)
- Bereket Beyene Gebre
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Bedilu Deribe
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Mintesnot Abeto
- College of Health Science, Hawassa University, Hawassa, Ethiopia
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Cramer H, Lauche R, Adams J, Frawley J, Broom A, Sibbritt D. Is Depression Associated with Unhealthy Behaviors among Middle-Aged and Older Women with Hypertension or Heart Disease? Womens Health Issues 2020; 30:35-40. [PMID: 31727443 DOI: 10.1016/j.whi.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 09/06/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Depression is a common comorbidity in patients with cardiovascular conditions. This study aims to assess the association between comorbid depression and health-promoting behavior in middle-aged and older Australian women with hypertension or heart disease. METHODS Data are from a subset of 45 and Up Study participants with diagnosed chronic illness (n = 1,925). Health behaviors including smoking status, alcohol consumption, and physical activity were assessed. Associations of depression with health behaviors in women with hypertension or heart disease were analyzed using unadjusted and adjusted (for chronic conditions and demographic measures) logistic regression models. RESULTS A total of 666 women with hypertension and 220 women with heart disease were included in the analysis. In adjusted analyses, women with hypertension and comorbid depression were 2.36 (95% confidence interval, 1.02-5.46) times more likely to be risky or high-risk drinkers and 55% (adjusted odds ratio, 0.45; 95% confidence interval, 0.27-0.73) less likely to be highly physically active, compared with women without depression. Women with heart disease and comorbid depression were 65% (adjusted odds ratio, 0.35; 95% confidence interval, 0.12-0.95) less likely to be highly physically active, compared with women without depression. CONCLUSIONS This study provides the first data indicating that depression may be a barrier to health-promoting behavior in middle-aged and older women with hypertension or heart disease. Given that physical inactivity and risky alcohol consumption are important risk factors for aggravation of cardiologic conditions, health-promoting behaviors should be specifically targeted in the treatment of women with comorbid depression.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Frawley
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alex Broom
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
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17
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Cao YY, Xiang X, Song J, Tian YH, Wang MY, Wang XW, Li M, Huang Z, Wu Y, Wu T, Wu YQ, Hu YH. Distinct effects of antihypertensives on depression in the real-world setting: A retrospective cohort study. J Affect Disord 2019; 259:386-391. [PMID: 31470183 DOI: 10.1016/j.jad.2019.08.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Evidence is increasing that pathways of antihypertensives may have a role in the pathogenesis of depression. However, how the class of antihypertensives affects depression risk remains unclear. METHODS The effects of different classes of antihypertensives on depression were explored using an insurance database in Beijing, China. Antihypertensives in our study included calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), and diuretics (DIUs). Those initially treated with only one class of antihypertensives were included. Stratified analysis was conducted for demographic characteristics, comorbidities, and statin prescriptions. RESULTS In total, 181,709 newly detected hypertension patients were included. The median follow-up period was 4.33 years and 19,030 participants were with depression by the end. After adjusting for covariates, the incidence density (95% confidence interval, CI) of depression in the BB, ACEI, DIU, CCB, and ARB groups was 3.16 (2.98-3.33), 3.10 (2.91-3.29), 2.70 (2.45-2.94), 2.67 (2.53-2.81), and 2.30 (2.16-2.43) per 100 person-years, respectively. Compared with ARB group, the hazard ratio (95% CI) of depression for BB, ACEI, DIU, and CCB group was 1.37 (1.32-1.43), 1.35 (1.28-1.42), 1.17 (1.08-1.27), and 1.16 (1.12-1.21), respectively. Stratified analysis suggested the highest depression ID remained within the BB or ACEI group. LIMITATIONS Detailed clinical information was unavailable, which may introduce bias. Patients on monotherapy as initial treatment were included and caution is needed for extrapolation. CONCLUSIONS Compared with ARBs, there may be a class effect of other antihypertensives on the risk of depression.
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Affiliation(s)
- Y Y Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - X Xiang
- BeiGene (Beijing) Co., Ltd., Beijing 100027, China
| | - J Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Y H Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - M Y Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - X W Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - M Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Z Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Y Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - T Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Y Q Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
| | - Y H Hu
- Medical Informatics Center, Peking University Health Science Center, Beijing 100191, China.
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Lewis K, Marrie RA, Bernstein CN, Graff LA, Patten SB, Sareen J, Fisk JD, Bolton JM. The Prevalence and Risk Factors of Undiagnosed Depression and Anxiety Disorders Among Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1674-1680. [PMID: 30888037 DOI: 10.1093/ibd/izz045] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with a high prevalence of comorbid depressive and anxiety disorders. A significant proportion of IBD patients with comorbid psychiatric disorders remain undiagnosed and untreated, but factors associated with diagnosis are unknown. We evaluated the prevalence of undiagnosed depression and anxiety in an IBD cohort, along with the associated demographic and clinical characteristics. METHODS We obtained data from the enrollment visit of a cohort study of psychiatric comorbidity in immune-mediated diseases including IBD. Each participant underwent a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) to identify participants who met lifetime criteria for a diagnosis of depression or anxiety. Those with a SCID-based diagnosis were classified as diagnosed or undiagnosed based on participant report of a physician diagnosis. RESULTS Of 242 eligible participants, 97 (40.1%) met SCID criteria for depression, and 74 (30.6%) met criteria for anxiety. One-third of participants with depression and two-thirds with anxiety were undiagnosed. Males were more likely to have an undiagnosed depressive disorder (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.28-8.85). Nonwhite participants were less likely to have an undiagnosed anxiety disorder (OR, 0.17; 95% CI, 0.042-0.72). CONCLUSION Our findings highlight the importance of screening for depression and anxiety in patients with IBD, with particular attention to those of male sex and with a lower education level.
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Affiliation(s)
- Kylee Lewis
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - James M Bolton
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Psychiatry, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Tshomo Y, Chaimongkol N. Prevalence of depression and its associated factors among persons with chronic medical illness in Bhutan. Arch Psychiatr Nurs 2019; 33:347-351. [PMID: 31280778 DOI: 10.1016/j.apnu.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/30/2019] [Accepted: 02/09/2019] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the prevalence of depression and factors associated with the depression among persons with chronic medical illness. A total of 120 adult patients visited at a medicine OPD hospital in Bhutan were recruited and asked to complete self-report questionnaires. Descriptive statistics and binary logistic regression were employed to analyze the data. Results revealed 41% of the prevalence rate of depression in persons with chronic medical illness in Bhutan. Patients' age ≤ 40 years, being a female, and those with low level of physical activity and low social support were significantly associated with depression. Nurses and related health care providers could utilize these findings to develop an intervention to prevent depression in persons with medical chronic illness by promoting social support and physical activity focusing on females, and young adults.
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Affiliation(s)
- Yezer Tshomo
- Eastern Regional Referral Hospital, Mongar, Bhutan
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20
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Xiong X, Wang P, Duan L, Liu W, Chu F, Li S, Li X, Su K, You H, Xing Y. Efficacy and safety of Chinese herbal medicine Xiao Yao San in hypertension: A systematic review and meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 61:152849. [PMID: 31035044 DOI: 10.1016/j.phymed.2019.152849] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/15/2019] [Accepted: 01/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Xiao Yao San (XYS) is thought to be beneficial for the treatment of hypertension in China. PURPOSE A systematic review and meta-analysis was performed to evaluate the efficacy and safety of XYS in hypertension. STUDY DESIGN A comprehensive literature search was conducted in 7 electronic databases for randomized controlled trials from their inception until January 7, 2019. METHODS Methodological quality was assessed independently using the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS A total of 17 trials including 1460 hypertensive patients met the selection criteria. Pooled analysis favored XYS plus antihypertensive drugs on blood pressure (BP), Hamilton anxiety scale, self-rating anxiety scale, self-rating depression scale, 9-item patient health questionnaire scale, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, homocysteine, and C-reactive protein. No significant difference between XYS plus antihypertensive drugs and antihypertensive drugs on major cardiovascular and cerebrovascular events was identified. XYS was well tolerated in the treatment of hypertension. CONCLUSION XYS adjuvant to antihypertensive drugs maybe beneficial for hypertensive patients in lowering BP, improving depression, regulating blood lipids, and inhibiting inflammation. However, the efficacy and safety of XYS are still uncertain due to methodological shortcomings. More long-term, randomized, double-blinded clinical trials are needed in future studies.
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Affiliation(s)
- Xingjiang Xiong
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Pengqian Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lian Duan
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Liu
- Department of Cardiology, Traditional Chinese Medicine Hospital of Beijing, Beijing University of Chinese Medicine, Beijing, China
| | - Fuyong Chu
- Department of Cardiology, Traditional Chinese Medicine Hospital of Beijing, Beijing University of Chinese Medicine, Beijing, China
| | - Shengjie Li
- Department of Biological Science and Technology, School of Life Sciences, Tsinghua University, Beijing, China; Department of Molecular Biology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoke Li
- Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, USA
| | - Kelei Su
- Department of Respiration, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hu You
- Department of Chinese Medicine, Nanjing Benq Hospital, Nanjing Medical University, Nanjing, China; College of Basic Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Yanwei Xing
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Sunny AK, Khanal VK, Sah RB, Ghimire A. Depression among people living with type 2 diabetes in an urbanizing community of Nepal. PLoS One 2019; 14:e0218119. [PMID: 31181109 PMCID: PMC6557519 DOI: 10.1371/journal.pone.0218119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/27/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a major public health problem which accounts for serious medical and economic consequences. Depression is an important associated condition that upsets the management and complications of diabetes. This study aimed to measure the prevalence of depression among people living with Type 2 Diabetes and to examine the factors linked with it. METHODS This community based, cross-sectional study was conducted among 278 people living with type 2 diabetes in Duhabi-Bhaluwa municipality, Nepal. A face to face interview was conducted using a pre-tested semi-structured questionnaire to gain information on socio-demographic characteristics and clinical profile of the participants. Depression was assessed using the Beck Depression Inventory (BDI-II) scale. Variables were categorical and were thus, compared with Pearson's chi-square tests and binary logistic regression models. RESULTS The prevalence of depression in this study was 22.7%. Most people indicative of having depression were of older age, females, below secondary level education, with a smaller family size, with low family income, using insulin, without a family history of diabetes and/or having an additional illness. However, multivariate analysis showed that the only significant factors for depression were older age, education below secondary level, homemaker, smaller family size, using insulin and having an additional illness. CONCLUSION The prevalence of depression in this study is consistent with that reported by other communities. Factors like older age, lower education level, being a homemaker, living in a small size family, insulin use and additional illness could increase the likelihood of developing Major Depressive disorder among people with type 2 diabetes, hence, psychosocial assessment is necessary along with diabetes management plan in a primary health care setting.
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Affiliation(s)
- Avinash K. Sunny
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Vijay K. Khanal
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ram B. Sah
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Anup Ghimire
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
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Demirtürk E, Hacıhasanoğlu Aşılar R. The effect of depression on adherence to antihypertensive medications in elderly individuals with hypertension. JOURNAL OF VASCULAR NURSING 2018; 36:129-139. [DOI: 10.1016/j.jvn.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 11/28/2022]
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Abstract
Hypertension and depression, as 2 major public health issues, are closely related. For patients having hypertension, in particular, depression is a risk factor for mortality and jeopardizes their wellbeing. The aim of the study is to apply support vector machine (SVM) learning to blood tests and vital signs to classify patients having hypertension complicated by depression and patients having hypertension alone for the identification of novel markers.Data on patients having both hypertension and depression (n = 147) and patients having hypertension alone (n = 147) were obtained from electronic medical records of admissions containing the records on blood tests and vital signs. Using SVM, we distinguished patients having both hypertension and depression from gender- and age-matched patients having hypertension alone.SVM-based classification achieved 73.5% accuracy by 10-fold cross-validation between patients having both hypertension and depression and those having hypertension alone. Twelve features were selected to compose the optimal feature sets, including body temperature (T), glucose (GLU), creatine kinase (CK), albumin (ALB), hydroxybutyrate dehydrogenase (HBDH), blood urea nitrogen (BUN), uric Acid (UA), creatinine (Crea), cholesterol (TC), total protein (TP), pulse (P), and respiration (R).SVM can be used to distinguish patients having both hypertension and depression from those having hypertension alone. A significant association was identified between depression and blood tests and vital signs. This approach can be helpful for clinical diagnosis of depression, but further studies are needed to verify the role of these candidate markers for depression diagnosis.
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Affiliation(s)
- Xiuli Song
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University Web Sciences Center Big Data Research Center, University of Electronic Science and Technology of China Information Center, West China Hospital, Sichuan University College of Foreign Languages and Cultures, Sichuan University, Chengdu, PR China
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Luitel NP, Baron EC, Kohrt BA, Komproe IH, Jordans MJD. Prevalence and correlates of depression and alcohol use disorder among adults attending primary health care services in Nepal: a cross sectional study. BMC Health Serv Res 2018; 18:215. [PMID: 29587724 PMCID: PMC5869789 DOI: 10.1186/s12913-018-3034-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/19/2018] [Indexed: 11/07/2022] Open
Abstract
Background Although depression and alcohol use disorder (AUD) are expected to be common among patients presenting to primary health care setting, there is limited research on prevalence of depression and AUD among people attending primary health care services in low-income countries. The aim of this study was to assess the prevalence of depression and AUD among adults attending primary care facilities in Nepal and explore factors associated with depression and AUD. Methods We conducted a population-based cross-sectional health facility survey with 1474 adults attending 10 primary healthcare facilities in Chitwan district, Nepal. The prevalence of depression and AUD was assessed with validated Nepali versions of the Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorder Identification Test (AUDIT). Results 16.8% of the study sample (females 19.6% and males 11.3%) met the threshold for depression and 7.3% (males 19.8% and females 1.1%) for AUD. The rates of depression was higher among females (RR = 1.48, P = 0.009), whereas rates of AUD was lower among females (RR = 0.49, P = 0.000). Rates of depression and AUD varied based on education, caste/ethnicity, occupations and family income. Conclusions In Nepal, one out of five women attending primary care services have depression and one out of five men have AUD. Primary care settings, therefore, are an important setting for detection and treatment initiation for these conditions. Given that “other” occupation is at increased risk for both conditions, it will be important to assure that treatments are feasible and effective for this high risk group.
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Affiliation(s)
- Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
| | - Emily C Baron
- Alan J. Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Brandon A Kohrt
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.,Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Ivan H Komproe
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands.,Research and Development Department, HealthNet TPO, Amsterdam, Netherlands
| | - Mark J D Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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25
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The Incidence of Depression among the Population of Central Kazakhstan and Its Relationship with Sociodemographic Characteristics. Behav Neurol 2017; 2017:2584187. [PMID: 29209102 PMCID: PMC5676366 DOI: 10.1155/2017/2584187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/31/2017] [Accepted: 10/01/2017] [Indexed: 11/29/2022] Open
Abstract
It has been established that the presence of depression is accompanied by an increased risk of morbidity and mortality in cerebrovascular and cardiovascular diseases and diabetes. The aim of this research was to estimate depressive symptom prevalence among the population in Central Kazakhstan and to define the relationship with social-demographic and behavioral factors. 1820 respondents of the population of Central Kazakhstan, aged 25 to 65, were performed. Participants included 777 urban and 1043 rural residents. Depressive symptoms assessed with the Patient Health Questionnaire (PHQ-9). The results showed that some degree of depressive symptoms was detected in 75.7% of the respondents. A minimal degree of depressive symptoms was observed in 28.51%, mild in 27.7%, moderate in 13.7%, and severe and very severe degree of depressive symptoms in 4.6% and 1.2%, respectively; the absence of depression symptoms was reported in 24.3% of the respondents. The study found a relationship between the prevalence of depressive symptoms and factors such as gender, education, income, presence of chronic diseases, and physical activity. We have not found a correlation between the frequencies of depressive symptoms with age, employment, character of labor, and marital status.
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Mahmood S, Hassan SZ, Tabraze M, Khan MO, Javed I, Ahmed A, Siddiqui OM, Narmeen M, Ahmed MJ, Tariq A, Patel MS, Fatima K. Prevalence and Predictors of Depression Amongst Hypertensive Individuals in Karachi, Pakistan. Cureus 2017; 9:e1397. [PMID: 28900587 PMCID: PMC5572043 DOI: 10.7759/cureus.1397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective While studies evaluating the prevalence of depression and hypertension have been extensively carried out in high income countries, there is a paucity of information assessing the prevalence of depression within hypertensive patients in low income nations. The primary objective of this study was to investigate the prevalence of undiagnosed depression in hypertensive patients within a tertiary care facility in Karachi, Pakistan. The secondary objective was to assess factors associated with undiagnosed depression in this group. Methods A cross-sectional study was conducted at the Civil Hospital Karachi Outpatient Department from January 2017 to April 2017. The sample population was composed of 411 hypertensive patients. Interviews were conducted after taking informed consent, with data concerning basic demographic details and lifestyle habits gathered. Blood pressure was recorded and its severity was classified as per the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines. Depression was evaluated and its severity classified as per the Patient Health Questionnaire-9 (PHQ-9) scale, with a score of 10 or above set as the cut-off point. Data were entered and analyzed using the IBM Statistical Package for the Social Sciences 23.0. (IBM, NY, USA) Results The prevalence of depression within 411 hypertensive patients was 40.1% (n = 165). The mean age of the sample was 45.7 ± 11.2 years, and the majority were females (72%, n = 295), unemployed (72%, n = 296), had primary or no education (67%, n = 277), and were of low socioeconomic status (78%, n = 321). The average systolic and diastolic blood pressures were 143.8 ± 21.7 and 93.3 ± 15.5 mm Hg, respectively. Factors which had a significant association with depression were gender (p = 0.009), age class (p = 0.035), educational status (p = 0.000), employment status (p = 0.003), socioeconomic status (p = 0.008), physical activity (p = 0.025), smoking (p = 0.017), and family history of hypertension (p = 0.022). Conclusion With such a high prevalence rate of undiagnosed depression within hypertensive patients, it is pertinent to establish screening programs for early detection and community programs to raise awareness regarding long-term complications of untreated depression.
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Affiliation(s)
- Samar Mahmood
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syeda Z Hassan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muqadus Tabraze
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad O Khan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Iqra Javed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ameer Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Omer M Siddiqui
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mehek Narmeen
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maham J Ahmed
- Department of Internal Medicine, Ziauddin University, Karachi, Pakistan
| | - Afreen Tariq
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mustafa S Patel
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Shamsi A, Nayeri ND, Esmaili M. Life experiences of patients before having hypertension: a qualitative study. Electron Physician 2017; 9:3925-3933. [PMID: 28461866 PMCID: PMC5407224 DOI: 10.19082/3925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/15/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Identification of causes of hypertension on the basis of the perspectives and experiences of patients is the key to success in health plans of these patients. The aim of this study was to describe the experiences of life before becoming hypertensive patients. Methods This qualitative study was conducted during August 2015 to April 2016. Twenty-seven hypertensive patients referred to hospitals affiliated to Tehran University of Medical Sciences were selected based on purposive sampling, and semi-structured in-depth interviews were conducted with them. The data were analyzed by the content analysis method and using qualitative data analysis software MAXqda 2011. Results Three main categories were extracted from data analysis. Patients experienced factors such as negligence and neglect, life stress, lack of healthy lifestyles and abuse awareness, spirituality abandonee in the main category of “personal experience,” factors such as family conflicts, heredity, inappropriate nutritional and life style in the main category of “family life,” and also factors such as job stress, economic problems, urbanization, chemical agents during the war in the main category of “social life.” Conclusions Based on the findings, patients before becoming hypertensive under the influence of their culture and beliefs had experienced many risk factors associated with hypertension. Comprehensive planning and appropriate to the cultural, social, and beliefs context about the prevention and correction of these factors is necessary.
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Affiliation(s)
- Afzal Shamsi
- M.SC. of Nursing Education, Ph.D. Student, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Ph.D. of Nursing Education, Professor, Nursing and Midwifery care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaili
- Ph.D. of Nursing Education, Assistant Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 2017; 389:951-963. [PMID: 28271846 PMCID: PMC5491333 DOI: 10.1016/s0140-6736(17)30402-6] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 11/30/2016] [Indexed: 12/11/2022]
Abstract
The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.
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Affiliation(s)
- Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA.
| | - Brandon A Kohrt
- Department of Psychiatry, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Africa Mental Health Foundation, Nairobi, Kenya
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK
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Lam MS, Fitzpatrick AL, Shrestha A, Karmacharya BM, Koju R, Rao D. Determining the Prevalence of and Risk Factors for Depressive Symptoms among Adults in Nepal. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2017; 2:18-26. [PMID: 30574570 DOI: 10.4103/jncd.jncd_34_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Context Nepal is currently experiencing a rapid growth in non-communicable diseases (NCDs). Depression has previously been associated with NCDs in South Asia; however, data regarding its prevalence and risk factors is lacking in Nepal. Aims This study aims to describe the prevalence of and risk factors for depressive symptoms in a suburban population of adults within Nepal. Setting and Design We conducted a cross-sectional analysis of baseline data collected from participants enrolled in the Dhulikhel Heart Study (DHS), a population-based, longitudinal cohort study investigating cardiovascular risk factors in Dhulikhel, a suburban town outside Kathmandu. Subjects and Methods Baseline questionnaire data from 1,073 adults age 18 years and older included the Center for Epidemiologic Studies Depression Scale (CESD). A score of 16 or greater on the CESD has been shown to indicate major depressive symptomatology. Statistical Analysis Using STATA 13 we conducted Pearson's chi-squared tests and multiple logistic regressions to examine associations between the binary CESD score and gender, age, education, marital status, body mass index (BMI), physical activity, and hypertensive status. Results The mean CESD score in the sample was 11.7 (SD: 5.3), with 21.3% scoring 16 or greater. Age over 60 and lack of formal education were associated with increased risk of depressive symptoms. Being physically active was associated with decreased risk of depressive symptoms. Conclusions The estimated prevalence of depression among adults in Dhulikhel was 21.3%. Significant risk factors for increased depressive symptoms included lack of formal education, age over 60, and physical inactivity.
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Affiliation(s)
- Michelle S Lam
- University of Washington, Department of Global Health.,University of Washington, Department of Medicine, School of Medicine
| | - Annette L Fitzpatrick
- University of Washington, Department of Global Health.,University of Washington, Department of Family Medicine.,University of Washington, Department of Epidemiology
| | - Archana Shrestha
- University of Washington, Department of Epidemiology.,Harvard University, T.H. Chan School of Public Health
| | - Biraj M Karmacharya
- University of Washington, Department of Global Health.,Dhulikhel Hospital - Kathmandu University School of Medical Sciences, Department of Community Medicine.,Dhulikhel Hospital - Kathmandu University School of Medical Sciences, Department of Community Programs
| | - Rajendra Koju
- University of Washington, Department of Global Health.,Dhulikhel Hospital - Kathmandu University School of Medical Sciences, Department of Cardiology
| | - Deepa Rao
- University of Washington, Department of Global Health.,University of Washington, Department of Psychiatry and Behavioral Sciences
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Kohrt BA, Bourey C. Culture and Comorbidity: Intimate Partner Violence as a Common Risk Factor for Maternal Mental Illness and Reproductive Health Problems among Former Child Soldiers in Nepal. Med Anthropol Q 2016; 30:515-535. [PMID: 27558762 PMCID: PMC5177473 DOI: 10.1111/maq.12336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/13/2016] [Accepted: 08/17/2016] [Indexed: 12/11/2022]
Abstract
Our objective was to elucidate how culture influences internal (psychological), external (social), institutional (structural), and health care (medical) processes, which, taken together, create differential risk of comorbidity across contexts. To develop a conceptual model, we conducted qualitative research with 13 female child soldiers in Nepal. Participants gave open-ended responses to intimate partner violence (IPV) vignettes (marital rape, emotional abuse, violence during pregnancy). Twelve participants (92%) endorsed personal responses (remaining silent, enduring violence, forgiving the husband). Twelve participants endorsed communication with one's husband. Only four participants (31%) sought family support, and three contacted police. Ultimately, 12 participants left the relationship, but the majority (nine) only left after the final IPV experience, which was preceded by prolonged psychological suffering and pregnancy endangerment. In conclusion, comorbidity risks are increased in cultural context that rely on individual or couples-only behavior, lack external social engagement, have weak law and justice institutions, and have limited health services.
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Kohrt BA, Luitel NP, Acharya P, Jordans MJD. Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal. BMC Psychiatry 2016; 16:58. [PMID: 26951403 PMCID: PMC4782581 DOI: 10.1186/s12888-016-0768-y] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/01/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite recognition of the burden of disease due to mood disorders in low- and middle-income countries, there is a lack of consensus on best practices for detecting depression. Self-report screening tools, such as the Patient Health Questionnaire (PHQ-9), require modification for low literacy populations and to assure cultural and clinical validity. An alternative approach is to employ idioms of distress that are locally salient, but these are not synonymous with psychiatric categories. Therefore, our objectives were to evaluate the validity of the PHQ-9, assess the added value of using idioms of distress, and develop an algorithm for depression detection in primary care. METHODS We conducted a transcultural translation of the PHQ-9 in Nepal using qualitative methods to achieve semantic, content, technical, and criterion equivalence. Researchers administered the Nepali PHQ-9 to randomly selected patients in a rural primary health care center. Trained psychosocial counselors administered a validated Nepali depression module of the Composite International Diagnostic Interview (CIDI) to validate the Nepali PHQ-9. Patients were also assessed for local idioms of distress including heart-mind problems (Nepali, manko samasya). RESULTS Among 125 primary care patients, 17 (14 %) were positive for a major depressive episode in the prior 2 weeks based on CIDI administration. With a Nepali PHQ-9 cutoff ≥ 10: sensitivity = 0.94, specificity = 0.80, positive predictive value (PPV) =0.42, negative predictive value (NPV) =0.99, positive likelihood ratio = 4.62, and negative likelihood ratio = 0.07. For heart-mind problems: sensitivity = 0.94, specificity = 0.27, PPV = 0.17, NPV = 0.97. With an algorithm comprising two screening questions (1. presence of heart-mind problems and 2. function impairment due to heart-mind problems) to determine who should receive the full PHQ-9, the number of patients requiring administration of the PHQ-9 could be reduced by 50 %, PHQ-9 false positives would be reduced by 18 %, and 88 % of patients with depression would be correctly identified. CONCLUSION Combining idioms of distress with a transculturally-translated depression screener increases efficiency and maintains accuracy for high levels of detection. The algorithm reduces the time needed for primary healthcare staff to verbally administer the tool for patients with limited literacy. The burden of false positives is comparable to rates in high-income countries and is a limitation for universal primary care screening.
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Affiliation(s)
- Brandon A. Kohrt
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar Kathmandu, G.P.O Box 8974/C.P.C. Box 612, Nepal ,Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar Kathmandu, G.P.O Box 8974/C.P.C. Box 612, Nepal
| | - Prakash Acharya
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, G.P.O Box 8974/C.P.C. Box 612, Nepal.
| | - Mark J. D. Jordans
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar Kathmandu, G.P.O Box 8974/C.P.C. Box 612, Nepal ,Center for Global Mental Health, Institute of Psychiatry, King’s College London, London, UK ,HealthnetTPO, Research Department, Amsterdam, The Netherlands
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Tilahune AB, Bekele G, Mekonnen N, Tamiru E. Prevalence of unrecognized depression and associated factors among patients attending medical outpatient department in Adare Hospital, Hawassa, Ethiopia. Neuropsychiatr Dis Treat 2016; 12:2723-2729. [PMID: 27822044 PMCID: PMC5087759 DOI: 10.2147/ndt.s118384] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Depression is an illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about him or herself and thinks about things. Depression is one of the most common mental disorders affecting 121 million people in the world, and it frequently goes unrecognized among patients. It is estimated that 5%-10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention. An institution-based cross-sectional study design was implemented to determine the magnitude and associated factors of unrecognized depression among patients attending the adult medical outpatient department in Adare Hospital, Hawassa, Southern Nations, Nationalities, and Peoples' Region, Ethiopia, among 326 patients selected using systematic random sampling technique. Data were collected using the interviewer-administered technique. A structured questionnaire was used to collect data on sociodemographic characteristics and other independent variables. Depression was assessed using the Patient Health Questionnaire 9. Data were entered and ana-lyzed using SPSS 20. The level of significance was determined at P<0.05. About 326 patients were interviewed, of whom 186 (57.1%) were males. The mean age of participant was 34 with standard deviation of ±13.1 years. Current substance users accounted for 106 (32.5%) of the total participants. Of 326 respondents, 80 (24.5%) had significant depressive symptoms, while the detection rate of depression by the clinician was 0%. Depression was associated with female sex (adjusted odds ratio [AOR] =1.63 [1.14-2.34]), age >60 years (AOR =4.14 [1.87-9.14]), being divorced (AOR =3.13 [1.70-5.76]), and having an average monthly income <750 ETB (AOR =1.92 [1.119-3.195]). The findings of this study revealed that the prevalence of depression among patients attending general medical outpatient department was highly underrecognized and unmanaged. On the basis of these results, we recommended that health-care providers perform a thorough assessment to address common mental disorders, especially depression, and suggest that training to recognize and manage depression appropriately be given.
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Affiliation(s)
- Asres Bedaso Tilahune
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Gezahegn Bekele
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Nibretie Mekonnen
- Department of Medical Case Team, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
| | - Eyerusalem Tamiru
- Department of Medical Case Team, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
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