Sage Journals: Discover world-class research

Abstract

Background

The presence of depression among hypertensive patients leads to a lack of adherence to treatment and poor compliance with lifestyle adjustments.

Objectives

To assess the magnitude and associated factors of depression among hypertensive patients attending hospitals in Arba Minch town, Gamo zone, south Ethiopia, 2024.

Methods

An institution-based cross-sectional study was employed from 1 May to 30 June 2024. The total sample size was 395. A systematic random sampling technique was used. Data was collected through face-to-face interviews. Data was entered into Epi Data version 3.1 and then exported to the SPSS version 25 statistical package for analysis. Logistic regression analysis tested the association between the independent and the outcome variables. Finally, a significant independent association was interpreted at a P-value of less than 0.05 with 95%CI.

Result

The magnitude of depression among hypertensive patients was 43.6% with 95% CI (38.2–48.7). Taking multiple antihypertensive medications [AOR: 2.19, 95%CI: 1.16–4.16], history of admission [AOR: 0.24, 95%CI: 0.12–0.46], blood pressure status [AOR: 0.07, 95%CI: 0.03–0.16], body mass index <18.5 kgm2 [AOR: 0.12, 95%CI: 0.02–0.83], 18.5–24.9 kgm2 [AOR: 0.14, 95%CI: 0.04–0.52], 25–29.9 kgm2 [AOR: 0.23, 95%CI: 0.06–0.91], family history of hypertension [AOR: 3.06, 95%CI: 1.27–7.37], family history of depression [AOR: 5.01, 95%CI: 2.02–12.43], ever alcohol drinker [AOR: 3.37, 95%CI: 1.32–8.58], and ever smoke cigarette [AOR: 3.44, 95%CI: 1.26–9.34] were associated with depression among hypertensive patients.

Conclusion

The number of antihypertensive medications, history of admission, blood pressure status, body mass index, family history of hypertension, family history of depression, ever alcohol drinker, and ever smoked cigarette were significantly associated with depression among hypertensive patients. Therefore, limiting the number of medications, controlling blood pressure, reducing body mass index, screening and treating family-related hypertension and depression, and abstinence from alcohol and smoking might reduce the burden of depression among hypertensive patients.

Keywords

Magnitude associated factors depression hypertensive patients Arba Minch town

Introduction

Raised blood pressure is one of the leading risk factors for global mortality. It is estimated to have caused 9.4 million deaths and 7% of the disease burden, as measured in disability-adjusted life years (Shanthi et al., 2014). In low-and middle-income nations, hypertension is on the rise. Hypertension and depression have a bidirectional link (Whooley & Wong, 2013).

Currently, depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Globally, around 350 million people are affected by depression with a 7% lifetime risk. By 2030, it is expected to be the leading cause of disability worldwide, reduce individual's productivity at work or school daily activities of life at severe stages, and can lead to suicide (WHO, 2017, Asmare et al., 2022).

Review of Literature

Depression is consistently higher in people affected by chronic diseases. Like patients with other chronic medical conditions, hypertensive patients experience many profound emotions which increase their risk for the development of mental health disorders, particularly depression (DeJean et al., 2013). Literature shows that the magnitude of depression among hypertensive patients is 26.8%, which is higher than the same year-supported study which estimated the global magnitude of depression to be around 4.4% (WHO, 2017).

In hypertensive patients, depression is associated with poorer health status, including lower quality of life (Rueda & Perez-Garcia, 2013), lower rate of treatment compliance (Moise et al., 2014), and even increased mortality (Oganov et al., 2015). People with depression suffer from a lack of occupational and social role function, and it is easier for hypertensive patients with depression further to develop depressive symptoms (Irene et al., 2014).

When uncontrolled blood pressure and poor adherence to antihypertensive medication are recognized among hypertensive patients, it is important to consider depression as a co-factor (Tigist et al., 2015; WHO, 2017). Unhealthy lifestyles such as intake of alcohol, smoking, unhealthy diet, and physical inactivity are associated with depression in patients at risk of cardiovascular disease in both genders (Bitew, 2014; FDRE Ministry of Health, 2016). In Ethiopia, the previous studies focused only on patients from public hospitals (Asmare et al., 2022; Nigusu et al., 2023); however, the current study included patients from private hospitals. Therefore, this study aimed to assess the magnitude and associated factors of depression among hypertensive patients attending hospitals in Arba Minch town, south Ethiopia. The findings of this study might lead clinicians and policymakers to develop strategies and go on to effective interventions for hypertensive patients with depression.

Methods and Materials

Study Area and Period

The study was conducted in Arbaminch town. Arbaminch town is the capital of the Gamo zone. It is located 505 km from the south of Addis Ababa and 115 Km from Wolaita Sodo, the center of the south Ethiopia regional state. The town is one of the lowlands in the south Ethiopia region having a hot climate with an average temperature of 29'0c and an annual mean rainfall of 900 mm. Arbaminch town has one General hospital, one primary hospital, and two public health centers. The study was conducted from 1 May 1 to 30 June 2024.

Study design: A hospital-based cross-sectional study design was employed.

Source population: All hypertensive patients attending public and private hospitals in Arba Minch town.

Study population: All hypertensive patients attending public and private hospitals in Arba Minch town during the data collection period.

Eligibility Criteria

All hypertensive patients attending public and private hospitals in Arba Minch town during the data collection period were included. However, hypertensive patients aged less than 18 years old, pregnant mothers having gestational hypertension, critically ill patients, and patients with severe psychiatric disorders who couldn't give correct information were excluded.

Sample Size Determination

The sample size was determined using the single population proportion formula. The assumptions used to calculate the sample size were a population proportion of depression of 0.371% (Nigusu et al., 2023), which was taken from the previous study with a 95% confidence level and a margin of error of 5%.

n = {(\frac{z α}{2})}^{2 \frac{p (1 - p)}{d^{2}}} = (1.96)^{2 \frac{(0.371) (0.629)}{{(0.05)}^{2}}} = 358.58 = 359

By considering a 10% non-response rate, the total sample size calculated using depression was 395.

Sampling Procedures

There are two public hospitals (Arba Minch General Hospital and Dilfana Primary Hospital) and one private hospital (Nechisar Hospital) in which hypertensive patients are attending in the town. Then, the 2 months (March and April 2024) attending a report of each hospital was determined, the 2-month report of Arba Minch General Hospital 982, Dilfana Primary Hospital 206, and Nechisar Hospital 168 patients. Next, the determined number was proportionally allocated according to the total sample size. Finally, the patients for interview in each hospital were selected by using a systematic random sampling technique based on the calculated constant value which was 1356/395 = 3, the constant value was 3 and the data collectors interviewed every constant three intervals on a daily bases in each hospital, and the first interview patient was identified by a lottery method (Figure 1).

Figure 1.

Schematic diagram showing sampling procedure of hypertensive patients attending hospitals of Arba Minch Town, South Ethiopia, 2024.

Study Variables

Dependent variable: Depression

Independent Variables

Sociodemographic and economic factors: gender, age, religion, educational status, occupational status, marital status, ethnicity, and residence.

Psychosocial and clinical factors: number of antihypertensive medications, duration of hypertension, history of admission, blood pressure status, body mass index (kgm2), family history of hypertension, family history of depression, and comorbid illness.

Behavioral-related factors: ever alcohol drinker, current alcohol drinker, ever cigarette smoker, current cigarette smoker, ever chat chewer, current chat chewer, and physical activity

Operational Definition

Hypertension: A rise in blood pressure when systolic blood pressure is ≥ 140 mm Hg and/or diastolic blood pressure is ≥ 90 mm Hg (Kroenke et al., 2001; WHO, 2013; Asmare et al., 2022).

Depression: It was measured using seven Hospital Depression Scale (HDS) questions, in which each question has four response options ranging from zero to three. Then, the sum of the individual response scores is expected to be zero to 21. Finally, it was recorded and dichotomized as yes (if the score is ≥ 8) or no (if the score is < 8) (Asmare et al., 2022).

Blood pressure status: Blood pressure was measured by the American Heart Association's guidelines for blood pressure assessment. It was categorized as controlled (when a systolic < 140 or diastolic < 90) or uncontrolled (when a systolic ≥ 140 or diastolic ≥ 90) (Kroenke et al., 2001; James et al., 2014; Asmare et al., 2022; Nigusu et al., 2023).

Physically active: Those who are doing moderate to vigorous activity at work or leisure time for at least 30 min, for 4 or more days a week (Halima et al., 2019; Asmare et al., 2022).

Smoking status: This is the habit of smoking cigarettes. It was a current smoker (when patients have smoked cigarettes in the past month) or ever smoker (when patients smoked at least once in their lifetime) (Asmare et al., 2022; Nigusu et al., 2023).

Drinking status: This is the habit of drinking alcoholic-containing drinks. It was current drinker (when the patients have drank alcohol-containing drinks in the past month) or ever drinker (when patients drink alcoholic-containing drinks at least once in their lifetime (Asmare et al., 2022; Nigusu et al., 2023).

Comorbid illness: Any of the following diseases in addition to hypertension: arthritis, HIV/AIDS, Leprosy, stroke, heart attack, heart disease, asthma, chronic lung disease (COPD or emphysema), chronic kidney disease, chronic liver disease, diabetes, thyroid disease, neurological problems (seizure, epilepsy, Parkinson's), and cancer (Asmare et al., 2022).

Data Collection Tool and Procedure

The tool was prepared in English and was structured questionnaires. Data was collected through face-to-face interviews of patients in the hospital by three clinical nurses and supervised by an experienced epidemiologist.

Data Quality Assurance

The tool was adopted from previously validated HDS formats prepared in English. HDS has seven questions. Based on the subject's response, the score for each of the questions in the sub-scales is summed up. In each of the sub-scales, the scores range from 0 to 21, and the items will have four points scale. The higher the score is the more severe the symptoms (Zigmond & Snaith, 1983; Reda, 2011; James et al., 2014; WHO, 2013; Nigusu et al., 2023). It was translated into Amharic for data collection. Data collectors and supervisors trained for 2 days on the objectives of the study, how to select study participants, how to keep the confidentiality of information, the contents of the questionnaire, how to interview and fill on data collection format, and data quality management by the investigator. A pre-test was done on 5% of the total sample size at Geresse Primary Hospital and modification was performed based on the pre-test paper. The supervisor conducted every other day follow-up during the whole period of data collection. Every day, after data collection, each questionnaire was reviewed and checked for completeness by the investigators. The necessary feedback was given to data collectors.

Data Processing and Analysis

Data was entered into Epi Data version 3.1 and then exported to the SPSS version 25 statistical package for analysis. Data cleaning was performed to check for missed values and then descriptive analysis such as proportions, percentages, tables, and graphs was used for presentation. Multi-co linearity was checked. To test the association between the independent and the outcome variable, logistic regression analysis was done. Goodness fittest was done using the Hosmer–Lemeshow model goodness fit test. Variables significant in bivariate analysis with a P-value less than 0.25 were entered in multivariable analysis to identify the independent association of independent variables with health maternal satisfaction with delivery service. Finally, a significant independent association was interpreted at a P-value of less than 0.05 with 95%CI.

Result

Sociodemographic Characteristics of Respondents

Among 395 hypertensive patients, 390 responded and that made the overall response rate 98.7%. The mean age of the participants was 48.76 with SD ± 13.957 years. More than of the respondents, 298 (76.4%), were males and 223 (57.2%) were in the age group 40–60 years old. Half, 252 (64.6%), were followers of the protestant religion and the educational status of 154 (39.5%) was grade 1–8^th. About 131 (33.6%) were governmental employee and 262 (67.2%) were married. The ethnicity of 322 (82.6%) was Gamo and the residence of 242 (62.1%) was urban (Table 1).

Table 1.

Sociodemographic Characteristics of Hypertensive Patients Attending Hospitals of Arba Minch Town, South Ethiopia, 2024.

Variables (n = 390)	Categories	Frequency	Percent
Gender	Male	298	76.4
Gender	Female	92	23.6
Age	20–39 years	101	25.9
	40–60 years	223	57.2
	61–84 years	66	16.9
Religion	Protestant	252	64.6
	Orthodox	94	24.1
	Muslim	27	6.9
	Others (Catholic, Adventist, Apostles)	17	4.4
Educational status	Unable to read and write	90	23.1
	Grade 1–8^th	154	39.5
	Grade 9–12^th	73	18.7
	Above grade 12^th	73	18.7
Occupational status	Governmental employee	131	33.6
	Merchant	114	29.2
	Self-employee	58	14.9
	Retired	59	15.1
	Private employee	28	7.2
Marital status	Married	262	67.2
	Single	82	21.0
	Widowed	27	6.9
	Divorced	19	4.9
Ethnicity	Gamo	322	82.6
	Zaise	35	9.0
	Gidicho	23	5.9
	Others (Wolaita, Amhara, Oromia)	10	2.6
Residence	Urban	242	62.1
Residence	Rural	148	37.9

Psychosocial and Clinical Characteristics of Respondents

More than half of the hypertensive patients, 231 (59.2%), are taking two or more medications. Additionally, the duration of hypertension for 325 (83.3%) participants was less than 10 years. About 203 (52.1%) had a history of admission and 243 (62.3%) patient's blood pressure was under control. The body mass index of 253 (64.9%) patients was within 18.5–24.9 kilogram per meter squire and 264 (67.7%) patients had no family history of hypertension and similarly 251 (64.4%) patients had no depression. The majority, 347 (89.0%), of the respondents had comorbid illnesses (Table 2).

Table 2.

Psychosocial and Clinical Characteristics of Hypertensive Patients Attending Hospitals of Arba Minch Town, South Ethiopia, 2024.

Variables (n = 390)	Category	Frequency	Percent
Number of antihypertensive medication	One	159	40.8
Number of antihypertensive medication	Two or more	231	59.2
Duration of hypertension	< 10 years	325	83.3
Duration of hypertension	≥ 10 years	65	16.7
History of admission	Yes	203	52.1
History of admission	No	187	47.9
Blood pressure status	Controlled	243	62.3
Blood pressure status	Uncontrolled	147	37.7
Body mass index (kg/m²)	<18.5	16	4.1
	18.5-24.9	253	64.9
	25–29.9	87	22.3
	≥ 30	34	8.7
Family history of hypertension	Yes	126	32.3
Family history of hypertension	No	264	67.7
Family history of depression	Yes	139	35.6
Family history of depression	No	251	64.4
Comorbid illness	Yes	347	89.0
Comorbid illness	No	43	11.0

Behavioral-Related Characteristics of Respondents

The majority of the respondents, 302 (77.4%), were not ever alcohol drinkers; however, only 49 (55.7%) were current alcohol drinkers. The majority, 331 (84.9%), of the respondents did not ever smoke cigarettes, but only 24 (40.7%) were current cigarette smokers. The majority, 309 (79.2%), of the respondents did not ever chew chat, but only 22 (40.7%) were current chat chewers. Most of the respondents, 356 (91.3%), practice physical exercise (Table 3).

Table 3.

Behavioral-Related Characteristics of Hypertensive Patients Attending Hospitals of Arba Minch Town, South Ethiopia, 2024.

Variables (n = 390)	Category	Frequency	Percent
Ever alcohol drinker	Yes	88	22.6
Ever alcohol drinker	No	302	77.4
Current alcohol drinker (n = 88)	Yes	49	55.7
Current alcohol drinker (n = 88)	No	39	44.3
Ever cigarette smoker	Yes	59	15.1
Ever cigarette smoker	No	331	84.9
Current cigarette smoker (n = 59)	Yes	24	40.7
Current cigarette smoker (n = 59)	No	35	59.3
Ever chat chewer	Yes	81	20.8
Ever chat chewer	No	309	79.2
Current chat chewer (n = 81)	Yes	22	27.2
Current chat chewer (n = 81)	No	59	72.8
Physical activity	Yes	356	91.3
Physical activity	No	34	8.7

Magnitude of Depression among Hypertensive Patients

Out of 390 hypertensive patients, 220 (56.4%) were not depressed. On the other hand, 170 (43.6%) were depressed (Figure 2).

Figure 2.

Magnitude of depression among hypertensive patients attending hospitals of Arba Minch town, South Ethiopia, 2024.

Factors Associated with Depression among Hypertensive Patients

In bivariable logistic regression analysis, age, educational status, occupational status, residence, number of antihypertensive medications, history of admission, blood pressure status, body mass index, family history of hypertension, family history of depression, comorbid illness, ever alcohol drinker, and ever smoke cigarette were associated with depression among hypertensive patients. Whereas, in multivariable logistic regression analysis, the number of antihypertensive medications [AOR: 2.19, 95%CI: 1.16–4.16], history of admission [AOR: 0.24, 95%CI: 0.12–0.46], blood pressure status [AOR: 0.07, 95%CI: 0.03–0.16], body mass index <18.5 kgm² [AOR: 0.12, 95%CI: 0.02–0.83], 18.5–24.9 kgm² [AOR: 0.14, 95%CI: 0.04–0.52], 25–29.9 kgm² [AOR: 0.23, 95%CI: 0.06–0.91], family history of hypertension [AOR: 3.06, 95%CI: 1.27–7.37], family history of depression [AOR: 5.01, 95%CI: 2.02–12.43], ever alcohol drinker [AOR: 3.37, 95%CI: 1.32–8.58], and ever smoke cigarette [AOR: 3.44, 95%CI: 1.26–9.34] were associated with depression among hypertensive patients (Table 4).

Table 4.

Factors Associated with Depression among Hypertensive Patients Attending Hospitals of Arba Minch Town, South Ethiopia, 2024.

Variables (n = 390)	Category	Depression		COR(95%CI)	AOR(95%CI)	P-value
Variables (n = 390)	Category	Yes	No	COR(95%CI)	AOR(95%CI)	P-value
Age	20-39 years	60(15.4%)	41(10.5%)	1	1
	40–60 years	115(29.5%)	108(27.7%)	1.46(0.76–2.81)	1.01(0.35–2.87)	0.989
	61–84 years	45(11.5%)	21(5.4%)	2.01(1.13–3.59)	1.16(0.46–2.89)	0.752
Educational status	Unable to read & write	39(10.0%)	51(13.1%)	1	1
	Grade 1–8^th	89(22.8%)	65(16.7%)	1.27(0.68–2.37)	2.38(0.67–8.48)	0.181
	Grade 9–12^th	56(14.4%)	17(4.4%)	0.71(0.41–1.24)	0.76(0.25–2.27)	0.621
	Above grade 12^th	36(9.2%)	37(9.5%)	0.29(0.15–0.60)	0.33(0.09–1.09)	0.069
Occupational status	Gove’tal employee	92(23.6%)	39(10.0%)	1	1
	Merchant	54(13.8%)	60(15.4%)	0.76(0.32–1.80)	0.53(0.16–1.76)	0.301
	Self-employee	21(5.4%)	37(9.5%)	2.00(0.85–4.71)	1.19(0.37–3.78)	0.770
	Retired	35(9.0%)	24(6.2%)	3.17(1.24–8.12)	1.74(0.48–6.27)	0.394
	Private employee	18(4.6%)	10(2.6%)	1.23(0.49–3.13)	0.76–0.18–3.19)	0.710
Residence	Urban	157(40.3%)	85(21.8%)	1	1
Residence	Rural	63(16.2%)	85(21.8%)	2.49(1.64–3.79)	1.56(0.73–3.34)	0.253
No antihypertensive medication	One	107(27.4%)	52(13.3%)	1	1
No antihypertensive medication	Two or more	113(29.0%)	118(30.3%)	2.15(1.41–3.27)	2.19(1.16–4.16)	0.016*
History of admission	Yes	92(23.6%)	111(28.5%)	0.38(0.25–0.58)	0.24(0.12–0.46)	0.000*
History of admission	No	128(32.8%)	59(47.9%)	1	1
Blood pressure status	Controlled	113(29.0%)	130(33.3%)	0.33(0.21–0.51)	0.07(0.03–0.16)	0.000*
Blood pressure status	Uncontrolled	107(27.4%)	40(10.3%)	1	1
Body mass index (kgm²)	<18.5	13(3.3%)	3(0.8%)	0.08(0.020.36)	0.12(0.02–0.83)	0.031*
	18.5–24.9	161(41.3%)	92(23.6%)	0.21(0.09–0.46)	0.14(0.04–0.52)	0.003*
	25–29.9	37(9.5%)	50(12.8%)	0.49(0.20–1.16)	0.23(0.06–0.91)	0.037*
	≥ 30	9(2.3%)	25(6.4%)	1	1
Family history of hypertension	Yes	98(25.1%)	28(7.2%)	9.33(5.66–15.38)	3.06(1.27–7.37)	0.013*
Family history of hypertension	No	72(18.5%)	192(49.2%)	1	1
Family history of depression	Yes	104(26.7%)	35(9.0%)	8.33(5.18–13.39)	5.01(2.02–12.43)	0.001*
Family history of depression	No	66(16.9%)	185(47.4%)	1	1
Comorbid illness	Yes	212(54.4%)	135(34.6%)	6.87(3.09–15.26)	2.46(0.79–7.58)	0.118
Comorbid illness	No	8(2.1%)	35(9.0%)	1	1
Ever alcohol drinker	Yes	62(15.9%)	26(6.7%)	4.28(2.56–7.17)	3.37(1.32–8.58)	0.011*
Ever alcohol drinker	No	108(27.7%)	194(49.7%)	1	1
Ever smoke cigarette	Yes	35(9.0%)	24(6.2%)	2.12(1.21–3.72)	3.44(1.26–9.34)	0.016*
Ever smoke cigarette	No	135(34.6%)	196(50.3%)	1	1

Hint: “*”= statistically significant at a P-value less than 0.05, “1”= reference group.

Discussion

The magnitude of depression among hypertensive patients was 43.6% with 95% CI (38.2–48.7). It was in line with a study done in Ghana 41.7% (Ademola et al., 2019), Pakistan 40.1% (Samar et al., 2017), Saudi Arabia 48.7% (Abdullah et al., 2017), Bosnia and Herzegovina 46% (Kosana et al., 2017), and India 41% (Vishnu & Sayujya, 2019). This might be due to similarities in study design and similar behavioral characteristics of respondents. However, it was higher than studies done in Hawassa, Southern Ethiopia, at 24.7% (Bereket et al., 2019), Ghana at 11% (Irene et al., 2014), Nigeria at 26.6% (Ademola et al., 2019), Ethiopia at 36.8% (Asmare et al., 2022), and 37.2% (Nigusu et al., 2023). The variation might be due to the differences in environmental factors, genetically related factors, sample size, method of assessment of depression, and data collection tool variation. However, it was lower than studies conducted in Afghanistan 58.1% (Mohammad et al., 2018), and Al-Mukarramah, Saudi Arabiya 66.7% (Ebtesam, 2014). This might be a result of the sociocultural and socio-economic characteristics of respondents.

In this study, several antihypertensive medication was significantly associated with depression among hypertensive patients. Hypertensive patients whose number of antihypertensive medications was two or more were 2.19 times more likely to be depressed compared to hypertensive patients whose number of antihypertensive medications was one. This might be due to the fear and psychological stress of taking more medications.

This study revealed that the history of admission was significantly associated with depression among hypertensive patients. Hypertensive patients who had a history of admission were 76% less likely to be depressed compared to hypertensive patients who did not have a history of admission. This might be due to reassurance and psychological coping of previous admission.

This study showed that blood pressure status was significantly associated with depression among hypertensive patients. Hypertensive patients whose blood pressure was controlled were 93% less likely to be depressed compared to hypertensive patients whose blood pressure was not controlled. This was supported by other studies that found hypertensive subjects whose blood pressure was uncontrolled were more likely to be depressed (Zhanzhan et al., 2015; Mohammad et al., 2018; Ashok & Ghosh, 2019; Bereket et al., 2019; Asmare et al., 2022). It could be because poor adherence of depressed subjects to their medications results in poor blood pressure. In another study, the odds of depression were 2.41 times greater in patients who had poor blood pressure control . As a result, hypertensive patients with uncontrolled hypertension should be given individual and socio-economic status-based supportive psychotherapy is essential.

This study indicated that body mass index was significantly associated with depression among hypertensive patients. Hypertensive patients whose body mass index <18.5 kgm² was 88%, body mass index 18.5–24.9 kgm² were 86%, and body mass index 25–29.9 kgm² were 77% less likely to be depressed compared to hypertensive patients whose body mass index was ≥ 30 kgm². This might be related to the absence of stress exerted by obesity.

In this study, a family history of hypertension was significantly associated with depression among hypertensive patients. Hypertensive patients who had a family history of hypertension were 3.06 times more likely to be depressed compared to hypertensive patients who did not have a family history of hypertension. In another study, it was stated that hypertensive patients with having family history of hypertension were more likely to have depression than the opponent group (Prathibha et al., 2017; Ashok & Ghosh, 2019; Nigusu et al., 2023). This relation might be due to chromosomal similarities among the families, familial lifestyle, and the habitual activity practiced in the family that predisposes them to hypertension.

In this study, a family history of depression was significantly associated with depression among hypertensive patients. Hypertensive patients who had a family history of depression were 5.01 times more likely to be depressed compared to hypertensive patients who did not have a family history of depression. This was stated in another study that hypertensive patients having a family of mental illness were more likely to have depression (Abdisa et al., 2022; Asmare et al., 2022). This relation might be due to the familial habitual activity practiced and living status in the family that dispose them to hypertension.

In this study, ever alcohol drinking was significantly associated with depression among hypertensive patients. Hypertensive patients who were ever alcohol drinkers were 3.37 times more likely to be depressed compared to hypertensive patients who were not ever alcohol drinkers. This finding is comparable with studies conducted in different parts of the world (Anna et al., 2014; Bitew, 2014; Vishnu & Sayujya, 2019; Asmare et al., 2022). This might be due to the influence of health effects, social problems, and economic and productivity loss related to alcohol increases the risk of depression.

In this study, ever cigarette smoking was significantly associated with depression among hypertensive patients. Hypertensive patients who were ever cigarette smokers were 3.44 times more likely to be depressed compared to hypertensive patients who were not ever cigarette smokers. This finding was supported by other studies that indicate the odds of depression are higher in substance users (Anna et al., 2014; Asmare et al., 2022). This might be due to the influence of health effects, social problems, and economic and productivity loss related to alcohol increases the risk of depression.

Implication for Practice

It is known that depression is common among hypertensive patients globally. The burden is high in developing countries including Ethiopia. Hypertensive patients follow their status in health facilities. Identifying the magnitude of depression and its associated factors among hypertension is imperative for healthcare stakeholders and healthcare policymakers to design strategies, and it gives clues for healthcare workers to detect and link to psychiatry clinics at an early stage and prevent further complications.

Conclusion

About four in 10 hypertensive patients attending hospitals in Arba Minch town had depression. Taking multiple antihypertensive medications, history of admission, blood pressure status, body mass index, family history of hypertension, family history of depression, ever alcohol drinker, and ever smoked cigarette were significantly associated with depression among hypertensive patients. Therefore, limiting the number of antihypertensive medications, controlling blood pressure, maintaining normal body mass index, screening family-related diseases, and abstaining from alcohol drinking and cigarette smoking might reduce the burden of depression among hypertensive patients.

Supplemental Material

sj-docx-1-son-10.1177_23779608251321148 - Supplemental material for Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town, South Ethiopia

Supplemental material, sj-docx-1-son-10.1177_23779608251321148 for Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town, South Ethiopia by Elias Ezo, Tamirat Takele, Taye Mezgebu, Asnakech Zekiwos, Sentayehu Admasu, Getachew Ossabo, Bethelhem Birhanu, Eldana Amare and Ayalnesh Mechal in SAGE Open Nursing

Supplemental Material

sj-docx-2-son-10.1177_23779608251321148 - Supplemental material for Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town, South Ethiopia

Supplemental material, sj-docx-2-son-10.1177_23779608251321148 for Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town, South Ethiopia by Elias Ezo, Tamirat Takele, Taye Mezgebu, Asnakech Zekiwos, Sentayehu Admasu, Getachew Ossabo, Bethelhem Birhanu, Eldana Amare and Ayalnesh Mechal in SAGE Open Nursing

Footnotes

Acknowledgment

We would really like to thank the study participants for their openness to participate kindly provision of the vital records, and scarification of their precious time.

Authors' Contribution

All authors made a full-size contribution to the work said, whether this is within the concept, have a look at layout, execution, acquisition of facts, evaluation, and interpretation, or all areas; took component in drafting, revising, and significantly reviewing the object; gave very last approval of the version to be published; have agreed at the magazine to which the item has been submitted; and agreed to be responsible for all factors of the paintings.

Data Availability

The data used for analysis are available on secure and affordable request.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Consideration

Institutional Research Ethical Review Committee of Paramed College, Arba Minch approved the proposal of this research (PC/AM/114/2016).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Informed Consent

Written informed consent was obtained from each participant before initiation of the study, as the information obtained from them would not have been disclosed to a third person and it was only for investigation purposes.

ORCID iDs

Elias Ezo

Taye Mezgebu

Asnakech Zekiwos

Sentayehu Admasu

Getachew Ossabo

Bethelhem Birhanu

Supplemental Material

Supplemental material for this article is available online.

References

Abdisa

Letta

Nigussie

(2022). Depression and anxiety among people with hypertension on follow-up in Eastern Ethiopia: A multi-center cross-sectional study. Frontiers in Psychiatry, 13, 853551. https://doi.org/10.3389/fpsyt.2022.853551

Abdullah

Mohamed

Areej

Wafaa

Mohammed

Abdulazeez

(2017). Depression and anxiety among hypertensive and diabetic primary health care patients. Saudi Medical Journal, 8, 621–628. https://doi.org/10.15537/smj.2017.6.17941

Ademola

Boima

Odusola

Agyekum Nwafor

C. E.

Salako

(2019). Prevalence and determinants of depression among patients with hypertension: A cross-sectional comparison study in Ghana and Nigeria. Nigerian Journal of Clinical Practice, 22(4), 8. https://doi.org/10.4103/njcp.njcp_351_18

Anna

Dan

J. S.

Soraya

David

(2014). The association between hypertension and depression and anxiety disorders: Results from a nationally-representative sample of South African adults. PLOS one, (5), 9. https;//doi.org/10.1371/journal.pone.0005552

Ashok

V. G.

Ghosh

S. S.

(2019). Prevalence of depression among hypertensive patients attending a rural health centre in Kanyakumari. National Journal of Community Medicine, 10(3), 172–175.

Asmare , et al. (2022). The magnitude and associated factors of depression among people with hypertension in Addis Ababa, Ethiopia: A hospital-based cross-sectional study. BMC Psychiatry, 22, 327. https://doi.org/10.1186/s12888-022-03972-6

Bereket

Bedilu

Mintesnot

(2019). The 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. Dove Press Journal, 13, 9. https://doi.org/10.2147/IBPC.S240015

Bitew

T. P.

(2014). Prevalence and risk factors of depression in Ethiopia: A review. Ethiopian Journal of Health Science, 24(2), 9. https://doi.org/10.4314/ejhs.v24i2.9

DeJean

Giacomini

Vanstone

Brundisini

(2013). Patient experiences of depression and anxiety with chronic disease: A systematic review and qualitative meta-synthesis. Health Quality Ontario, 13(16), 33.

10.

Ebtesam

B. A.

(2014). Depression among hypertensive patients at Al-Hejrah PHC center Makkah Al-Mukarramah, Saudi Arabiya. Valley International Journal, 1(9), 19.

11.

FDRE. (2016). National strategic plan for prevention and control of non-communicable disease in Ethiopia. FDRE Ministry of Health, 2014-2016.1–64.

12.

Halima

Alemayehu

Mengesha

Asmare

(2019). Determinants of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: A cross-sectional study. International Journal of the Mental Health System, 13(13), 12. https://doi.org/10.1186/s13033-019-0269-8

13.

Irene

Frances

Samuel

(2014). Mental health in hypertension: Assessing symptoms of anxiety, depression, and stress on anti-hypertensive medication adherence in Ghana. International Journal of the Mental Health System, 1–6.

14.

James

P. A.

Oparil

Carter

B. L.

Cushman

W. C.

Dennison Himmelfarb

Handler

(2014). Evidence-based guideline for the management of high blood pressure in adults.

15.

Kosana

Mirko

Jankovic

Ivana

(2017). Prevalence of depression in patients with hypertension in Bosnia and Herzegovina. International Journal of Medical and Health Research, 3(2), 6.

16.

Kroenke

Spitzer

R. L.

Williams

J. B.

(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

17.

Mohammad

Hideki

Susumu

Mohammad

Ahmad

, et al. (2018). Anxiety and depression among hypertensive outpatients in Afghanistan. International Journal of Hypertension, 2018, 8. https://doi.org/10.1155/2018/8560835

18.

Moise

Davidson

K. W.

Chaplin

(2014) Depression and clinical inertia in patients with uncontrolled hypertension. JAMA Internal Medicine, 174(2), 1–3. https://doi.org/10.1001/jamainternmed.2014.115

19.

Nigusu

Ermias

Abose

Ezo

Gebre

Mezgebu

(2023). Magnitude and severity of depression and associated factors among hypertensive patients attending follow-up treatment at public hospitals of Hadiya zone, Ethiopia. SAGE Open Nursing August, 24(9), 23779608231193744. https://doi.org/10.1177/23779608231193744. PMID: 37637867; PMCID: PMC10460206

20.

Oganov

R. G.

Pogosova

G. V.

Koltunov

I. E.

(2015). Depressive symptoms worsen cardiovascular prognosis and shorten the length of life in patients with arterial hypertension and ischemic heart disease. Kardiologiia, 51, 7.

21.

Prathibha

M. T.

Varghese

Jincy

(2017). Prevalence of depression among hypertensive individuals in urban Trivandrum: A cross-sectional study. International Journal of Community Medicine and Public Health, May 22, 4(6), 2156–2161. https://doi.org/10.18203/2394-6040.ijcmph20172194

22.

Reda

A. A.

(2011). Reliability and validity of the Ethiopian version of the hospital anxiety and depression scale (HADS) in HIV infected. PLOSone, 6(1), 6. https://doi.org/10.1371/journal.pone.0016049

23.

Rueda

Perez-Garcia

A. M.

(2013). Coping strategies, depressive symptoms and quality of life in hypertensive patients: Mediational and prospective relations. Psychology Health, 28, 18. https://doi.org/10.1080/08870446.2013.795223

24.

Samar

Syeda

Muqadus

Mohammad

Javed

Ameer

, et al. (2017). Prevalence and predictors of depression amongst hypertensive individuals in Karachi, Pakistan. Cureus, 12, 1–12. https://doi.org/10.7759/cureus.1397

25.

Shanthi

Tim

Douglas

Jeremy

Cecile

, et al. (2014). Global status report on non-communicable disease. World Health Organization.

26.

Tigist

Meaza

Yonas

(2015). Prevalence of disability and associated factors among registered leprosy patients in all Africa Tb and leprosy rehabilitation and training centre (ALERT), Addis Ababa, Ethiopia. Ethiopian Journal of Health Science, 25, 8. https://doi.org/10.4314/ejhs.v25i4.4

27.

Vishnu

Sayujya

(2019). Prevalence of depression among hypertensive patients attending a rural health center in Kanyakumari, India. Open Access Journal, 10(3), 4.

28.

WHO. (2013). A global brief on hypertension. World Health Organization.

29.

WHO. (2017). Depression and other common mental disorders. World Health Organization, WHO.

30.

Whooley

Wong

J. M.

(2013). Depression and cardiovascular disorders. Annual Review of Clinical Psychology, 9(1), 327–354. https://doi.org/10.1146/annurev-clinpsy-050212-185526

31.

Zigmond

A. S.

Snaith

R. P.

(1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 9. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town,South Ethiopia

Abstract

Background

Objectives

Methods

Result

Conclusion

Keywords

Introduction

Review of Literature

Methods and Materials

Study Area and Period

Eligibility Criteria

Sample Size Determination

Sampling Procedures

Study Variables

Independent Variables

Operational Definition

Data Collection Tool and Procedure

Data Quality Assurance

Data Processing and Analysis

Result

Sociodemographic Characteristics of Respondents

Psychosocial and Clinical Characteristics of Respondents

Behavioral-Related Characteristics of Respondents

Magnitude of Depression among Hypertensive Patients

Factors Associated with Depression among Hypertensive Patients

Discussion

Implication for Practice

Conclusion

Supplemental Material

sj-docx-1-son-10.1177_23779608251321148 - Supplemental material for Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town, South Ethiopia

Supplemental Material

sj-docx-2-son-10.1177_23779608251321148 - Supplemental material for Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town, South Ethiopia

Footnotes

Acknowledgment

Authors' Contribution

Data Availability

Declaration of Conflicting Interests

Ethical Consideration

Funding

Informed Consent

ORCID iDs

Supplemental Material

References

Supplementary Material