FACTORS ASSOCIATED WITH DEPRESSION AND ANXIETY AMONG HYPERTENSIVE PATIENTS IN UMUGUMA SPECIALIST HOSPITAL, OWERRI, IMO STATE

ABSTRACT

Hypertension is a global challenge with high morbidity and mortality rates. Depression is a burdensome disease of global importance, and although prevalent, it is mostly undiagnosed in patients with hypertension. Anxiety is another significant cause of increased BP and is an independent predictor of future hypertension. The aim of this study is to find out the factors associated with depression and anxiety among hypertensive patients in Umuguma Specialist Hospital, Owerri, Imo State.Hospital based cross-sectional study was conducted at Umuguma Specialist Hospital, Owerri, Imo State. Systematic random sampling method was used to meet the criteria in this research to select a sample size of 334 respondents. Data were analyzed using SPSS version 21. The result shows that the prevalence of depression and anxiety among the hypertensive patients is 77.8%. Out of which 242 (72.5%) were both depressed and anxious, 74 (22.2%) were neither depressed nor anxious, 14 (4.2%) were anxious but not depressed while 4 (1.2%) were depressed but not anxious. Majority of the patients were from urban areas, married and were retired government employees having monthly income of 18,000-47,000 and more than 70% of them were depressed, anxious or both conditions. Mild to extremely severe depressive symptoms were present in 73.7%, anxiety in 76.6%, and stress in 31.1% of patients. Anxiety was common among 256 (76.6%) of the hypertensive patients. The study also showed that alcohol intake,  sleep quality, co-morbidity, social support and dieting habits had independent effects on the inci­dence of depression and anxiety in the patients (P = <0.001, 0.035, 0.006, 0.001 and <0.001, respectively). Factors such as use of snuff, smoking of cigarette, engaging in stressful activities and daily salt intake were found not have influence on the prevalence of depression and anxiety on hypertensive patients. Study findings highlight the need of psychiatric evaluation, counseling, and support services which will keep the heart of these patients in good condition. The study recommended that Clinical doc­tors should educate their patients, and control precipitating factors, even while admin­istering active antihypertensive medications and antidepressants to prevent disease progression and improve health-related quality of life.

CHAPTER ONE

INTRODUCTION

• BACKGROUND TO THE STUDY

Hypertension is a global challenge with high morbidity and mortality rates. The etiology of hypertension is multi-factorial, which results from the combined influence of genetic and environmental factors. It predisposes to coronary heart disease and cardiac dysfunction and has deleterious neurological effects on retina, central nervous system, and kidneys. The overall prevalence of raised blood pressure (BP) in adults aged 25 years and over was around 40% in 2008 (WHO, 2011). However, because of population growth and aging, the number of people with hypertension rises from 600 million in 1980 to 1 billion in 2008(WHO, 2011). It was seen that awareness of hypertension among those affected by the disease is generally high as compared to the general population. The WHO celebrates 17th May as “World Hypertension Day” and the main aim of this day is to provide awareness of hypertension so that we can prevent the complications arising out of high BP such as heart attack, heart failure, stroke, kidney failure, retinal hemorrhage, and atherosclerosis(DeJean D, Vanstone M, Brundisini F, Giacomini M, 2013). Besides, it is one of the modifiable risk factors as hypertensive patients also experience many profound emotions which increase their risk for the development of mental health disorders, particularly anxiety and depression (Vetere G, Ripaldi L, Ais E, Korob G, Kes M, Villamil A., 2007).

Depression is a burdensome disease of global importance, and although prevalent, it is mostly undiagnosed in patients with hypertension. The research evidence suggests that anxiety is another significant cause of increased BP and is an independent predictor of future hypertension (Sushil Kumar Sharma, Vineeta Sawhney, 2016).

Stress is among the psychologicalvariables that has long been listed among the potentialand important risk factors of hypertension and coronary heart disease. There is large variability of exposure andoutcomes in terms of stresses and the subsequent effects.Production of stress hormones, for example cortisol,may be triggered by normal physiological activitiesin humans. This may help prepare the individual sensingor involved in a stressful situation. However,prolonged activation of stress hormones can be harmful(Bernard Agyei, Mary Nicolaou, Linda Boateng, Henriette Dijkshoorn, Bert-Jan van den Born, Charles Agyemang, 2014).

Several studies have supported these underlying mechanismswhich may lead to sustained elevated blood pressure,but others do not. Furthermore, acute stressful eventshave no consistent association with hypertension. Chronicstress on the other hand, particularly the non-adaptive responseto stress, have been reported as more likely thecause of sustained elevation of blood pressure (Sparrenberger F, Cichelero FT, Ascoli AM, Fonseca FP, Weiss G, Berwanger O, Fuchs SC, Moreira LB, Fuchs FD, 2009).

Anxiety disorders are common and costly in older adults and thedetection and diagnosis of anxiety disorders in late life is complicatedby medical co morbidity, cognitive decline, and changes in lifecircumstances that do not face younger age groups. Furthermore, theexpression and report of anxiety symptoms may differ with age. Patients with chronic conditions like hypertension may experiencemany negative emotions which increase their risk for the developmentof mental health disorders particularly anxiety. Hypertension seemsto be more strongly related to anxiety. Patients with hypertensionmanifested symptoms of anxiety, depression and stress(Aberha M, Gebeyehu A, Ayano G, 2016).

Hypertension is a common health condition among Nigerian adults and many are dying as a result. Depression, anxiety and stress have been discovered in most hypertensive patients and it worsens their condition. The co-existence of these disorders is associated with barriers to treatment and poor medical outcomes. Therefore, accessing depression and anxiety among hypertensive patients has a pivotal role for further inventions.

1.2 STATEMENT OF THE PROBLEM

The burden of depression and anxiety among hypertensive patients is rapidly increasing. A hypertensive patient with depression and anxiety will experience a change in sleep patterns and excessive energy loss(James Tosin Akinlua, Richard Meakin, Aminu Mahmoud Umar, Nick Freemantle, 2015). People with this condition are not efficient in the work place thereby reducing the country’s labour force. It may also be difficult for patients with this condition to attend social gatherings. The presence of this condition increases the financial burden of the patient as he attempts to improve his health. It also increases the job description of the patient’s care giver. Hypertensive patients suffering from depression and anxiety are at a higher risk to develop cardiovascular disease(Norzila Zakaria, Azlin Baharudin, Rosdinom Razali, 2009). All medical professionals should take extra caution to prevent lethal complication by treating hypertension, depression and anxiety properly.

• OBJECTIVES OF THE STUDY

1.3.1 General Objective

The general objective of this study is to find out the factors associated with depression and anxiety among hypertensive patients.

1.3.2 Specific Objectives

In order to achieve the overall objective of the study, the following are the specific objectives of this study:

1. To find out the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.
2. To determine if the presence of non-modifiable factors e.g. age, sex, marital status and history of disease has influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.

• To determine if the presence ofmodifiable factors e.g. smoking, alcohol intake, use of snuff, stressful activities and dieting habits has influence on the prevalence of depressionand anxiety among hypertensive patients in Umuguma Specialist Hospital, Imo State.

1. To determine if socio-economic variables e.g. education level and income have influence on the prevalence of depressionand anxiety among hypertensive patients in Umuguma Specialist Hospital, Imo State.
2. To determine if the presence of a co-morbid disease e.g. diabetes is a causative to the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.

• RESEARCH QUESTIONS

1. What is the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State based on?
2. Do non-modifiable risk factors e.g. age, sex, marital status and history of disease have influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State?

• Do modifiable risk factors e.g. smoking, alcohol intake, use of snuff, stressful activities and dieting habits have influence on the prevalence of depressionand anxiety among hypertensive patients in Umuguma Specialist Hospital, Imo State?

1. Do socio-economic variables e.g. education level and income have influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State?
2. Does the presence of a co-morbid disease e.g. diabetes serve as a causative to the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State?

1.5 RESEARCH HYPOTHESES

1. Hypothesis 1: The presence ofnon-modifiable factors e.g. age, sex, marital status and history of disease has no significant influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.
2. Hypothesis 2: The presence ofnon-modifiable factors e.g. age, sex, marital status and history of disease has significant influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.

• Hypothesis 3: the presence of modifiable factors e.g. smoking, alcohol intake, use of snuff,stressful activities and dieting habits has no significant influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.

1. Hypothesis 4: the presence of modifiable factors e.g. smoking, alcohol intake, physical activities and dieting habits has significant influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.
2. Hypothesis 5: socio-economic variables e.g. education level and income haveno significant influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.
3. Hypothesis 6: socio-economic variables e.g. education level and income have significant influence on the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.

• Hypothesis 7: the presence of a co-morbid disease e.g. diabetes is not a causative to the prevalence of depressionand anxiety among hypertensive patients in Umuguma Specialist Hospital, Imo State.
• Hypothesis 8: the presence of a co-morbid disease e.g. diabetes isa causative to the prevalence of depression and anxietyamong hypertensive patients in Umuguma Specialist Hospital, Imo State.

1.6 SIGNIFICANCE OF THE STUDY

The findings of this study will contribute to the benefit of society considering that hypertension is the cause of many deaths every year. The presence of depression and anxiety worsens the condition of hypertensive patients as well as fastens their death. The co-existence of these conditions justifies the need for more awareness of the factors responsible for depression and anxiety among hypertensive patients and how to control them. Thus, the health facilities that apply the recommended approach will be guided on what should be emphasized by health care professionals to improve affected patients’ condition. For the researcher, the study will help her uncover factors responsible for the prevalence of depression and anxiety among hypertensive patients that many researchers were not able to explore. Thus, a new theory on controlling such factors may be arrived at.

1.7 SCOPE OF STUDY

The study will unveil the modifiable and non-modifiable factors, metabolic and co-morbidfactors responsible for the prevalence of depression among hypertensive patients in Umuguma Specialist Hospital, Imo State. The study will facilitate prevention and control of depression and anxiety among hypertensive patients. The study will be carried out on patients who are twenty years and above. These patients are those who visit the hospital regularly to manage their condition. These patients visit the hospital from nearby communities e.g. Obinze. This study will be completed by the end of the second semester of the 2016/2017 academic session.

1.8 OPERATIONAL DEFINITION OF TERMS

1. Factors: elements, circumstances, or influences which contribute to produce a result.
2. Depression: a period unhappiness or low morale which lasts longer than several weeks and may include ideation of self-inflicted injury or suicide.

• Prevalence: the total number of cases of a disease in a given statistical population at a given time, divided by the number of individuals in that population.

1. Hypertensive patients: patients with abnormally high blood pressure
2. Patient: a person who receives treatment from a doctor or other medically educated person.
3. Gender:The psychological experience of being male or female. The study wants to find out if there are gender differences in predisposition of hypertension among middle age adults. There are few literatures backing gender differences on development of high blood pressure. But few previous researchers had proposed that men are more predisposed to hypertension than women.

• Occupation:It means the economic trade of each participant. Most patients have various occupation or trade as a means of livelihood.
• Socio-Economic Status:It means the social economic strata in which the participants belong to. The present study will ascertain whether differences in socio-economic status will actually predict the predisposition of people to high blood pressure (hypertension).

1. Personality Type:A personality characteristics that appears to be important in influencing the health consequence of stress has been termed the type (A) personality while the reverse is type (B) personality.
2. Evasive Life Experience:Psychological significant events that occur in a person’s life. Major life events create stress because they required adjustment and coping. Interestingly, major events in our lives are often stressful whether they are positive or negative. Common negative life events that create stress for us include such things as business failure, lost of employment, automobile crash and the lost of a loved one.

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