AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2637-8892/240
1 Sidama Regional State Health Bureau
2 Pharma College
*Corresponding Author: Derese Desalegn Buta, Sidama Regional State Health Bureau.
Citation: Derese Desalegn Buta, Elsabet S. Hayesso, Meron Philipos. (2024), Magnitude and Associated Factors of Depression and Anxiety Among People with Hypertension in Hawassa City, Sidama Region, Ethiopia, Psychology and Mental Health Care, 8(1): DOI:10.31579/2637-8892/240
Copyright: © 2024, Derese Desalegn Buta. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 06 December 2023 | Accepted: 25 December 2023 | Published: 03 January 2024
Keywords: anxiety; associated factors; depression; Ethiopia; hypertension; hawassa city; magnitude and sidama regional state
Background: Anxiety and depression are common among patients with hypertension. However, they are still unrecognized and untreated especially in developing countries. Identifying factors associated with anxiety and depression is helpful for early screening and management. Presence of depression and anxiety among hypertensive patients lead to lack of adherence to treatment and poor compliance to lifestyle adjustments, which increase patient’s risk of morbidity and mortality.
Objectives: - To assess the magnitude and associated factors of depression and anxiety among people with hypertension in Hawassa city public hospitals, Sidama region, Ethiopia, 2022.
Method: A Hospital-based cross-sectional study was conducted in selected public Hospitals in Hawassa City Administration from April to August 2022. A total of 397 participants who have been followed hypertensive clinic were selected by systematic sampling. Depression and anxiety were assessed through Hospital Anxiety and Depression Scale. Pretested and structured questionnaire was used for data collection with face-to-face interview technique. Data were entered in to EPI info version 3.5.3 and exported to SPSS version 20 for further analysis. Descriptive statistics was used to explore the data in relation to relevant variables. Binary logistic regression analysis was employed. Odds ratio with 95% confidence intervals (CI) was computed to assess the magnitude of anxiety and depression among hypertensive patients attending public Hospitals in Hawassa city administration. Associations were determined by using AOR at 95% CI and p value less than or equal to 0.05.
Result – The prevalence of anxiety, depression and comorbid anxiety and depression were found to be 37.8%, 29.5% and 16.5% respectively. Factors found to have significant association with depression were being female gender, presence of comorbid illnesses and with long duration of hypertension. Factors found to have significant association with anxiety were being female sex, presence of comorbid illnesses and retired and non-paid job. Similarly being female gender, presence of chronic comorbid illnesses, family history of depression, ever alcohol drinking were associated with comorbid anxiety and depression.
Conclusion and Recommendation: - High prevalence of anxiety and depression were observed in Public Hospitals of Hawassa city administration. They are significantly associated with socio-demographic, clinical and behavioral factors. Clinicians and health sector leaders should consider mental health status of hypertensive patients.
Background: Today world is facing double burden of diseases, especially with increasing burden of non-communicable disease including cardiovascular diseases, cancer, chronic respiratory diseases and diabetes [1]. In 2016 non communicable diseases were estimated to account for 71% of the 57 million global deaths in addition to that 78% of all NCD deaths, and 85% of premature adult NCD deaths, occurred in low- and middle-income countries (LMICs) [2]. The burden of anxiety and depression among hypertensive patients are rapidly increasing. Anxiety and depression are common disorders that result in mental illnesses. Hypertensive patients suffering from anxiety and depression are at greater risk to develop cardiovascular diseases [3]. The total number of people living with anxiety and depression in the world are estimated to 322 million and 264 million, respectively [1]. Anxiety and depression are common in diabetic, hypertensive and heart failure patients than the general population [2].
Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. This raised blood pressure is one of the leading risk factors for different cardiovascular diseases. If left untreated hypertension contributes high financial burden, myocardial infarction, stroke, renal failure and burden to health systems [4].
The highest prevalence of hypertension was observed in the African Region at 46% of adults aged 25 and above [5]. In Ethiopia NCDs are estimated to account for 39% of all deaths, in 2016. Around 275,000 deaths were due to NCDs in 2015 and nearly 24% were adults 18 years and over expected to have raised blood pressure [1, 2].
Anxiety and depression have a direct relation with chronic illnesses [6, 7]. A meta-analysis study conducted reported that anxiety and depression were common among patients with chronic illness in both developed and developing countries [8]. By 2020, 5.7% increment were expected in the global burden of disease because of depression and by 2030 it become the leading cause of disability worldwide, reduce individual’s productivity at work or school performance and at severe stages it can lead to suicide [6].
Depression and anxiety can cause chronic stimulation of sympathetic nervous system that results in insulin resistance and affects the function of the heart and blood vessels [9]. Epidemiological studies suggest that relationship of psychological features, such as anxiety and depression and cardiovascular diseases may involve impaired regulation of the heart by autonomic nervous system [10].
There are different factors that influence depressive symptoms among patients with cardiovascular disorders. Both depressive symptoms and hypertension are psycho-physiologic phenomena [8]. The age, lack of social support, residence, educational level, sex and high numbers of prescribed medications were found as contributing factors for the development of depressive symptoms in hypertensive patients [10, 11].
Those with non-comorbid depressive disorder, non-comorbid anxiety disorder, and comorbid depression-anxiety were more likely to have hypertension compared to persons with neither a depressive nor an anxiety disorder [12].
1.2 statement of the problem
Hypertensive patients with chronic diseases are at higher risk to develop mental illnesses. Differently from general population, depression is more common among patients affected chronic illness (13). Having a chronic illness puts patients at higher risk of anxiety and depression [14]. A facility based cross-sectional study done in Ghana and Nigeria in 2013 revealed the prevalence of depression to be 41.7% and 26.6% respectively [32]. Another similar study done in Ethiopia showed the prevalence of depression to be 24.7% and anxiety 28.5% among hypertensive patients [34].
There were different factors known to affect the magnitude of anxiety, depression and comorbid anxiety and depression among hypertensive patients. A systematic review study done in Ethiopia showed that sex, age and duration of diseases were found to be contributing factors depression [17]. Also, there are other associated factors with anxiety and depression among hypertensive patients, such as low income, lack of social support, educational status and residence of the patients [11, 18, 19, 20, 21].
Anxiety and depression have various undesirable health significances in patients with chronic illnesses. Medication non adherence, rapid disease progression, interfere with a person’s ability to function day to day activities and poor quality of life as well as poor health outcomes were effects of untreated and unrecognized anxiety and depression [9, 10, 22].
The control of hypertension may insure on individuals being adherent to measure to reduce behavioral risk factors and drug treatment as prescribed [23]. Patient adherence with medical advice is one of the strategies in the management of chronic diseases, like hypertension that can be determined by Anxiety as well as depression [24, 25, 26].
Recognizing contributing factors of anxiety and depression in hypertensive patients is supportive for early identification of cases and management. Nonetheless, magnitude and factors associated with depression and anxiety in patients with hypertension are not evaluated sufficiently in developing countries including Ethiopia. Thus, current study was aimed to assess magnitude associated factors with anxiety and depression among patients attending hypertension follow up clinics in Hawassa city public Hospital, Sidama, Ethiopia.
1.3 Significance of the study
This research was expected to put a ground for the identification of the magnitude of anxiety, depression and comorbid anxiety-depression among hypertensive patients in the study area. And it also planned to determine contributing factors of depression and anxiety among hypertensive patients that will help to improve patient’s compliance to recommended proper lifestyle and adherence to anti-hypertensive treatment they are on, so that severity can be avoided. The findings of current study will also help hospitals and other similar institutes to better diagnose similar issues for furtherance in their process and also help as baseline information for future research. The study results will help to increase awareness among health care professionals for the early screening and treatment of this problem also.
1.4 Conceptual framework
Figure 1: Conceptual frame work on the determinants of depression and anxiety among hypertensive patients developed by researchers from different literatures [26, 27, 29, 32 33].
3.1 Study area
Hawassa is the administrative city of Sidama national regional state, which is located 275km away from Addis Ababa the capital city of Ethiopia. According to National census projection the total population of City for the year 2019/20 were 376,940 [12]. Out of the total population 192,239 (51%) females and 184,701 (49%) were males. There are one governmental comprehensive specialized Hospital, two general hospitals, one primary Hospital and six private primary hospitals those with hypertension follow up clinics in Hawassa City Administration. The City also has five health centers and 47 private clinics. The study was conducted in selected public Hospitals found in Hawassa City namely; Adare general hospital and Tula Primary Hospital.
3.2 Study design and period: A Facility based cross-sectional study was employed to assess the magnitude and associated factors of depression and anxiety among hypertensive patients attending public Hospitals in Hawassa city, Sidama region, Ethiopia. The study period was August 1 to August 30/2022
3.3 Source and study population:
The source population were all patients diagnosed to have high blood pressure who have been visiting hypertension follow up clinics of the public Hospitals of Hawassa city, Sidama region, Ethiopia, 2022. The study population includes all selected hypertensive patients who visited public Hospitals hypertension follow up clinics during the data collection period and included in this study.
3.4 Sample size calculation:
For the first and second objectives, sample size was determined using a single population proportion formula.
ni= ((
4.1 Description of the socio-economic and demographic
Total study sample were 397 of which 388 hypertensive patients were interviewed, which made response rate to be 97.8%. Out of the total respondents 209 (53.8%) were males. Mean age were 49.47 years (SD=11.46), with majority 131 (33.7%) were in the age group 48-57 years.
Regarding the educational status of respondents 53 (13.8%) were unable to read and write, while 90 (23.1%) attended primary education. More than two third 263 (67.8%) were married and nearly 384 (99%) were permanent resident of Hawassa City. The monthly median average income were 2500 birr (inter-quartile range of 1500 birr), one hundred thirty five (34.9%) were government employees.
| Variables | Frequency (n=388) | Percent (%) | |
| Sex | Male | 209 | 53.8 |
| Female | 179 | 46.2 | |
| Age | 18-27 years | 9 | 2.5 |
| 28-37 years | 52 | 13.5 | |
| 38- 47 years | 111 | 28.7 | |
| 48-57 years | 131 | 33.7 | |
| 58-67 years | 62 | 16 | |
| =>68 years | 22 | 5.7 | |
| Employment status | NG employee | 25 | 6.4 |
| Government employee | 135 | 34.9 | |
| Self employed | 28 | 7.1 | |
| Non – paid job | 14 | 3.7 | |
| Home maker | 50 | 13 | |
| Retired | 70 | 18.2 | |
| Unemployed (able to work) | 27 | 6.9 | |
| Unemployed (unable to work) | 38 | 9.8 | |
| Marital status | Married | 263 | 67.8 |
| Single | 29 | 7.6 | |
| Widowed | 27 | 6.9 | |
| Divorced | 69 | 17.7 | |
| Educational status | Unable to read and write | 53 | 13.8 |
| Primary education | 90 | 23.1 | |
| 2ry and preparatory education | 87 | 22.4 | |
| College and above | 158 | 40.8 | |
| Residence | Urban | 384 | 99 |
| Rural | 4 | 1 | |
| Monthly average income | <1> | 91 | 23.3 |
| 1,000-3,599 birr | 259 | 66.8 | |
| 3,600-10,799 birr | 27 | 6.9 | |
| =>10,800 birr | 11 | 2.9 | |
4.2 Clinical and individual characteristics of respondents
As it is shown in the table 4, at least one or more comorbid illnesses are presented in two fifth (41.3%) of the respondents and blood pressure is under control status in more than half (57.5%) of them. Duration of hypertension in 118 (30.5%) of the participants is greater than 10 years. Family history of hypertension and family history of depression reported by 50 (12.8%) and 76 (19.7%) of the respondents respectively. From all
the respondents 38 (9.8%) of them smoke cigarette at least once in their life and 16 (42.5%) of them are current smokers. In addition to this, 274 (70.5%) of the participants drink alcohol once in their life and 176 (64.5%) of them currently drink alcohol. About one tenth (14%) of the respondents do physical activity at leisure time or work (Table 4).
| Variables | Frequency (n=388) | Percent (%) | |
| Comorbid illness | Yes | 160 | 41.3 |
| No | 228 | 58.7 | |
| Blood pressure control | Yes | 223 | 57.5 |
| No | 165 | 42.5 | |
| Duration of hypertension | <5> | 125 | 32.2 |
| 5-10 years | 145 | 37.3 | |
| >10 years | 118 | 30.5 | |
| Family history of HTN | Yes | 50 | 12.8 |
| No | 338 | 87.2 | |
| Family Hx of depression | Yes | 76 | 19.7 |
| No | 312 | 80.3 | |
| Ever smoke | Yes | 38 | 9.8 |
| No | 350 | 90.2 | |
| Current smoke | Yes | 16 | 4.2 |
| No | 372 | 95.8 | |
| Ever alcohol | Yes | 274 | 70.5 |
| No | 114 | 29.5 | |
| Current alcohol | Yes | 176 | 45.5 |
| No | 212 | 54.5 | |
| Physical activity | Yes | 56 | 14.5 |
| No | 332 | 85.5 | |
Table 4: Description of clinical, behavioural and individual characteristics of hypertensive patients attending public hospitals in Hawassa, Sidama, Ethiopia, 2022
4.3 Prevalence of depression among hypertensive patients
The prevalence of depression among hypertensive patients found to be 37.8% (95% CI; 33.4-42.5%) with 24.6% of them were mildly depressed and 13.2% were markedly depressed.
Figure 3:- The prevalence of depression among hypertensive patients visiting selected public hospitals in Hawassa, Sidama, Ethiopia, 2022
4.4 Prevalence of anxiety among hypertensive patients
The prevalence of anxiety among hypertensive patients found to be 29.5% (95% CI; 24.8-33.9%) with 22.6% of them were mildly anxious and 6.9% were markedly anxious.
Figure 4:- The prevalence of anxiety among hypertensive patients visiting selected public hospitals in Hawassa, Sidama, Ethiopia, 2022 G.C
4.5 Prevalence of comorbid anxiety-depression among hypertensive patients
From total participants of the study 16.5% (95% CI; 13.3-19.9%) of them had comorbid anxiety and depression and 50.9% (95% CI; 45.9-55.8%) of the participants had either depression or anxiety. In addition to this, 43.5% of hypertensive patients with depression had comorbid anxiety and 55.8% of the hypertensive patients with anxiety had comorbid depression.
4.6 Factors associated with depression, anxiety and comorbid anxiety and depression among hypertensive patients
4.6.1 Factors associated with depression
Bivariate logistic regression analysis was done to examine the association of each independent variables with depression. Variables with P-value of less than 0.25 on bivariate logistic regression, sex, marital status, monthly income, presence of comorbid illnesses, blood pressure control, duration of hypertension, family history of depression and current alcohol drinking status were entered into multivariable logistic regression. In the final
model the strength of association was measured by AOR with 95% confidence interval and variables associated with depression with P-value <=0.05 considered as significantly associated.
As shown in table 5, in multivariable logistic regression analysis, females were 5.4 times more likely to have depression compared to males. Married subjects had 75% reduced odds of having depression compared to those who were single. Those who had comorbid illnesses were 3 times more likely to have depression when compared to those who have no any comorbid illnesses. And those with uncontrolled blood pressure were 2.8 times more likely to have depression when compared with those subjects who have controlled blood pressure. Participants with duration of hypertension 5 to 10 years are 3.2 times and more than 10 years are 5.8 times more likely to have depression compared to patients with less than 5 years of hypertension duration. Participants with family history of hypertension were 4.5 times more likely to have depression when compared to their counterparts. Currently alcohol drinker participants were 1.8 times more likely to have depression compared to those who were not alcohol drinkers currently.
| Variables | Depression n (%) | No Dep n (%) | COR (95% CI) | AOR (95% CI) | P- value |
Sex Male Female |
53(25.6) 93(52.1) |
156 (74.4) 86(47.9) |
1 3.17(2.09-4.81) |
1 5.37(3.08-9.35) |
0.000*** |
Marital status Married Divorced Widowed Single |
59(22.5) 25(36.1) 7(25) 12(41.9) |
204(77.5) 44(63.9) 20(75) 17(58.1) |
0.40(0.17-0.99) 0.78(0.47-1.38) 0.46(0.20-1.15) 1 |
0.25(0.08-0.78) 0.94(0.48-1.83) 0.42(0.12-1.41) 1 |
0.017* 0.860 0.159 |
Monthly average income <1> 1,000-3,599 birr 3,600-10,799 birr =>10,800 birr |
51(55.8) 77(29.8) 14(53.6) 5(41.7) |
40(44.2) 182(70.2) 13(46.4) 6(58.3) |
1.77(0.52-5.97) 0.59(0.18-1.93) 1.62(0.41-6.34) 1 |
0.80(0.17-3.80) 0.32(0.07-1.38) 0.57(0.10-3.24) 1 |
0.779 0.126 0.528
|
Comorbid illnesses Yes No |
84(52.4) 63(41.4) |
76(47.6) 165(58.6) |
2.88(1.90-4.37) 1 |
3.03(1.78-5.16) 1 |
0.000*** |
Blood pressure control Yes No |
57(25.6) 90(54.3) |
166(74.4) 75(45.7) |
1 3.45(2.27-5.25) |
1 2.80(1.65-4.75) |
0.000*** |
Duration of HTN >10 years 5-10 years <5> |
63(53.2) 60(41.4) 24(19.1) |
55(46.8) 85(58.6) 101(80.9) |
4.83(2.75-8.45) 3.00(1.75-5.16) 1 |
5.8(2.90-11.65) 3.17(1.61-6.23) 1 |
0.000*** 0.001*** |
Family Hx of depression Yes No |
50(66.3) 96(30.9) |
26(33.7) 216(69.1) |
4.39(2.61-7.38) 1 |
4.53(2.37-8.66) 1 |
0.000*** |
Current alcohol Yes No |
73(41.6) 74(34.7) |
103(58.4) 148(65.3) |
1.34(0.90-2.00) 1 |
1.77(1.02-3.07) 1 |
0.041* |
Table 5: Factors associated with depression among hypertensive patients attending public hospitals in Hawassa, Sidama, Ethiopia, 2022
4.6.2 Factors associated with anxiety
Bivariate logistic regression analysis was done to examine the association of each independent variable with anxiety. Variables with P-value of less than 0.25 on bivariate logistic regression, sex, employment status, monthly income, presence of comorbid illnesses, blood pressure control, duration of hypertension, family history of depression, current cigarette smoking, current alcohol drinking status and physical activity, were entered into multivariable logistic regression. In the final model the strength of association was measured by OR with 95% confidence interval and variables associated with anxiety with P-value <0>
As seen in table 6, in multivariable logistic regression analysis, female hypertensive subjects are 3.1 times more likely to have anxiety when compared with males. Those who are retired are 6.4 times and with non-paid job are 6.5 times more likely to have anxiety compared to subjects who work in non-governmental organization.
Participants with comorbid illnesses are 3.1 times more likely to have anxiety when compared with participants who have no comorbid illnesses. Subjects with duration of hypertension 5 to 10 years were 2.7 times more likely to have anxiety compared to those with duration of hypertension less than 5 years. And participants with duration of hypertension more than 10 years were 4.9 times more likely to have anxiety compared to those with duration of hypertension less than 5 years. Those participants who drink alcohol currently were 2.2 times more likely to have anxiety compared with their counterparts.
| Variables | Anxiety n (%) | No anxiety n (%) | COR (95% CI) | AOR (95% CI) | P- value |
Sex Male Female |
41(19.6) 73(41) |
168(80.4) 106(59) |
1 2.84(1.82-4.42) |
1 3.10(1.77-5.42) |
0.000*** |
Employment status Unemployed (unable to work) Unemployed (able to work) Retired Homemaker No paid job Self employed Government employee Non-governmental employee |
13(35) 1(3.6) 26(37.8) 16(32.1) 4(26.7) 9(31) 41(30.3) 4(15.4) |
25(65) 26(96.6) 44(62.2) 34(67.9) 10(73.3) 19(69) 94(69.7) 21(84.6) |
2.96(0.85-10.32) 0.20(0.02-1.96) 3.35(1.05-10.73) 2.60(0.77-8.72) 2.00(0.42-9.55) 2.48(0.66-9.31) 2.39(0.78-7.35) 1 |
1.62(0.40-6.61) 0.25(0.02-2.74) 6.35(1.73-23.32) 1.34(0.32-5.60) 6.54(1.18-36.41) 1.87(0.41-8.48) 2.71(0.78-9.47) 1 |
0.504 0.259 0.005** 0.693 0.032* 0.417 0.117 |
Monthly average income <1> 1,000-3,599 birr 3,600-10,799 birr =>10,800 birr |
37(41.1) 65(25) 10(35.7) 3(25) |
54(58.9) 194(75) 17(64.3) 8(75) |
2.09(0.53-8.22) 1.00(0.26-3.80) 1.67(0.37-6.71) 1 |
1.74(0.36-8.45) 1.06(0.24-4.72) 1.54(0.27-8.86) 1 |
0.494 0.943 0.630 |
Comorbid illnesses Yes No |
66(41.1) 49(21.3) |
94(58.9) 179(78.7) |
2.57(1.66-3.97) 1 |
3.13(1.79-5.47) 1 |
0.000*** |
Blood pressure control Yes No |
51(23.1) 63(38.2) |
172(72.9) 102(61.8) |
1 2.06(1.34-3.17) |
1 1.22(0.71-2.09) |
0.474 |
Duration of HTN >10 years 5-10 years <5> |
47(39.5) 45(30.9) 20(18.3) |
71(60.5) 100(69.1) 105(81.7) |
2.92(1.65-5.65) 2.00(1.14-3.50) 1 |
4.85(2.29-10.26) 2.71(1.35-5.43) 1 |
0.000*** 0.005** |
Family Hx of depression Yes No |
28(36.3) 87(27.8) |
48(63.7) 225(72.2) |
1.48(0.88-2.47) 1 |
1.79(0.95-3.39) 1 |
0.072 |
Current smoke Yes No |
0(0) 114(30.8) |
16(100) 258(69.2) |
0.00(0.00-) 1 |
0.00(0.00-) 1 |
0.998 |
Current alcohol Yes No |
59(33.5) 55(26.1) |
117(66.5) 157(73.9) |
1.42(0.93-2.19) 1 |
2.23(1.29-3.87) 1 |
0.004** |
Physical activity Yes No |
12(22) 102(30.7) |
44(78) 230(69.3) |
1 1.57(0.82-3.09) |
1 2.12(0.95-4.71) |
0.065 |
*Statistically significant at p-value<0 xss=removed xss=removed>Table 6: Factors associated with anxiety among hypertensive patients attending public hospitals in Hawassa, Sidama, Ethiopia, 2022
4.6.3 Factors associated with comorbid depression and anxiety
As described in table 9, bivariate logistic regression analysis was done to examine the association of each independent variable with comorbid depression and anxiety. Variables with P-value of less than 0.25 on bivariate logistic regression, sex, monthly income, presence of comorbidities illness, blood pressure control, duration of hypertension, family history of hypertension, family history of depression, current smoking and ever alcohol drinking status, were entered into multivariable logistic regression. In the final model the strength of association was measured by OR with 95% confidence interval and variables associated with comorbid depression and anxiety with P-value <0>
Accordingly female hypertensive patients were 9.9 times more likely to have comorbid depression and anxiety when compared with male hypertensive subjects. Subjects with comorbid illnesses were 2.4 times more likely to have comorbid depression and anxiety when compared with hypertensive patients who have no any comorbid illnesses.
Hypertensive patients with duration of hypertension more than 10 years were 5.2 times more likely to have comorbid depression and anxiety compared to participants with duration of hypertension less than 5 years.
Study subjects with family history of hypertension were 4.5 times more likely to have comorbid depression and anxiety when compare with subjects who have no family history of hypertension. Participants who ever drink alcohol were 3.3 times more likely to have comorbid depression and anxiety when compared to those participants with no lifetime alcohol drinking status.
| Variables | Comorbid A & D n (%) | No comorbid A & D n (%) | COR (95% CI) | AOR (95% CI) | P- value |
Sex Male Female |
11(5.5) 52(29.3) |
198(94.5) 127(70.7) |
1 7.13(3.68-13.8) |
1 9.88(4.44-21.96) |
0.000*** |
Monthly average income <1> 1,000-3,599 birr 3,600-10,799 birr =>10,800 birr |
30(23.6) 24(9.5) 8(28.6) 1 |
61(76.4) 235(90.5) 19(71.4) 1 |
1.45(0.37-5.75) 0.30(0.08-1.20) 1.20(0.26-5.61) 1 |
0.90(0.15-5.59) 0.26(0.05-1.56) 0.75(0.10-5.59) 1 |
0.911 0.142 0.776
|
Comorbid illnesses Yes No |
37(23.2) 27(11.7) |
123(76.8) 201(88.3) |
2.28(1.34-3.88) 1 |
2.35(1.18-4.70) 1 |
0.016* |
Blood pressure control Yes No |
21(9.4) 43(26) |
202(90.6) 122(74) |
1 3.39(1.95-5.90) |
1 1.89(0.92-3.89) |
0.082 |
Duration of HTN >10 years 5-10 years <5> |
32(27.4) 24(16.4) 8(6.1) |
86(72.6) 121(83.6) 117(93.9) |
5.81(2.57-8.15) 3.03(1.32-6.97) 1 |
5.21(2.01-9.49) 2.33(0.88-6.16) 1 |
0.001** 0.087 |
Family Hx of HTN Yes No |
4(7.7) 60(17.7) |
46(92.3) 278(82.3) |
0.39(0.13-1.11) 1 |
0.84(0.24-3.02) 1 |
0.794 |
Family Hx of depression Yes No |
25(32.5) 39(12.5) |
51(67.5) 273(87.5) |
3.36(1.90-5.95) 1 |
4.51(2.10-9.71) 1 |
0.000*** |
Ever alcohol Yes No |
52(18.8) 12(10.8) |
222(81.2) 102(89.2) |
1.91(0.99-3.64) 1 |
3.34(1.48-7.52) 1 |
0.004** |
Current smoking Yes No |
0(0) 64(17.2) |
16(100) 308(82.8) |
0.00(0.00-) 1 |
0.00(0.00-) 1 |
0.998 |
*Statistically significant at p-value<0 xss=removed xss=removed>
Table 7: Factors associated with comorbid anxiety and depression among hypertensive patients attending public hospitals in Hawassa, Sidama, Ethiopia, 2022
The current study was carried out to assess the magnitude and factors associated with depression and anxiety among hypertensive patients attending selected public hospitals in Hawassa city administration. The result revealed that the prevalence of depression among hypertensive patients to be 37.8%, and it is consistent with study result in Ghana 41.7% [32], Pakistan 40.1 [28] and India 41% [27].
In contrary to this finding, the current finding is lower than study in Afghanistan which was 58.1% [29]. The reason for the difference could be the health facilities set up of the countries. In opposite to this study, the lower prevalence of depression obtained from the study conducted in Jimma, Western Ethiopia, in 2019 found to be 24.7% [33]. Studies in Ghana and Nigeria found prevalence of depression to be 11% [26] and 26.6% [32] respectively. The difference might be due to geographical variations, readiness of health facilities and method of assessment of depression.
The prevalence of anxiety among hypertensive patients was found to be 29.5%, which is nearly consistent with study conducted in Menelik Hospital, in Ethiopia, in 2016, which was 28.5% of participants with hypertension to have anxiety (34). However, the finding of this study is smaller than a study in Afghanistan 42.3 %[29] and Saudi Arabia 38.4 %[31]. The difference could arise from cultural and environmental difference. In contrary to this study, the prevalence of anxiety among hypertensive patients in Ghana was found to be 57% [20]. The possible reason for these variations might be due to difference in instrument and the settings studies conducted [29].
The finding of this study showed that 16.5% of participants have comorbid depression and anxiety and half of subjects suffer from either anxiety or depression. High prevalence of comorbid anxiety and depression reported from a study in Afghanistan which is 28.2% [29], similarly a study in Saudi Arabia reported 29.5% to have comorbid anxiety and depression and prevalence of either of the disorders were 57.3% [31]. The above-mentioned reasons could explain the difference observed.
According to this study, hypertensive females have 5.4 times increased chance to be depressed. This is higher than a study finding from South Africa, which is 3.5 times [26] and much higher than study findings from Jimma Medical center, Western Ethiopia, a 2.6 times increased risk [33]. Similarly, majority of literature suggests the same findings [27, 28, 30, 31, 35]. Possible explanation for this variation might be socio-cultural variation. In addition to this, higher magnitude of depression in females could rise from changes in sex hormone and influences in females related to social norms and gender issues, which are parents restrictive behaviors towards their daughter than sons affects their daughters senses of self-control and self-esteem and make them vulnerable to depression. Sexual and domestic violence could also contribute for the higher risks in females [25].
With respect to marital status, married hypertensive patients have 75% reduced chance being depressed. The study in India, Bosnia and Herzegovina reported same findings [27, 35]. Differently from this, studies in Ethiopia, South Africa, Pakistan, Afghanistan and Ghana found that marital status of hypertensive patients have no association with their depression status [26, 27, 28, 29, 32]. The possible reason for this could be married hypertensive patients are being stable, sharing the increasing burden of living cost and retaining positive healthy behaviors.
The study finding revealed that hypertensive patients with comorbid illnesses are 3 times more likely to be depressed. Similar result was obtained from the study conducted in Afghanistan that hypertensive patients with comorbid diabetes were 22.7 times more likely to have depressed [29]. A possible reason could be that comorbid illnesses may increase the stress.
In respect to blood pressure control, the result showed that hypertensive patient with blood pressure is uncontrolled are 2.8 times more likely to be depressed. The finding of this study is consistent with a study in Saudi Arabia [30]. It could be because of poor adherence of hypertensive patients to their medications result in poor blood pressure.
Also this study examined that hypertensive patient with duration of hypertension 5 to 10 years and more than 10 years have 3.2 and 5.8 times increased chance of being depressed respectively. This finding is consistent with previous study conducted in Pakistan [27]. The reason might be that as time of being comorbid increase the worries also increase and the client might be depressed.
A family history of depression are 4.5 times more like to have depression. Similar finding was also obtained from the study conducted at Jimma, Western Ethiopia, hypertensive patients with family history of depression have 7 times higher chance of being depressed [33]. The reason might be that similarity in genetically factors.
The hypertensive patient who drink alcohol have 1.8 times increased chance of being depressed. This finding is similar with study findings in South Africa, which was 1.9 times higher chance of being depressed [25]. The possible reason for this could be influence of health effect, social problem, economic and productivity loss associated with alcohol increase the risk of depression and anxiety.
According to this study, female hypertensives are 3.1 times more likely to be anxious. This finding is comparable with study findings in Ethiopia and in South Africa, a 2.57 and 3.2 times higher chance of anxiety among female hypertensives respectively [26, 34]. In addition to this, study conducted in China, found significant association with occurrence and severity of anxiety among female hypertensives patients [21]. The possible explanation could be the higher burden for females, domestic and gender based violence could also contribute.
Also this study finding showed that study participants who are retired and non-paid job are more likely to be anxious. In contrary to this few studies showed no association of occupational status with hypertensive patient of being anxious were reported [21, 26]. The reason might be retired peoples are less interact with other peoples because of their limited movement which makes them unable to share their ideas and feelings that lead them to feeling of being isolated and ignored.
The findings of this study also shown that hypertensive patient with duration of hypertension 5 to 10 years and more than 10 years are 2.7 and 4.9 times more likely to be anxious respectively when compared to subjects with duration of hypertension less than 5 years. The result is in line with studies which studied that severity of anxiety increases with duration of hypertension when persists for more than 5 years [21]. The reason might be that due the increase of stress as time increases.
According to this study, female hypertensive patient were 9.9 times more likely to develop comorbid anxiety and depression. This is also supported with other studies’ result that female hypertensive subject had 12.5 higher odd of being comorbid anxious and depressed compared to male hypertensive subjects [26]. The above suggested reasons for anxiety and depression could explain the higher odd of females to have comorbid anxiety and depression.
With respect to comorbid illnesses, the study revealed that comorbid illnesses with hypertension to increase the probability of being comorbid anxious and depressed by 2.4 times. This is consistent with the study result obtained from Indian which reported hypertensive subject with comorbid diabetes are 10.2 times more likely to have comorbid anxiety and depression [29].
This study also reported that ever alcohol drinker hypertensive subjects are 3.3 times more likely to have comorbid anxiety and depression compared to their counter parts. The above predicted reason for depression and anxiety might attribute for the higher odds of comorbid anxiety and depression among subjects with comorbid illnesses.
Strength and Limitation of the study
Current study had numerous strengths. Among these, outcome variables (anxiety and depression) are assessed through validated tools (HADS), it was carried out in representative selected public hospitals. Likewise there were limitations of the study also. Due to its cross sectional nature of study it was difficult to known temporal relationship, there was possibility of recall bias and since the study was done in institutions, it might not be generalized to the general population with hypertension.
Conclusion
High prevalence of anxiety, depression and their correlate were observed in selected public hospitals of Hawassa city administration. Depression was significantly associated with female gender, being married, presence of comorbid illnesses, uncontrolled blood pressure, duration of hypertension 5 to 10 and more than 10 years, family history of depression and current alcohol drinking. On the other hand, anxiety was found to be significantly associated with the being female gender, presence of comorbid illnesses, duration of hypertension 5 to 10 and more than 10 years, current alcohol drinking, retired and hypertensive subjects with non-paid job. Comorbid anxiety and depression were also found to have significant association with the being female gender, presence of comorbid illnesses, duration of hypertension more than 10 years, family history of depression and drinking alcohol ever.
Recommendations: Based on the findings of the study the following recommendations are suggested:- Prepare trainings for health professionals to widen their understandings about high burden and determinant factors of anxiety and depression among hypertensives, provide hypertension clinics with anxiety and depression screening tool, educate hypertensive patients about depression and anxiety risks and modifiable factors like alcohol drinking. Providing depression and anxiety screening for those who are at more risk and link to a psychiatric clinic those who are in need. Need for psychiatric evaluation, counseling, and support services for hypertensive patients as an important component for the management of hypertension especially at advanced stage. Finally Researches and policy makers are needed to develop strategies for the prevention and control of psychological distress among patients with hypertension.
ALERT All African Tuberculosis and Leprosy Rehabilitation and Training Hospital
BSc Bachelor of Science
CDC Centers for Disease Control and Prevention
CSA Central Statistical Agency
COVID-19 Coronavirus Disease 2019
FMOH Federal Ministry of Health
HAD Hospital Anxiety and Depression Scale
HAD-A Hospital Anxiety and Depression Scale, Anxiety sub-scale
HAD-D Hospital Anxiety and Depression Scale, Depression sub-scale
HTN Hypertension
IRB Institutional Review Board
JNC Joint National Committee
LMICs Low and Middle Income Countries
NCD Non-Communicable Diseases
OR Odds Ratio
PHQ Patient Health Questionnaire
SD Standard Deviation
SPSS Statistical Package for Social Science
Ethical clearance and consent to participate
Ethical clearance: The research proposal of the current study was submitted and approved by Research Ethics Committee of Pharma College, School of Public Health. The institutional permissions were obtained from the Sidama Regional Health Bureau and study facilities. Similarly an informed consent was obtained from each respondents.
The datasets produced and/or analyzed throughout the current study are not openly accessible due to institutional regulation but are obtainable from the corresponding author for reasonable request.
All authors declare that they have no competing interests.
There was no financial support for the current study obtained from anywhere and the researchers tried to cover it accordingly.
MF- Elaborate in the initiation of the research question, prepared the research proposal, carried out the research, did the data entry and analysis
DD- Conducted edition, advising all steps proposal development and thesis writing, cooperatively prepared research tools and develop the manuscript.
ES- conducted edition, advising each steps of thesis writing.
All authors have read and approved the final manuscript.
We authors would like to thank the Pharma College, department of Health Science, School of graduate studies for approval of ethical clearance. We are also actual thankful for data collectors, supervisors and study participants.
Derese Desalegn Buta, Regional Health Bureau of Sidama Regional State and Phama College of Health Science,
Meron Filiphos and Elsabet Shudra are from Regional Health Bureau of Sidama Regional State.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
