Poor mental health and adverse psychosocial experiences and perceptions are associated with hypertension in cape town

Objective: To determine any differences in mental health (depression and anxiety traits) and poor psychosocial well-being by hypertension status, in adults at high-risk for diabetes. Design and method: In a population-based cross-sectional study, socio-demographic characteristics, lifestyle behaviours (cigarette smoking, alcohol misuse, physical inactivity), and mental health and psychosocial information were collected via administered questionnaires. Depression and anxiety traits were investigated using the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder (GAD-7) screening questions. Blood pressures (BP) were measured, and hypertension defined as systolic BP >=140 mmHg and/or diastolic BP >=90 mmHg, self-reported hypertension diagnosis or on antihypertension medication. Multivariable logistic regressions determined the associations with hypertension; the basic model comprised socio-demographic and lifestyle behaviours. Mental health and psychosocial variables were entered individually in separate models. Results: Among 678 participants, median age among those with (n=384) and without (n=290) hypertension was 54 vs. 49 years (p<0.001). Prevalence of depression scores >=10 (17.4% vs. 10.0%, p=0.004) and anxiety scores >=10 (11.7% vs. 8.2%, p=0.392) were higher in participants with than without hypertension but were only significant for depression. In the basic regression model, only increasing age was significantly associated with hypertension. Participants with depression score >=10 vs. <=4 were twice as likely to have hypertension (OR: 2.07, 95%CI: 1.23-3.46, p=0.006). Increasing anxiety scores were related to hypertension (OR: 1.05, 95%CI: 1.01-2.64, p=0.034). Poor psychosocial well-being, defined as 1) decreasing social support (OR: 1.03, 95%CI: 1.01-1.06, p=0.039), 2) physical health or emotional problems interfering with social activities all/most of the time (OR: 2.07, 95%CI: 1.02-4.17, p=0.043), 3) perception of worsening health (OR: 1.06, 95%CI: 1.02-1.11, p=0.002), and 4) a serious ongoing health problem (OR: 1.52, 95%CI: 1.01-2.30, p=0.048), was associated with hypertension in separate models. Quality of life and increasing number of adverse life events experienced were not significantly associated with hypertension. Conclusions: The high burden and associations of depression and anxiety traits, and poor psychosocial well-being with hypertension suggest a need for strategies to mitigate the effects of these conditions on hypertension.