Prevalence of perceived depression and anxiety among hypertensives attending imo specialist hospital owerri, Nigeria

Background: Depression is a burdensome disease of global importance, and although prevalent, it is mostly undiagnosed in patients with hypertension. Anxiety is another signifi cant factor associated with increased Blood Pressure and is an independent predictor of future hypertension. The aim of this study was to determine the prevalence of depression and anxiety among hypertensive’s attending Imo Specialist Hospital Owerri, Nigeria. Research Article Prevalence of perceived depression and anxiety among hypertensives attending imo specialist hospital owerri, Nigeria Chikere Ifeanyi Casmir Ebirim1*, Ugonma Winnie Dozie1, Somtochukwu Mercy Orji1, Angela Juliet Uka-Okali2, Uchenna Launa Iwumune3, Queen KenechukwuDozie1, Leo clinton Chukwu4, Ekundayo Babajide Otuyelu5, Chidiebere Peter Echieh6, Uchenna Ewelike7, Emmanuel Adeyemi Odumeru8, Alvan Ifeanyi Okene9, Uchenna Francis Agu10 and Maureen Maduagwu11 1Department of Public Health, Federal University of Technology Owerri, Nigeria 2Federal Medical Centre, Umuahia, Abia State, Nigeria 3Rimma Hospital, No. 4 College road, Umudagu Mbieri, Owerri, Nigeria 4Department of Pharmacology, Chukwuemeka Odumegwu Ojukwu University, Awka Camps, Nigeria 5Edi International Hospital, 1 Coronation Drive, off Aideyan Avenue GRA, Benin City, Edo State, Nigeria 6Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar Nigeria 7National Health Insurance Scheme, Abuja, Nigeria 8Department of Medical Imaging Science, College of Medicine and Health Science, University of Rwanda, Remera, Kigali Campus, Rwanda 9Universal Basic Education (UBE), Ministry of Education, Port Harcourt, Rivers State, Nigeria 10Department of Human Physiology, College of Medicine, University of Nigeria Enugu Campus, Enugu State, Nigeria 11Health Services Department, Rivers State University, Port Harcourt, Nigeria Received: 08 January, 2020 Accepted: 04 August, 2020 Published: 05 August, 2020 *Corresponding author: Dr. Chikere Ifeanyi Casmir Ebirim, Senior Lecturer, Department of Public Health, Federal University of Technology, P.M.B 1526, Owerri, Nigeria, Tel: +2348038870206; E-mail:


Background to the study
Hypertension is a chronic disease with high morbidity and mortality rate. The etiology of hypertension is multi-factorial, which results from the combined infl uence 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 [1]. 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 [2]. People with this condition are not effi cient in the work place thereby reducing the country's labour force. It may also be diffi cult for patients with this condition to attend social gatherings. The presence of this condition increases the fi nancial 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 [3]. All medical professionals should take extra caution to prevent lethal complication by treating hypertension, depression and anxiety properly. Hypertensive patients experience many profound emotions which increase their risk for the development of mental health disorders, particularly anxiety and depression [4].
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 signifi cant cause of increased BP and is an independent predictor of future hypertension [5].
Depressive symptoms and syndromes are common in the medically ill, although they are frequently unrecognized and untreated. Hypertension is signifi cantly associated with symptoms of depression [6].
One of the known factors associated with poor compliance with antihypertensive medication was depression and scientifi c studies have examined the relation between them. However it has also been proposed that hypertension itself is a risk factor for depression. In Malaysia, neurotic depression (3.31%) is the most common psychiatric diagnosis and the prevalence of emotional disorders is 15.2%. This indicates clearly that hypertensive patients who are suffering from depressive illness are at a higher risk to develop cardiovascular disease.
All medical professionals should take extra caution to prevent lethal complication by treating hypertension and depression properly [3].
In one study on normotensive and mildly hypertensive patients, the perception of being hypertensive was associated with greater anxiety during clinic BP measurement [5]. Anxiety disorder is amongst the most common psychiatric disorders all over the world. Emerging evidence suggests that anxiety and the anxiety disorders, which have received relatively less attention in many patients, have co-morbid anxiety symptoms that are associated with increased severity of psychiatric illness, additive functional impairment and medical costs and also amplify symptoms of some medical illnesses and appear to worsen clinical outcomes. However, there is a remarkable lack of data from rigorously designed clinical trials to guide treatment decisions in patients with common medical illness [7].
Anxiety disorders are common and costly in older adults and the detection and diagnosis of anxiety disorders in late life is complicated by medical co-morbidity, cognitive decline, and changes in life circumstances that do not face younger age groups. Furthermore, the expression and report of anxiety symptoms may differ with age. For these reasons, anxiety disorders in late life may be even more likely to be under diagnosed than in younger age groups [8]. Patients with anxiety exhibit a higher likelihood of medication nonadherence on hypertension treatment and they may limit the feature of treatment option, worsen the prognosis of patients, increase death rate from the disease or the ability to enjoy life [9].
Research evidence suggests that anxiety is another signifi cant cause of increased BP and is an independent predictor of future hypertension. Similarly, stress is known to be signifi cantly correlated with hypertension and causes many cardiac problems. Natural reaction of the cardiovascular response to stress is the increase in heart rate [5].

Methodology
Hospital based cross-sectional study was conducted at Imo Specialist Hospital, Owerri, Nigeria. Imo Specialist Hospital, Owerri is a public general hospital located in Owerri West Local Federal and Imo State Housing estates. It borders Owerri at the Methods: A hospital based cross sectional study was undertaken, utilizing systematic random sampling method in the recruitment of 334 respondents. Depression and anxiety was determined using a standard tool known as depression, anxiety, and stress scale-21 (DASS-21). The questionnaire was administered to the respondents by the researcher after an informed consent was obtained. Data were analyzed using SPSS version 21.
Results: A total of 334 respondents were recruited for the study comprising 190 (56.9%) females and 144 (43.1%) males. The Overall prevalence of depression and anxiety among the hypertensive patients was 77.8%. The result indicated that among the hypertensive's, 242 (72.5%) had both conditions of depressed and anxious, 74 (22.2%) were neither depressed nor anxious, 14 (4.1%) were anxious but not depressed while 4 (1.2%) were depressed but not anxious.

Prevalence of depression and anxiety among hypertensive's
Depression and anxiety was determined using a standard tool known as depression, anxiety, and stress scale-21 (DASS-21). Information on depression and anxiety were retrieved, scored and categorized. The Overall prevalence of depression and anxiety among the hypertensive patients was 77.8% (33.5%) had extremely severe anxiety. This is shown in Table 2.

Discussion
A higher percentage of the participants were aged above 60 years old. This could imply that the older a person becomes the higher the risk of hypertension. This fi nding is not different from the report of the study conducted in Urban Nepal by [10], which also reported a higher number of age group 45 to 64 years 169(53%) as respondents in their study. This is also inline with another study conducted in India which reported that 58% of their participants aged between 55 -75 years [11]. This is true because aging is associated with worry and worsening heath condition. This fi nding corresponds to that of Zhanzhan, et al. (2015) on the prevalence of depression among hypertensive [12]. Majority of the respondents in the present study were females (56.9%). This is similar to the fi nding of Kulkarni  who reported a lower proportion of tertiary level of education among their respondents [13,5].
The fi ndings of this result indicated a high prevalence of 72.5% co-morbidity depression and anxiety among hypertensives. This fi nding is higher than 26.6 % reported by Ademola, et al. (2019) [13], in a similar Nigeria hospital setting.
It is also higher than 33.3% that reported by Prathibha, et al.
(2017) amongst individuals in urban Trivandrum India [14]. In another study in Indian tertiary health care 40% prevalence of depression among hypertensives was reported [11]. A study in Kingdom of Saudi Arabia indicated that depression and/or anxiety was found in 57.3% of respondents with hypertension and diabetes [15]. This fi nding is also higher than 58.1% and 42.3% prevalence reported comorbidity for depression and anxiety among hypertensives in Afghanistan City of Andkhoy [16]. The higher prevalence may be related to worries that come with having a chronic disease which includes fi nancial burden, disability lost days, low socio-economic status, worsening condition and also lack of adequate care experienced in this part of the country. Hopelessness due to economic situation in this geopolitical region, where majority of the residents take home meager salary after putting in adequate manpower in their places of work could also exacerbate the situation. Also the difference could also arise from varying instrument used.
Furthermore severe depression and anxiety was found in 39.6% and 50.6% of the participants respectively. In a similar study conducted in another geopolitical zone in Nigeria severe depression was found in 2.9 % of the hypertensives, while that of Ghana was 6.6% [13]. Nine percent severe depression was found in an Indian study [11], while 4.3% and 11.5% severity was reported for depression and anxiety in a study conducted in Saudi Arabia [15]. Also Severity of 4.0% was reported depression in a study conducted in Trivadrum India [14].

Conclusion
There is a high prevalence of depression and anxiety among hypertensive patients. This is worrisome because  counseling, and support services for hypertensives which will in-turn improve hypertension management in the society.

Ethics approval and consent to participate
Permission to conduct the study was gotten from School of Health Ethical Committee, Federal University of Technology Owerri. Also a permission letter was gotten from the Chief Medical Directors Imo State Specialist Hospital. Verbal consent was obtained from the participants after all necessary explanations were given; this was deemed appropriate because of the general literacy level of the residents. During the data collection observations and information gotten were handled with utmost confi dentiality.

Availability of data and material
The data used for this research was gotten from fi eld survey conducted by the researchers and can be made available on Request.