MAGINITUDE AND ASSOCIATED FACTORS OF DEPRESSION AMONG HYPERTENSIVE PATIENTS ATTENDING TREATMENT FOLLOW UP IN CHRONIC OPD AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, HAWASSA, SOUTHERN ETHIOPIA

doi:10.21203/rs.2.11095/v1

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MAGINITUDE AND ASSOCIATED FACTORS OF DEPRESSION AMONG HYPERTENSIVE PATIENTS ATTENDING TREATMENT FOLLOW UP IN CHRONIC OPD AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, HAWASSA, SOUTHERN ETHIOPIA

https://doi.org/10.21203/rs.2.11095/v1

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ABSTRACT Objective: The aim of this study was to assess the magnitude and factors associated with depression among Hypertensive patients attending treatment follow up in chronic OPD at Hawassa University comprehensive Specialized Hospital (HUCSH) from March to May, 2019. Result: The magnitudes of depression among Hypertension (HPN) patients were found to be 73 (24.7%). The independent predictors were Sex 2.6(1.16, 5.83), Age 11.2(2.98, 42), educational status, Social support 2.55 (1.09, 5.94), family history of depression 7.12(1.48, 34.26), hypertension 7.57(2.67, 21.44) and medication adherence 11.6(4.23, 31.78). So, continuous health information dissemination at different level regard to factors affecting them should be given. Strengthen a referral linkage with psychiatric unit for psycho behavioral therapy will bring good clinical outcome. Besides, controlling hypertension was crucial to bring good clinical outcome. Key words: depression, magnitude, associate factor, patient health questionnaire (PHQ-9).

Psychiatry

depression

magnitude

associate factor

patient health questionnaire (PHQ-9)

Objective: The aim of this study was to assess the magnitude and factors associated with depression among Hypertensive patients attending treatment follow up in chronic OPD at Hawassa University comprehensive Specialized Hospital (HUCSH) from March to May, 2019.

Result: The magnitudes of depression among Hypertension (HPN) patients were found to be 73 (24.7%). The independent predictors were Sex 2.6(1.16, 5.83), Age 11.2(2.98, 42), educational status, Social support 2.55 (1.09, 5.94), family history of depression 7.12(1.48, 34.26), hypertension 7.57(2.67, 21.44) and medication adherence 11.6(4.23, 31.78). So, continuous health information dissemination at different level regard to factors affecting them should be given. Strengthen a referral linkage with psychiatric unit for psycho behavioral therapy will bring good clinical outcome. Besides, controlling hypertension was crucial to bring good clinical outcome.

Key words: depression, magnitude, associate factor, patient health questionnaire (PHQ-9).

Background

The World Health Organizations International Classification for Diseases and Related Disorders (ICD-10) describes the criteria for a depressive episode, where at least four items, such as unhappiness/sense of empty/depressed mood, exhaustion or energy loss, loss of interest in activities, lack of emotional reactions, sleep disturbance, motor retardation, loss of appetite, weight loss and loss of libido are present for a duration of two weeks [1]. Hypertension is elevated blood pressure of systolic, diastolic or both readings [2]. Depression affects 350 million people around the world with a lifetime risk of 7%. Depression is likely to cause a 5.7% increase in the global burden of disease by 2020 and is to become the leading cause of disability worldwide by the year 2030. Approximately one fourth of the adults were diagnosed with hypertension, and the proportion will reach about 1/3 by 2025 [3]. Similarly, hypertension is one of the leading causes of global mortality and disability. In 2010, it had been estimated that a 31.1% of the global population (1.39 billion) was hypertensive [4] Patients with depression and/or anxiety represent a particularly vulnerable population as they are at higher risk for developing hypertension. In addition, patients with co-morbid hypertension and mental health disorders are a higher-risk population for cardiovascular disease related mortality [5]. Depression and hypertension combined have a far more detrimental effect on health than individually and are reported to decrease the quality of life and cause an increased risk of myocardial infarction and stroke. Studies also suggest that the impact of co morbid depression on patients with hypertension may have a major bearing upon physical functioning, quality of life, and healthcare utilization [6]. It is well known that both hypertension and depression emerge from a complex interaction of social, biological, and behavioral factors [7]. So, this study aims to fill gap on magnitude of depression among hypertensive patient and their associated factors in the study area.

General objective

To assess magnitude and associated factors of depression among hypertensive patients attending treatment follow up in chronic Outpatient Department unit at Hawassa university comprehensive specialized hospital, Hawassa, Southern Ethiopia, 2019.

Specific objective

To determine magnitude of depression among hypertensive patients attending treatment follow up in chronic Outpatient Department unit at Hawassa university comprehensive specialized hospital, Hawassa, Southern Ethiopia, 2019.

To identify associated factors of depression among hypertensive patients attending treatment follow up in chronic Outpatient Department unit at Hawassa university comprehensive specialized hospital, Hawassa, Southern Ethiopia, 2019.

Study design

Institutional based cross sectional study was conducted.

Study Area and period

Hawassa University Comprehensive Specialized Hospital (HUCSH) is one of the teaching hospitals in Southern Ethiopia located at Hawassa town. This hospital serves more than 19 million of people. The study was conducted from March 20 to May 20, 2019

Population

Source population

Were all hypertensive patients attending treatment follow up in chronic Outpatient Department unit at HUCSH during data collection period.

The study population

Were sampled hypertensive patient attending treatment follow up in chronic Outpatient Department unit at HUCSH during data collection period.

Study Unit

Were individual Hypertensive patient who participated in the study.

Inclusion and Exclusion Criteria

Inclusion Criteria

All sampled Hypertensive patient whose age was 18 and above which can give informed consent was included.

Exclusion Criteria

Were sampled Hypertensive patient who were mentally ill and seriously ill during data collection period.

Sample size determination

The sample size was determined using a single population proportion formula. The p value from previous study shows the prevalence of depression in Northwest Ethiopia is 17.5% [8]. Taking margin of error (d) as 0.02 since p value is 17.5% to increase the sample size The study population (N) is about 332. So, Sample size = z² p (1-p)

           <sup>2</sup>  </p>

Sample size = 1.96² x 0.175(1-0.175)

           (0.02)<sup>2</sup></p>

ni=1386. Since the study population is < 10,000 we used population correction formula =

            = 1386x 332 /1386 + 332 = 268. </p>

Adding 10% Non répondent rates = Sample size X 10%

Non répondent =268 x

            = 27</p>

So, The Total sample size = 268+27= 295

Sampling technique

In Hawassa University Comprehensive Specialized Hospital; 332 patients were registered in the HPN registration book and sampling frame have been made from the list of patients who had been appointed for follow up during the study period. The 295 patients were selected consequently since patients visiting the health facility for follow up were random in nature. So, exit interview had done to collect data from patient while they visit the chronic outpatient clinic for follow up.

Variables

Dependent variable

Depression

Independent variable

Socio demographics: - like age, sex, educational status, marital status, Monthly income, occupation, family history of psychiatric illness, Social support

Behavioral factors:-alcohol intake, physical exercise, smoking, dietary intake and chat chew.

Disease and medication related factors: - Co-morbidity, medication adherence, HPN control, duration of illness, complication

Operational definition

No depression: Patient Health Questionnaire 9 score was 0 - 4

Depression: Patient Health Questionnaire 9 score was 5-27

Data collection and analysis

The initial English version of the questionnaire was translated into Amharic. Then it was back translated in English independently by language experts to maintain the equivalence of the test questionnaire in Amharic. The questionnaires have 4 parts. Socio demographic information, morisky medication adherence scale-8 and behavioral factors and disease and medication related factors were gathered from patients recorded data and own word.

Quality control

To assure the quality of the study finding, training for 4 data collectors and 2 supervisors had been given. Pre-test on 5% on “Adare General Hospital” was carried out . In addition to this, checking, editing, clearing the data and monitoring have done by supervisors.

Data processing and Analyzing

After checking collected data visually for completeness, the responses was cleaned, edited, coded and entered into the computer using Epic-data 3.1 version. The data was then exported to SPSS version 20.0. The data was checked for missed value before analysis. The descriptive analysis including frequency and cross tabs was used to assess frequency of variables with independent variables. Binary logistic regression was carried out to assess the association of dependent variable with independent variables and to determine predictors of poor adherence using odds ratios with 95% confidence interval. Finally forward stepwise logistic regression model with all independent variables having p value <0.05was fitted and adjusted odds ratio was calculated to identify independent predictors of poor adherence to medication among HPN patient.

Plan for dissemination

It was disseminate to Hawassa University CBE office of college of medicine and health science and to the school of Nursing. It was also disseminated to the Hawassa Compressive specialized Hospital.

Ethical consideration

The study was conducted after approval of ethical review committee of hawassa University College of medicine and health science. Permission to conduct the study was obtained from authorities at HUCSH. Written informed consent was obtained from each study participant by assuring privacy and confidentiality throughout the data collection period in the Hospital. An individual who was unwilling to participate from the beginning or at any part of the interview was allowed to withdraw. There was no risk or hazardous procedures putting the participants at harm.

Socio demographic characteristics

A total of 295 adult hypertensive patients were included in the study with a response rate of 100 %. Among them 189 (64.1%) were males (See table 1 below).

Magnitude of depression among hypertension

According to this study the magnitude of depression among HPN patients were found to be 73 (24.7%).

Socio demographic factors associated with depression

From the socio demographic variables affecting depression among hypertensive patient; sex, age, marital status, residence, educational status, occupation, social support and family history of depression were found to be associated in the binary logistic regression (BLR) (See table 1 below).

Behavioural characteristic and factors associated with depression

From the total of 295 hypertensive patient; 261(88.5%) didn’t smoke cigarette /tobacco and 275 (93.2%) didn’t do regular physical activity .From the behavioral factors that affect depression among hypertensive patient; drinking alcohol and smoking cigarette/ Tobacco were found to be associated in binary logistic regression (See table 2 below).

Disease and medication related characteristic and associated with depression

From the respondents; 212(71.6%) were found to be adhered to medication and their hypertension were also controlled.

In our study from disease and medication related characteristic and associated factors;those respondents having uncontrolled hypertension, not adhered to medication and those who stay with the disease longer than 20 years were found to be associated significantly in binary logistic regression. (See table 3 below).

Independent factors of depression

From 18 variables entered into BLR; 13 variables with p < 0.05 were entered into forward logistic regression. Then 8 variables were found to be independently associated .These were sex, marital status, educational status, social support, family history of depression, hypertension status and medication adherence.

In this study, the prevalence of depression was found to be 24.19 %. The finding was in line with the cross-sectional study done in Ebinet,North west Ethiopia (17.5%) [9], Nigeria (26.7%) [10] and Saudi Arabia (20.7%) [11] . In our study being female were two times more likely to be depressed than male. It is low when compared to that of study done in Saudi Arabia [12] and Nepal [13] in which females were four times more likely to develop depression. This might be due to sociocultural variation of the respondents

This study also indicated that increasing age is a predictor of depression among hypertensive patient. This study is also supported by 3 different studies done in Nepal [14, 15, 16]. This is an implication that the physiologic change in an individual patient with increased age makes to be depressed.

Concerning to marital status; our study indicated that those who had widowed/divorced were found to be much more likely depressed than when compared to married ones. Our study result also confirmed that those who didn’t had social support had found to be more depressed compared to those who responded that they had social support. This study result is higher than study done in public hospitals of eastern Ethiopia [17]. The difference could be the study participants involved in Harar hospitals were those admitted patients in a ward.

Regard to educational status, this study reveals that those illiterate and able to read and write were found to be depressed more likely than those having educational level above primary school. This study result were much high than the study done in china [18]. This is due to difference in economic level and difference to use cutoff point to diagnose depression.

Besides, this study had also showed that those who had family history of depression, not adhered respondents and those having uncontrolled hypertension were found to be seven ,seven and eleven times more likely depressed than those who had depressed respectively. It was higher than the study done at India in which those having family history of depression were AOR 95% CI 3.562 (1.972 – 6.585), not adhered to medication were AOR 95% CI 3.396 (1.809-6.375) and those having uncontrolled hypertension were AOR 95% CI 4.334 (2.377 – 7.904) [19] and this finding is low. This might be due to sociodemographic characteristic of the respondents. So, provision of continuous health information dissemination at different level and controlling those patients hypertension was crucial to bring good clinical outcome. Additionally, psycho behavioral therapy should be strengthened in a patients having familial history of depression.

The magnitude of depression among HPN patients was found to be high. The independent predictors were sex, age, marital status, educational status, social support, family history of depression, medication adherence and hypertension.

RECOMMENDATION:

So, continuous health information dissemination at different level regard to factors affecting them and controlling those patients hypertension was crucial to bring good clinical outcome. Besides, strengthen a referral linkage with psychiatric unit for psycho behavioral therapy will bring good clinical outcome.

LIMITATION

Recall bias may exist while the respondents respond the last two weeks situation while depression using PHQ -9 was assessed.

CBE: Community based education

HPN: Hypertension

HUCSH: Hawassa University Comprehensive Specialized Hospital

PHQ-9: patient health questionnaire with 9 item

WHO: World health organization

Ethics approval and consent to participate

Consent to publish

I am a corresponding author and first author of this finding.

Availability of data and materials

The data supporting the finding were avail in public repositories.

Competing interests

There is no competing interest.

Funding

No funding is required.

Author’s contribution

The author contributes for this study in analyzing the data gathered and preparing this manuscript.

Acknowledgement

First of all I would like to acknowledge Hawassa University College of medicine and health science Community based education office (CBE) for provision of an ethical clearance. I would also like to acknowledge Hawassa University comprehensive specialized Hospital for providing of permission for study to be conducted in chronic outpatient clinic. I also like to acknowledge Mr Anwar Assefa with his role as a data collector.

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2. NICE. 2011. Hypertension: Clinical management of primary hypertension in adults. London: National Institute for Health and Care Excellence. Available at: http://www.nice.org.uk/guidance/cg127/chapter/key-priorities-for-implementation

3. Li Z, Li Y, Chen L, Chen P, Hu Y. Prevalence of depression in patients with hypertension: A systematic review and meta- analysis. Medicine (Baltimore) 2015;94:e1317

4. Kumar C S, Vinod G Kulkarni. Prevalence of depression inpatients attending general medicine outpatient department for hypertension December 08,2018.

5. Mahmood S, Hassan SZ, Tabraze M, Khan MO, Javed I, Ahmed A, et al. Prevalence and predictors of depression amongst hypertensive individuals in Karachi, Pakistan. Cureus 2017; 9:e1397.

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7. WHO Depression. Geneva: World Health Organisation. 2012. doi: 10.1002/da.22048 PMID: 23281049.

8. WHO A global brief on hypertension. Geneva: World Health Organisation. 2013. doi: 10.1016/S0140-6736(13)60772-2 PMID: 23601936

9. Getasew Legas Molla , Haregwoin Mulat Sebhat , Zebiba Nasir Hussen , Amsalu Belete Mekonen, Wubalem Fekadu Mersha , and Tesfa Mekonen Yimer. Depression among Ethiopian Adults: Cross-Sectional Study, Psychiatry Journal 2016 , Article ID 1468120

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MAGINITUDE AND ASSOCIATED FACTORS OF DEPRESSION AMONG HYPERTENSIVE PATIENTS ATTENDING TREATMENT FOLLOW UP IN CHRONIC OPD AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, HAWASSA, SOUTHERN ETHIOPIA

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Abstract

Abstract

Introduction

Objective

Methods

Result

Discussion

Conclusion

Acronyms and Abbreviation

Declaration

References

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