An overall 400 participants including 213 women (53.2%) and 187 men (46.8%), with a mean age of 55.1 ± 14.1 years old were included. The majority of the participants were married (95.8%) illiterate (34.7%), urban residences (80.5%) and employed (77%). Also, the participants had a median number of 3 children (0–11). The demographic characteristics of participants within each study group are summarized in Table 1; regarding the demographic characteristics, the study groups were significantly different in age (p < 0.05), gender (p < 0.05), marriage status (p < 0.05), children number (p < 0.05), education (p < 0.05), residence place (p < 0.05) and occupation (p < 0.05).
Table 1
The demographics of participants (n = 400)
| Study Groups | P-value |
Control (n = 100) | HF (n = 100) | HTN (n = 100) | CAD (n = 100) |
Age (years)* | 43.5 (13.0) | 62.8 (11.5) | 55.8 (12.3) | 58.3 (12.3) | 0.000≠ |
Sex ¥ |
| Male | 37 (37.0) | 66 (66.0) | 21 (21.0) | 63 (63.0) | 0.000∂ |
| Female | 63 (63.0) | 34 (34.0) | 79 (79.0) | 37 (37.0) |
Marriage Status ¥ |
| Married | 89 (89.0) | 100 (100) | 95 (95.0) | 99 (99.0) | 0.000∂ |
| Unmarried | 11 (11.0) | 0 | 5 (5.0) | 1 (1.0) |
Children (number) § | 2 (0–8) | 4 (1–11) | 3 (0–10) | 3 (0–9) | 0.000¤ |
Education ¥ |
| Illiterate | 13 (13.0) | 59 (59.0) | 31 (31.0) | 36 (36.0) | 0.000∂ |
| Middle School | 22 (22.0) | 35 (35.0) | 35 (35.0) | 34 (34.0) |
| Diploma | 24 (24.0) | 6 (6.0) | 15 (15.0) | 16 (16.0) |
| University Degree | 41 (41.0) | 0 | 19 (19.0) | 14 (14.0) |
Residence Place ¥ |
| Urban | 90 (90.0) | 61 (61.0) | 90 (90.0) | 81 (81.0) | 0.000∂ |
| Rural | 10 (10.0) | 39 (39.0) | 10 (10.0) | 19 (19.0) |
Occupation ¥ |
| Unemployed | 6 (6.0) | 28 (28.0) | 5 (5.0) | 7 (7.0) | 0.000∂ |
| Employee | 21 (21.0) | 0 | 11 (11.0) | 12 (12.0) |
| Businessman | 25 (25.0) | 34 (34.0) | 9 (9.0) | 29 (29.0) |
| Retired | 10 (10.0) | 6 (6.0) | 11 (11.0) | 19 (19.0) |
| Housekeeper | 38 (38.0) | 32 (32.0) | 64 (64.0) | 33 (33.0) |
*Data are presented as Mean (SD) ¥Data are presented as n (%) §Data are presented as Median (min-max) ≠Analysis of variance (ANOVA) ∂Fisher's exact test ¤Kruskal-Wallis test |
Following the findings in Table 2, the study groups were significantly different in sleep duration (p < 0.05) and sleep disorder (p < 0.05). While 70% of participants in the control group reported having an adequate daily sleep (defined as 6–8 hours of sleep), respectively 49%, 63%, and 62% of patients in HTN, CAD, and HF groups reported having an adequate daily sleep (Table 2). Although only 38% of participants in control were suffering from sleep disorder, the disorder was as frequents as 71% in HTN group, 43% in CAD group, and 57% in HF group (Table 2). In addition, the status of spontaneous crying was significantly different between the groups (p < 0.05), as 12% control participants, 53% HTN patients, 20% CAD patients, and 10% HF patients reported to have spontaneous crying (Table 2). In general, insufficient daily sleep, sleep disorder, and spontaneous crying were more common among HTN patients compared to other participants.
Table 2
The sleeping and crying status of participants (n = 400)
| Study Groups | P-value≠ |
Control (n = 100) | HF (n = 100) | HTN (n = 100) | CAD (n = 100) |
Sleep Duration (hour)* | |
| 6–8 | 70 (70.0) | 62 (62.0) | 49 (49.0) | 63 (63.0) | 0.035 |
| 3–6 | 28 (28.0) | 38 (38.0) | 48 (48.0) | 35 (35.0) |
| < 3 | 2 (2.0) | 0 | 3 (3.0) | 2 (2.0) |
Sleep Disorder* | 38 (38.0) | 57 (57.0) | 71 (71.0) | 43 (43.0) | 0.000 |
Spontaneous Crying* | 12 (12.0) | 10 (10.0) | 53 (53.0) | 20 (20.0) | 0.000 |
*Data are presented as N (%) ≠Fisher's exact test |
The individuals’ scores of depression, anxiety and stress were classified by the normative values contained in the DASS manual. Regarding the depression levels, the frequency of normal versus (vs) severe levels in control, HTN, CAD, and HF groups were 90% vs 1%, 43% vs 9%, 91% vs 1%, and 94% vs 2%, respectively. The prevalence of normal vs severe levels of anxiety in control, HTN, CAD, and HF groups were 86% vs 1%, 24% vs 44%, 85% vs 2%, and 92% vs 2%, respectively. Finally, the prevalence of normal vs severe levels of stress in control, HTN, CAD, and HF groups were 92% vs 2%, 54% vs 10%, 94% vs 1%, and 96% vs 2%, respectively (Table 3).
Table 3
The levels of depression, anxiety and stress in study groups (n = 400)
| Study Groups |
Control (n = 100) | HF (n = 100) | HTN (n = 100) | CAD (n = 100) |
Depression Level |
| Normal | 90 (90.0) | 94 (94.0) | 43 (43.0) | 91 (91.0) |
| Mild | 8 (8.0) | 4 (4.0) | 28 (28.0) | 5 (5.0) |
| Moderate | 1 (1.0) | 0 | 20 (20.0) | 3 (3.0) |
| Severe | 1 (1.0) | 0 | 7 (7.0) | 1 (1.0) |
| Very Severe | 0 | 2 (2.0) | 2 (2.0) | 0 |
Anxiety Level |
| Normal | 86 (86.0) | 92 (92.0) | 24 (24.0) | 85 (85.0) |
| Mild | 7 (7.0) | 2 (2.0) | 7 (7.0) | 6 (6.0) |
| Moderate | 6 (6.0) | 4 (4.0) | 25 (25.0) | 7 (7.0) |
| Severe | 1 (1.0) | 0 | 25 (25.0) | 1 (1.0) |
| Very Severe | 0 | 2 (2.0) | 19 (19.0) | 1 (1.0) |
Stress Level |
| Normal | 92 (92.0) | 96 (96.0) | 54 (54.0) | 94 (94.0) |
| Mild | 4 (4.0) | 2 (2.0) | 16 (16.0) | 1 (1.0) |
| Moderate | 2 (2.0) | 0 | 20 (20.0) | 4 (4.00 |
| Severe | 2 (2.0) | 2 (2.0) | 9 (9.0) | 1 (1.0) |
| Very Severe | 0 | 0 | 1 (1.0) | 0 |
Data are presented as N (%) |
The overall scores of depressions in study groups had an average of 4.6 in the control group, 9.1 in HTN group, 3.7 in CAD group, and 4.4 in HF group (Table 4, Fig. 1). The depression scores between the study groups were significantly different (p < 0.05, Table 4), as the depression scores of HTN patients were significantly higher than the control participants (p < 0.05), CAD patients (p < 0.05) and HF patients (p < 0.05); this is while the depression scores were not significantly different between other study groups (Table 5).
Table 4
The comparison of depression, anxiety and stress scores between study groups (n = 400)
| Study Groups | |
Control (n = 100) | HF (n = 100) | HTN (n = 100) | CAD (n = 100) | P-value≠ |
Depression Score* | 4.6 (4.0–5.4) | 4.4 (3.5–5.3) | 9.1 (7.8–10.5) | 3.7 (3.1–4.5) | 0.000 |
Anxiety Score* | 3.9 (3.3–4.6) | 3.6 (3.0–4.2) | 11.1 (9.6–12.8) | 4.1 (3.5–4.8) | 0.000 |
Stress Score* | 6.5 (5.5–7.6) | 5.4 (4.7–6.2) | 13.6 (12.2–15.1) | 5.2 (4.5–6.0) | 0.000 |
*Data are presented as Geometric Mean (95% Confidence Interval) ≠Adjusted for patients’ demographics, sleep duration, sleep disorder, spontaneous crying with analysis of covariance (after logarithmic transformation) |
Table 5
The post-hoc differences of depression, anxiety and stress scores among the study groups (n = 400)
Variable | Study Groups | MD (95% CI)¥ | P-value≠ |
Depression Score |
| HF vs Control | 0.5 (-1.7–2.7) | 0.935 |
| HTN vs Control | 5.7 (3.7–7.7) | 0.000 |
| CAD vs Control | 0.3 (-1.6–2.3) | 0.967 |
| HTN vs HF | 5.2 (3.1–7.3) | 0.000 |
| CAD vs HF | -0.1 (-2.0–1.7) | 0.997 |
| CAD vs HTN | -5.3 (-7.3 – -3.4) | 0.000 |
Anxiety Score |
| HF vs Control | 1.2 (-0.9–3.3) | 0.466 |
| HTN vs Control | 8.7 (6.8–10.6) | 0.000 |
| CAD vs Control | 1.5 (-0.4–3.4) | 0.171 |
| HTN vs HF | 7.5 (5.5–9.5) | 0.000 |
| CAD vs HF | 0.3 (-1.4–2.1) | 0.966 |
| CAD vs HTN | -7.2 (-9.0 – -5.3) | 0.000 |
Stress Score |
| HF vs Control | 1.6 (-0.9–4.1) | 0.362 |
| HTN vs Control | 7.9 (5.6–10.1) | 0.000 |
| CAD vs Control | 1.0 (-1.3–3.3) | 0.675 |
| HTN vs HF | 6.3 (3.8–8.7) | 0.000 |
| CAD vs HF | -0.6 (-2.7–1.5) | 0.888 |
| CAD vs HTN | -6.9 (-9.1 – -4.6) | 0.000 |
¥MD (95% CI): Mean Difference (95% Confidence Interval) ≠ The post-hoc Tukey test ≠The significant comparisons are reported only |
The estimations for scores of anxiety revealed overall averages of 3.9, 11.1, 4.1, and 3.6 for control, HTN, CAD, and HF groups, respectively (Table 4). The study groups were significantly different in anxiety score (p < 0.05, Table 4); the significant differences of anxiety scores were among the HTN patients vs the patients in other groups (all: p < 0.05, Table 5), as HTN patients showed higher anxiety scores than others.
Regarding the overall scores of stress in study groups, which was significantly different between the groups (p < 0.05), the overall averages of 6.5, 13.6, 5.2, and 5.4 were estimated for control, HTN CAD, and HF groups, respectively (Table 4). Similar to depression and anxiety scores, the stress scores of HTN patients were significantly higher than the ones in other groups (p < 0.05), while the other inter-groups scores were not significantly different (Table 5).