This study revealed the prevalence of depression among hypertensive patients to be 37.8%, the finding is in line with studies done in Ghana 41.7%(16), Pakistan 40.1%(24) and India 41%(25). On the other hand, the current finding is lower than a study conducted in Afghanistan, which found prevalence of depression among hypertensives to be 58.1% (26). As suggested by the researchers, the reason for higher magnitude could be the ongoing conflict in different parts of the country. Similarly, higher prevalence of depression observed in a study from Saudi Arabia 48.7%(27) and Bosnia and Herzegovina 46% (28). Ebtesam B found the highest prevalence of depression which is in two third (66.7%) of hypertensive subjects (29). On the contrary, lower prevalence observed in few studies a study in Hawassa, Southern Ethiopia (30), Ghana (31) and Nigeria (16). The variations might be due to difference in environmental factors, genetical factors, sample size, method of assessment of depression and data collection tool (14). Higher magnitude of depression in this study could be attributed to COVID-19 pandemic at the time of data collection (32).
According to this study, hypertensive females are at 5.4 times increased chance to be depressed. This is higher than a study in South Africa 3.5 times (33) and much higher than a study in Hawassa, Southern Ethiopia, 2.6 times increased risk (30). Similarly, majority of studies in the literature suggests the same findings (24, 25, 27–29). Sociocultural variation could be the reason for the difference. 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 is parents restrictive behavior towards their daughter than their 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 risk in females (34).
With respect to marital status, hypertensive subjects who were married have 75% reduced chance of being depressed. This finding is consistent with prior reports in the literature (25, 28). Differently from this, studies in Ethiopia (30), South Africa (33), Pakistan (24), Afghanistan (26) and Ghana (16) found no association. The reason for reduced risk of depression among married could be being settled, sharing the increasing burden of living cost and retaining positive health behaviors (35).
In terms of comorbid illnesses, our study revealed that hypertensive patients with comorbid illnesses are 3 times more likely to be depressed. An Afghanistanian study reported that hypertensive subjects with comorbid diabetes are 22.7 times more likely to have depression (26). Similar to this, Vishnu G and et al found higher magnitude of depression among hypertensives with comorbidities (25). A plausible explanation for that could be, the sadness and consistent hardship the comorbid illnesses bring together (7).
In respect to blood pressure control, this study also found that hypertensive subjects who had uncontrolled blood pressure are 2.8 times more likely to be depressed. This finding is in accordance with a study in Saudi Arabia (29). It could be because of poor adherence of depressed subjects to their medications resulting in poor blood pressure (7).
Regarding duration of hypertension, this study showed that those with increased duration of hypertension likelihood of being depressed increased. Subjects with duration of hypertension 5 to10 years and more than 10 years have 3.2 and 5.8 times increased chance of being depressed respectively. This finding is comparable to a previous study which was conducted in Pakistan (25). It is also supported by Kosana S et al report, depression is significantly more expressed in hypertensives with prolonged duration of the disease (28).
With respect to family history of depression, this study found that hypertensive participants with family history of depression are 4.5 times more likely to have depression. This association is demonstrated by a study in Hawassa, Southern Ethiopia, where hypertensive subjects with positive family history had 7 times higher chance of being depressed (30). Similarity in genetical factors could be the reason (14).
Besides, our study also showed that hypertensive subjects who drink alcohol have 1.8 times increased chance of being depressed. This finding is comparable with a study conducted in South Africa, with 1.9 times higher risk of being depressed (33). A review by Tesera B revealed higher odd of depression among substance abusers than their counterparts (34). The possible explanation could be influence of health effect, social problem, economic and productivity loss associated with alcohol increase the risk of depression (36).