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Original article
peer-reviewed

Prevalence and Predictors of Depression Amongst Hypertensive Individuals in Karachi, Pakistan



Abstract

Objective

While studies evaluating the prevalence of depression and hypertension have been extensively carried out in high income countries, there is a paucity of information assessing the prevalence of depression within hypertensive patients in low income nations. The primary objective of this study was to investigate the prevalence of undiagnosed depression in hypertensive patients within a tertiary care facility in Karachi, Pakistan. The secondary objective was to assess factors associated with undiagnosed depression in this group.

Methods

A cross-sectional study was conducted at the Civil Hospital Karachi Outpatient Department from January 2017 to April 2017. The sample population was composed of 411 hypertensive patients. Interviews were conducted after taking informed consent, with data concerning basic demographic details and lifestyle habits gathered. Blood pressure was recorded and its severity was classified as per the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines. Depression was evaluated and its severity classified as per the Patient Health Questionnaire-9 (PHQ-9) scale, with a score of 10 or above set as the cut-off point. Data were entered and analyzed using the IBM Statistical Package for the Social Sciences 23.0. (IBM, NY, USA)

Results

The prevalence of depression within 411 hypertensive patients was 40.1% (n = 165). The mean age of the sample was 45.7 ± 11.2 years, and the majority were females (72%, n = 295), unemployed (72%, n = 296), had primary or no education (67%, n = 277), and were of low socioeconomic status (78%, n = 321). The average systolic and diastolic blood pressures were 143.8 ± 21.7 and 93.3 ± 15.5 mm Hg, respectively. Factors which had a significant association with depression were gender (p = 0.009), age class (p = 0.035), educational status (p = 0.000), employment status (p = 0.003), socioeconomic status (p = 0.008), physical activity (p = 0.025), smoking (p = 0.017), and family history of hypertension (p = 0.022).

Conclusion

With such a high prevalence rate of undiagnosed depression within hypertensive patients, it is pertinent to establish screening programs for early detection and community programs to raise awareness regarding long-term complications of untreated depression.



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Original article
peer-reviewed

Prevalence and Predictors of Depression Amongst Hypertensive Individuals in Karachi, Pakistan


Author Information

Samar Mahmood Corresponding Author

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Syeda Z. Hassan

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Muqadus Tabraze

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mohammad O. Khan

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Iqra Javed

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Ameer Ahmed

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Omer M. Siddiqui

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mehek Narmeen

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Maham J. Ahmed

Department of Internal Medicine, Ziauddin University, Karachi, Pakistan

Afreen Tariq

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mustafa S. Patel

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Kaneez Fatima

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Original article
peer-reviewed

Prevalence and Predictors of Depression Amongst Hypertensive Individuals in Karachi, Pakistan


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Original article
peer-reviewed

Prevalence and Predictors of Depression Amongst Hypertensive Individuals in Karachi, Pakistan

  • Author Information
    Samar Mahmood Corresponding Author

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Syeda Z. Hassan

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Muqadus Tabraze

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Mohammad O. Khan

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Iqra Javed

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Ameer Ahmed

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Omer M. Siddiqui

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Mehek Narmeen

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Maham J. Ahmed

    Department of Internal Medicine, Ziauddin University, Karachi, Pakistan

    Afreen Tariq

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Mustafa S. Patel

    Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Kaneez Fatima

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: June 26, 2017

    DOI

    10.7759/cureus.1397

    Cite this article as:

    Mahmood S, Hassan S Z, Tabraze M, et al. (June 26, 2017) Prevalence and Predictors of Depression Amongst Hypertensive Individuals in Karachi, Pakistan. Cureus 9(6): e1397. doi:10.7759/cureus.1397

    Publication history

    Received by Cureus: June 12, 2017
    Peer review began: June 14, 2017
    Peer review concluded: June 15, 2017
    Published: June 26, 2017

    Copyright

    © Copyright 2017
    Mahmood et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective

While studies evaluating the prevalence of depression and hypertension have been extensively carried out in high income countries, there is a paucity of information assessing the prevalence of depression within hypertensive patients in low income nations. The primary objective of this study was to investigate the prevalence of undiagnosed depression in hypertensive patients within a tertiary care facility in Karachi, Pakistan. The secondary objective was to assess factors associated with undiagnosed depression in this group.

Methods

A cross-sectional study was conducted at the Civil Hospital Karachi Outpatient Department from January 2017 to April 2017. The sample population was composed of 411 hypertensive patients. Interviews were conducted after taking informed consent, with data concerning basic demographic details and lifestyle habits gathered. Blood pressure was recorded and its severity was classified as per the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines. Depression was evaluated and its severity classified as per the Patient Health Questionnaire-9 (PHQ-9) scale, with a score of 10 or above set as the cut-off point. Data were entered and analyzed using the IBM Statistical Package for the Social Sciences 23.0. (IBM, NY, USA)

Results

The prevalence of depression within 411 hypertensive patients was 40.1% (n = 165). The mean age of the sample was 45.7 ± 11.2 years, and the majority were females (72%, n = 295), unemployed (72%, n = 296), had primary or no education (67%, n = 277), and were of low socioeconomic status (78%, n = 321). The average systolic and diastolic blood pressures were 143.8 ± 21.7 and 93.3 ± 15.5 mm Hg, respectively. Factors which had a significant association with depression were gender (p = 0.009), age class (p = 0.035), educational status (p = 0.000), employment status (p = 0.003), socioeconomic status (p = 0.008), physical activity (p = 0.025), smoking (p = 0.017), and family history of hypertension (p = 0.022).

Conclusion

With such a high prevalence rate of undiagnosed depression within hypertensive patients, it is pertinent to establish screening programs for early detection and community programs to raise awareness regarding long-term complications of untreated depression.



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Samar Mahmood, Medical Student

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

For correspondence:
samarmahmood95@gmail.com

Syeda Z. Hassan

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Muqadus Tabraze

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mohammad O. Khan, Medical Student

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Iqra Javed

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Ameer Ahmed

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Omer M. Siddiqui

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mehek Narmeen

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Maham J. Ahmed

Department of Internal Medicine, Ziauddin University, Karachi, Pakistan

Afreen Tariq

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mustafa S. Patel

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Kaneez Fatima

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Samar Mahmood, Medical Student

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

For correspondence:
samarmahmood95@gmail.com

Syeda Z. Hassan

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Muqadus Tabraze

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mohammad O. Khan, Medical Student

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Iqra Javed

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Ameer Ahmed

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Omer M. Siddiqui

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mehek Narmeen

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Maham J. Ahmed

Department of Internal Medicine, Ziauddin University, Karachi, Pakistan

Afreen Tariq

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Mustafa S. Patel

Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

Kaneez Fatima

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan