Introduction
Depression is one of the leading causes of various health problems in modern society. According to a recent report (1), depression will become the second most common health problem in the world because of the emerging lifestyle. The emerging technologies are changing the normal lifestyle and people are working extra hard to meet the new needs. Increasing cases of single-parenting, divorce, tough economic conditions, joblessness, and family pressure are likely going to increase levels of depression, especially among those aged 30 years or older. According to a recent study (2), the problem that medical practitioners face when dealing with depression is that most patients often ignore it. People rarely consider extreme stress as a medical condition that may require medical attention. If it is left unchecked, depression can lead to other serious health problems, besides disruptive the social and economic status of an individual. Studies have indicated that hypertension is often caused by depression (3). The studies show that both depression and hypertension share a common pathway, so it is possible for depression to lead to hypertension. Hypertension is also becoming common among adults. In Saudi Arabia alone, studies suggest that the prevalence of hypertension is 27% among those who are aged 30 years and above. In this paper, the focus is to determine the effect of hypertension on primary health care depressive patients.
Importance of the Research
According to a recent study (4), depression is known to cause a number of health-related problems, one of which is hypertension. As such, medical scholars have conducted wide studies on how depression leads to hypertension or causes other diseases. However, little attention has been given to how other health problems may cause depression. Depression and hypertension have a common path and as such, it is likely that hypertension may lead to depression. However, this is an approach of study that is yet to be given serious focus by scholars. Depression can be very disruptive not only on one’s health conditions but also in other spheres of life. Once one has been put on treatment, it is always necessary to take necessary precautions to ensure that other forces do not affect the recovery process. One of the studies (5) warns that hypertension may have a negative effect on primary healthcare depressive patients. It may slow the rate of recovery or even make the patients slide further into depression. It is necessary to determine the relationship between these two medical conditions to ensure that one does not hinder the management of the other. That is why this study was considered important.
Research Question
Primary health care depressive patients are often delicate and as such, it is necessary to find ways of eliminating other factors that may affect the healing process. That is why this research focuses on the relationship between hypertension and depression, with a special focus on how the former affects the latter. The following research question was developed to help in the process of collecting data.
Does comorbidity of hypertension and depression worsen the recovery rate?
Through this research question, it will be possible to determine if primary health care depressive patients who also have hypertension may have a problem in recovering at a normal rate.
Research Objectives
It is important to outline the objectives of the study that was used to assess whether the research project was a success. The following are the research objectives that were set for the research:
- To determine the correlation between the level of depression and level of control of hypertension;
- To evaluate the effect of depression on hypertension, satisfaction, lifestyle.
Methods
Literature Search Strategy
In this study, it was important to collect secondary data from reliable sources to help support data collected from primary sources. According to a recent report (6), it is always necessary to review the existing literature to avoid any possible duplication of already published information. Articles and books were retrieved from PubMed, EBSCO’s Medical Databases, MEDLINE, PsycINFO, and Cochrane Database of Systematic Reviews. Additional books and journals were available in the college library. These sources provided important information about what other scholars have found out in this field. It formed the basis for the study.
Primary Data Extraction
This was a case-control study that was conducted at all the Ministry of Health’s PHC clinics in AL Khobar city, in the Kingdom of Saudi Arabia. The study was conducted from March to April 2017. The study used 190 cases and 190 controls to help determine the relationship between depression and hypertension among primary health care depressive patients in the selected hospitals.
Findings and Discussion
Hypertension
According to a recent survey (7), it is predicted that about 1.56 billion people will be living with hypertension in the world by the end of the year 2025. The report states that one is considered to be suffering from hypertension if one’s blood pressure goes past 140 over 90 mmHg. Although most of the reports indicate that the problem is severe in developed countries such as the United States where about 75 million people have been diagnosed with the condition, one study (8) warns that the problem may be more serious in the developing nations of Africa, parts of Asia, and some countries in the Middle East. In most cases, hypertension goes for a very long time without the patient realizing that it is a condition that needs medical attention. The report shows that diseases related to hypertension such as cardiovascular diseases have become leading causes of death in many developed and developing countries around the world.
Dietary factors and one’s lifestyle are believed to be the primary causes of hypertension. Limited physical inactivity, excessive use of alcohol, regular use of tobacco, and regular intake of diets high in sodium are known to cause hypertension. Other factors such as age, race, size, and sex may also be considered risk factors. The problem is more common among the elderly than in the younger generation. African Americans are at a higher risk of developing the problem than Hispanic Americans. Those who are obese or overweight are at a greater risk of having high blood pressure than those of normal weight. Women are more prone to hypertension at an older age while men are more prone to hypertension at a younger age (9). Diabetes, depression, kidney disease, and Cushing syndrome are secondary causes of diabetes. Doctors are often keen on managing this health problem as soon as a diagnosis is made because of the devastating effect of related diseases if left unchecked.
Depression
Depression, which can be described as clinical depression or major depressive disorder, is defined in (9) as a serious mood disorder. Depression is known to disrupt the way one thinks, eats, sleep, works, or is related to people around them. It can be a mild condition such as baby blues that may last for about two months before clearing without any medication, or a more serious problem such as perinatal depression or persistent depressive disorder that can last for over two years. Other common types of depression include seasonal effective disorder, psychotic depression, and bipolar disorder (10). Persistent anxiety, hopelessness, worthlessness, helplessness, fatigue, difficulty in concentration, difficulty in sleeping or waking up, persistent headaches, loss of appetite and weight, and having suicidal thoughts are some of the common symptoms. The number of people who are suffering from this condition is increasing in various parts of the world and the worst affected group is the adults, especially the middle-aged individuals. Constant stress, trauma, and major life changes are known to be the primary causes of depression. Individuals with a family history of depression are also likely to develop the problem (11). Certain illness, especially those that cause pain, discomfort, or disability may also cause depression. This is common among patients who are incapacitated temporarily or permanently in a way because of their medical condition. Depression may cause other serious medical problems if left unchecked.
Correlation between Level of Depression and Level of Control of Hypertension
In the study that was conducted in AL Khobar city’s Ministry of Health clinics, it was established that there is a relationship between hypertension and depression. Among the primary health care depressive patients who were part of this study, a pattern was identified where primary health care depressive patients with high blood pressure recovered at a slower rate than those who were not suffering from hypertension. It came out clearly that comorbidity of hypertension and depression made the condition of the patient worse in two main ways. The first is the hypertension and depression has a common path of development. As such, it is likely that a patient who is suffering from hypertension may also have a problem of depression. Until and unless the problem of hypertension is addressed, such a patient may not fully recover from depression irrespective of the efforts that are put in place by the practitioner. The patient may be given the right dosage of medicine and proper psychological support, but as long as hypertension is still an issue, depression may set in as soon as the emotional support is stopped or is suspended. There are cases where a patient may completely fail to respond to the medication for depression when they have serious problem of hypertension.
The second factor is when a patient suffering from hypertension has developed a life-threatening condition (12). For instance, a patient may be diagnosed with a serious cardiovascular disease that is directly attributed to hypertension. The thought that the condition is not curable or the fact that they cannot do what they used to enjoy doing before may result into serious levels of stress that can easily degenerate into depression. As noted in one of the recent studies (13), sometimes a doctor may issue strict dietary guidelines and the physical and social guidelines that a patient suffering from high blood pressure must follow. If such a patient was receiving therapy for depression or anxiety disorder, then the treatment may not achieve much. This is specifically so because the stressors are not eliminated. Depression becomes more serious, not because depression and hypertension share a common path, but because the impact of hypertension is causing very high levels of stress that a patient cannot easily deal with under normal circumstances. Such patients easily become suicidal when they start viewing themselves as worthless and unable to do things that they use to do in the past.
Comorbidity of Hypertension and Depression
The case-control study that was conducted in the Ministry of Health PHC clinics in AL Khobar city shows a worrying trend about comorbidity of hypertension and depression. 190 cases and another 190 controls were used in this study. It was observed that patients with hypertension were likely to have depression. 85% of the patients with hypertension were diagnosed with varying degrees of depression. On the other hand, 25% of the patients with depression had hypertension. It was important to establish the reason behind this comorbidity. The researchers wanted to determine if it is hypertension that is causing depression or vice versa, or if these two health problems are independent of each other. Of the 190 cases, it was unfortunate that most of the participants could not tell when they started experiencing the problem of depression or hypertension, especially those who work in stressful environments and suspect that their condition was caused by the nature of their workplace environment. Among the participants suffering from both hypertension and depression, they were unable to tell which of the two health problems started ahead of the other. In fact, some of them were completely shocked that intense stress (depression) is a condition that should be managed through medical procedures. However, the study was able to establish a number of facts from the analysis that was conducted as discussed below.
Explaining why patients with hypertension were more likely to suffer from depression
It was established that 85% of the patients with hypertension suffered varying degrees of stress. The investigation revealed reasons why the comorbidity of hypertension and depression was very high among patients who have hypertension. Hypertension is caused by a number of factors, one of which is prolonged depression. When one is suffering from depression, it is not guaranteed that such an individual will develop hypertension. It is also likely that the depression may still be in early stages and as such cannot cause hypertension. As such, an individual with depression may be a potential candidate that can develop hypertension. On the other hand, when hypertension sets in after a period of depression, it is less likely that the hypertension will be successfully treated without treating the primary cause, depression. That is why a higher percentage of people with hypertension suffer from depression compared to the percentage of people with depression who suffer from hypertension. One of the recent studies (14) explains that in many cases, uncontrolled depression is a sure path to high blood pressure, especially if one’s physical activities is significantly reduced, dietary practices become unchecked, and social behavior gets affected. In the early stages, such individuals may not exhibit signs and symptoms of hypertension. However, the more the condition gets worse, the higher the chances are that the condition will develop into hypertension, or even into worse conditions related to hypertension such as cardiovascular diseases.
It was also established that other besides depression, a number of other factors are also responsible for hypertension among patients. One of them is dietary problem. In the Kingdom of Saudi Arabia, fast foods are becoming popular, especially among the young adults and teenagers. The poor eating habits are responsible for the increasing cases of obesity and overweight. Obesity is one of the known causes of hypertension. Some of the junk foods taken from the fast food stores have high sodium content. Food rich in sodium are known to cause hypertension, especially if taken regularly and in large proportions. The emerging lifestyle where indoor activities are becoming more popular than outdoor physical activities is also to blame when it comes to the rising cases of depression. Most of the teenagers prefer video games instead of the physical sports. On the other hand, the young adults currently spend most of their free time on Facebook, Twitter, and YouTube instead of visiting friends and family physically. It is considered a convenient way of engaging loved ones easily without having to strain. A combination of wrong eating habits and reduced physical activities is considered to be causing rapid increase in the number of people suffering from hypertension. It means that besides, depression, a number of factors can also contribute to hypertension.
Once one develops hypertension, they can easily become stressed up trying to deal with their new condition. Even for those whose high blood pressure was caused by depression, they start worrying about many other things about their lives, including a possibility of a sudden death. It explains why a high number of those who are suffering from hypertension are likely to develop depression. On the other hand, depression can only lead to hypertension if it lasts for a very long time without being properly managed. Many people who suffer from depression do not develop hypertension, especially if the conditions last for a while then disappears through therapy or on its own when the stressors are eliminated. It is important to note that the study established that the number of people diagnosed with depression is less than those who are suffering from hypertension. One of the studies (15) attributed this finding to a number of factors. The report shows that many people either fail to realize that they have the problem or ignore it as a normal state given the socio-economic and political forces in the environment. As such, this problem is often understated. Hypertension cannot be ignored, especially if its symptoms include pain. As such, statistics available shows that hypertension is more common than depression. One of the reports (16) also stated that the emerging technologies are introducing a new lifestyle likely to lead to hypertension and related diseases. It is more likely that a person with hypertension will seek medical attention than a person with depression would.
Effect of Depression on Hypertension, Satisfaction, Lifestyle
The analysis of comorbidity of hypertension and depression clearly outlines the relationship between the two conditions, and how one can lead to the other if no proper mechanism is taken to address it. It was established in the study that depression is a major cause of depression if it is left unchecked. It is important to address depression before it can degenerate into hypertension. One’s satisfaction with life can also be affected by depression. According to one of the recent surveys (7), depression can have serious negative impact on one’s level of satisfaction with life. Perinatal depression or persistent depressive disorder may last for a very long time and may cause a feeling that one is worthless or helpless, depending on its cause.
When one is struggling with forces beyond one’s control and he or she is unable to achieve the desired success, stress may set in. If the stressor is not eliminated in time, it may lead to depression. A feeling of helplessness comes in first, and if it is not address, then one may start feeling less useful to self and to the society. The level of satisfaction goes extremely low as one tries to battle with these forces. Many people become suicidal when the depression is not eliminated at the right time. They develop a feeling that they are not worthy enough to be alive. Severe depression is often accompanied with pain (5). The problem is that many people do not realize that they need professional help. They bear the pain silently or sometimes share with people who lack the capacity to give them professional help. Some people consider taking their own lives when the levels of satisfaction drop considerably.
The lifestyle of an individual can be significantly affected by stress. According to one of the studies (4), persistent depressive disorder makes it difficult for one to relate easily with others in social settings. Such individuals are often easily irritated and sometimes make irrational decisions. They tend to be judgmental and moody, and their actions or reactions very unpredictable. They find it making friends under that state of mind. Their friends and families will try to keep their distance when they realize that such a person is not capable to control their moods. It is common to find cases where a social person loses friends and close associates when their levels of depression go unchecked. They become lonely, making them to spend more time focusing on stressors instead of factors that can be used to overcome their condition. One may end up losing their valuable jobs if their behavior at work becomes erratic or when their performance drops considerably. Loss of one’s job may have further devastating impact on the patient, making them to slide further into depression.
Conclusion
Hypertension and depression are common medical conditions that are major causes of concern in the modern society. Poor dietary practices, limited physical exercise among the young adults and teenagers, and stress are some of the major causes of hypertension. Patients suffering from hypertension are likely to develop depression. The study shows that hypertension worsens conditions of primary health care depressive patients. The comorbidity of depression and hypertension makes it difficult to address either of the two conditions while the other is ignored. The conditions must be treated concurrently to ensure that a patient is able to overcome both of them. As shown in the study, it is highly advisable for one to identify stressors in life and find a way of dealing with them before the condition can degenerate to hypertension. The study also suggests that people should remain physically active to fight obesity, hypertension, and other related health complications. Being positive towards medication is critical, especially for a patient who has both conditions.
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