Helplessness predicts the development of hypertension in older Mexican and European Americans.
OBJECTIVE
The mechanisms by which depression is associated with an elevated risk of cardiovascular disease remain unclear. It is possible that depressive symptoms could increase the risk of hypertension, which in turn could predispose to cardiovascular disease. The goal of this study was to explore whether individual depressive symptoms might predict the incidence of hypertension in a cohort of 240 initially normotensive Mexican-American and European-American elders.


METHODS
Subjects were 65-78 years old on entering the San Antonio Longitudinal Study of Aging, an epidemiologic survey, at which time they completed the 30-item Geriatric Depression Scale in English or Spanish. Their blood pressure was reassessed a mean of 7.0 years later. Responses to six key scale items (depressed mood, decreased interest, worthlessness, hopelessness, helplessness, and fatigue) were evaluated for the ability to predict incident hypertension.


RESULTS
In univariate analyses, only helplessness significantly predicted incident hypertension (chi-square 13.5, df=1, P=.0003). In a Cox proportional hazards model adjusted for sex, education, number of comorbid diseases, current drinking, social well-being, and marital status, helplessness remained a very strong predictor [hazard ratio (HR) 4.99, 95% confidence interval (CI) 1.90-13.12, P=.0011]. Total depression score also predicted incident hypertension, but less strongly (HR 1.08, CI 1.00-1.17, P=.0339).


CONCLUSIONS
Helplessness may predict the development of hypertension in the elderly. Further research into this relationship might lead to interventions to reduce the risk of cardiovascular disease.
Psychiatry Service, South Texas Veterans Health Care System, San Antonio, TX 78229-4404, USA. stephen.stern@va.gov
Stephen L
SL
Stern
Rahul
R
Dhanda
Helen P
HP
Hazuda
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000208:ethnology / Q000523:psychology; D005260:Female; D006380:Helplessness, Learned; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D017058:Mexican Americans / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D012307:Risk Factors; D012649:Self Concept; D012737:Sex Factors; D012959:Socioeconomic Factors; D013781:Texas; D044465:White People / Q000523:psychology*