title: Prevalence of undiagnosed depression among persons with hypertension and associated risk factors: a cross-sectional study in urban Nepal.
abstract: BACKGROUND
  Despite an increasing number of studies exploring prevalence of depression among hypertensive patients in high income countries, limited data is available from low and middle income countries, particularly Nepal. Our aim was to investigate the prevalence of undiagnosed (sub clinical) depression and associated risk factors among hypertensive patients attending a tertiary health care clinic in Nepal.
  
  
  METHODS
  The study was based on a cross-sectional study design, with 321 hypertensive patients attending the Out-Patient Department of a central hospital in Nepal. Blood measure was recorded via a mercury column sphygmomanometer. Depression levels were assessed using the Beck Depression Inventory-Ia (BDI) scale. Demographics and risk factors were assessed.
  
  
  RESULTS
  The proportion of participants with undiagnosed depression was 15%. Multivariable analyses demonstrated an increase in BDI scores with increased aging. Approximately a 1 point increase in the BDI score was observed for each additional decade of aging in hypertensive patients. Additional factors associated with increased risk of depression included being female (4.28 point BDI score increase), smoking (5.61 point BDI score increase), being hypertensive with no hypertensive medication (4.46 point BDI score increase) and being illiterate (4.46 point BDI score increase).
  
  
  CONCLUSIONS
  Among persons with hypertension in outpatient settings in Nepal, demographic (age, sex, education), behavioural (smoking,) and adherence factors (anti-hypertensive medication) were associated with undiagnosed depression. Screening programs in Nepal may assist early intervention in hypertensive patients with sub clinical depression.
authors: Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Dinesh
authors: D
authors: Neupane
authors: Nobel College, Faculty of Science and Technology, Kathmandu, Nepal.
authors: Bindu
authors: B
authors: Panthi
authors: Rural Clinical School, University of New South Wales, Sydney, Australia.
authors: Craig S
authors: CS
authors: McLachlan
authors: Shiva Raj Mishra, Nepal Development Society, Kathmandu, Nepal.
authors: Shiva Raj
authors: SR
authors: Mishra
authors: Brandon A. Kohrt, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors: Brandon A
authors: BA
authors: Kohrt
authors: Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Per
authors: P
authors: Kallestrup
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data*