title: The impact of depression and cardiophobia on quality of life in patients with essential hypertension.
abstract: Patients with chronic conditions like hypertension may experience many negative emotions which endorse the development of anxiety and depression symptomatology, thus they increase their risk for poor quality of life. Several studies have shown an association between symptoms of psychological distress and hypertension. In this study we aimed to quantify the link between depression, cardiophobia and quality of life in hypertensive patients. A cross-sectional design was employed. A sample of 197 hypertensive patients (89 men-108 women, mean age 53 years, SD=12 ranged 25-78) from a university outpatient hypertension clinic in Greece participated. Ninety-four (47.7%) of the participants suffered from essential grade I hypertension; 68 (34.5%) were grade II; 16 (8.1%) were categorized as grade III, while only 11 (5.6%) patients were recorded as normotensives with high normal values. The questionnaires included: (a) question for the recording of social-demographic characteristics and clinical features, (b) The Short Form (SF-36) Health Survey, (c) The Beck Depression Inventory -I, and (d) The Cardiac Anxiety Questionnaire. There were no significant differences between the two genders with exception of marital status (p=0.010), dyslipidemia (p=0.050), grade of hypertension (p=0.014), cardiac left ventricular hypertrophy (p=0.004), renal failure (p=0.043) and stroke (p=0.024). Lower levels of quality of life and higher levels of depression and cardiophobia were observed compared to the general population. There were no significant differences on psychological measures between the two sexes (p>0.05). Cardiophobia was positively related to depressive symptomatology (r=0.533, p=0.000) while negatively to both physical and mental health summary measures of SF-36 health survey (r=-0.467, p=0.000 r=-0.537, p=0.000 respectively). Multiple linear regression models found that for psychical health depression and cardiac anxiety, avoidance activities had an influence on levels of quality of life in hypertensive patients, after controlling for age and other socio-demographic variables and clinical characteristics (Beta=-0.133, p=0.007, Beta=-0.364 p=0.000 and Beta=-0.167 p=0.006, respectively). For mental component summary depression and cardiophobia, heart focused attention had also impact on mental health in hypertensives (Beta=-0.438, p=0.016, Beta=-0.564, p=0.000 and Beta=-0.223, p=0.037, respectively) after adjustments. Heart focused anxiety symptoms-as avoidance activities and/or attention and monitoring cardiac activity, are related to hypertensive patients' present deteriorated depressive symptoms and levels of quality of life. Both depressive symptomatology and heart focused anxiety may be a mechanism partly responsible for hypertensive patients' present impaired levels of quality of life.
authors.affiliation: Department of Cardiology, "Hippokration" Hospital, Athens.|1st Department of Cardiology, University of Athens, Medical School, "Hippokration" Hospital, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Tsartsalis
authors.affiliation: Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Center, Anesthetics, Operations and Specialty Surgery Center, County Council of Östergötland, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Dragioti
authors.affiliation: 1st Department of Psychiatry, University of Athens, Medical School, Eginition University Hospital, Athens.|University Mental Health Research Institute, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Kontoangelos
authors.affiliation: 1st Department of Cardiology, University of Athens, Medical School, "Hippokration" Hospital, Athens, Greece.
authors.forename: Chr
authors.initials: C
authors.lastname: Pitsavos
authors.affiliation: 1st Department of Psychiatry, University of Athens, Medical School, Eginition University Hospital, Athens.
authors.forename: P
authors.initials: P
authors.lastname: Sakkas
authors.affiliation: 1st Department of Psychiatry, University of Athens, Medical School, Eginition University Hospital, Athens.
authors.forename: G N
authors.initials: GN
authors.lastname: Papadimitriou
authors.affiliation: 1st Department of Cardiology, University of Athens, Medical School, "Hippokration" Hospital, Athens, Greece.
authors.forename: Chr
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: Department of Cardiology, "Hippokration" Hospital, Athens.
authors.forename: I
authors.initials: I
authors.lastname: Kallikazaros
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006115:Greece; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009449:Neurocirculatory Asthenia / Q000175:diagnosis / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology