Prevalence and Predictors of Depression Symptoms Among Afghan Hypertensive Patients: Secondary Analysis of a Multi-Center Cross-Sectional Study

Muhammad Haroon Stanikzai,1 Mohammad Nasim Zafar,2 Khalid Akbari,3 Ahmad Haroon Baray,1 Hadia Sayam1 1Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan; 2Department of Para-Clinic, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan; 3Department of Internal Medicine, Faculty of Medicine, Paktia University, Gardez, Paktia, AfghanistanCorrespondence: Muhammad Haroon Stanikzai, Department of Public Health, Faculty of Medicine, Kandahar University, District # 10, 3801, Kandahar, Afghanistan, Tel +93704775578, Email haroonstanikzai1@gmail.comBackground: Although depression is a frequently occurring mental disorder in patients with hypertension, little is known about the symptoms of depression among Afghan hypertensive patients.Objective: This study aimed to analyze the prevalence and predictors of depression symptoms among Afghan hypertensive patients.Methods: This was a secondary analysis of a multi-center cross-sectional study conducted between August and December 2022 across three major provinces in Afghanistan. Socio-demographic and clinical characteristics of the eligible participants were used in the analysis. A score of ≥ 5 on the PHQ-9 (Patient Health Questionnaire) was considered the cut-off point for labeling hypertensive patients as screening positive for depressive symptoms. We performed binary logistic regression to determine the predictors of depression symptoms among hypertensive patients.Results: Out of 853 hypertensive patients, 51.8% (95% CI: 48.4– 55.2%) had depressive symptoms. Binary logistic regression revealed that low monthly household income [AOR=1.42, 95% CI (1.01– 1.97), low education level [2.41 (1.57– 3.71)], physical inactivity [1.81 (1.22– 2.71)], poor blood pressure control [2.41 (1.57– 3.71)], and the presence of medical comorbidity [1.59 (1.15– 2.19)] were the predictors of depression symptoms.Conclusion: This study showed a high prevalence of depressive symptoms among Afghan hypertensive patients. Moreover, we found that low monthly household income, physical inactivity, low education level, poor blood pressure control, and the presence of medical comorbidity were the predictors of depression symptoms. Our findings suggest that hypertensive patients should be screened for mental health symptoms, and those most at risk for depression should seek supportive counseling.Keywords: hypertension, depression, determinants, Afghanistan