PERCEIVED STRESS, DEPRESSION AND MEDICATION ADHERENCE AMONG HYPERTENSIVE PATIENTS ATTENDING A SECONDARY CARE HOSPITAL IN LAGOS, NIGERIA

Abstract

Objective: Hypertension is a significant public health problem as it accounts for 19.2% of all deaths globally and 16.4% of all deaths in low- and middle-income countries. Poor medication adherence negatively impacts hypertension control and has been associated with negative self-care behavior such as seen in perceived stress and depression. This study sought to investigate the prevalence of perceived stress, depression, and their association with the level of medication adherence amongst hypertensive patients attending a secondary care hospital in Lagos, Nigeria. Design and Methods: Descriptive cross-sectional design was adopted, and an interviewer-based questionnaire was administered for this study. Perceived stress, Depression and Medication Adherence were evaluated using the Perceived Stress Scale(PSS-10), Patient Health Questionnaire(PHQ-9) and Hill-Bone Compliance Scale. Data was analyzed by using Epi Info Version 7 and presented using frequency tables. T-test was used to compare continuous variables while the Chi-square and Fishers Exact test were used to compare categorical variables. Significance level was set at p < 0.05. Results: 331 hypertensive patients (221 women, 66.8%) were included in this study (Mean age of 60.0 ± 13.9 years). 77% had average to high levels of perceived stress (PSS-10 score of > 12) while 55% had varying levels of depression. Mean score on Hill-Bone Compliance Scale was 20.1 ± 3.7. Income level, Number of drugs used daily were significantly associated with perceived stress (p < 0.05,p < 0.01). Younger age, Female Gender, Presence of co-morbidities and Number of drugs used daily were significantly associated with depression(p < 0.01,p < 0.05,p < 0.05,p < 0.01). Perceived stress and depression were significantly associated with lower levels of medication adherence (p < 0.05; p < 0.01). Conclusion: This study lends credence to the idea that perceived stress and depression results in negative self-care behavior that adversely impacts medication adherence. Greater awareness of the potential for psychological distress in hypertensive patients must be emphasized to all physicians. Improving medication adherence rates requires collaborative care with intensified screening and appropriate management for social and psychological stressors.