PSYCHOLOGICAL DISTRESS, PSYCHOSOMATIC SYNDROMES AND PSYCHOLOGICAL WELL-BEING IN MASKED HYPERTENSION

Abstract

Objective: In patients affected by masked hypertension psychological variables have been poorly investigated so far. Some authors found an association of masked hypertension with hypochondria and/or depression. Studies on the relationship between masked hypertension and stress focused on stressors at work ignoring chronic/acute stressful life events related to other contexts. This research aims to understand psychological, psychosomatic and well-being characteristics among patients with masked hypertension. Design and method: 10 patients with masked hypertension, enrolled at the Division of Internal Medicine, were assessed. They were administered both observer- (interviews on clinical psychological distress and psychosomatic syndromes) and self-rated (questionnaires on subclinical distress and well-being) measures. Results: 40% of patients reported at least one depressive disorder (30% past major depressive episode and 20% persistent depressive disorder) and 40% at least one anxiety disorder (30% generalized anxiety, 10% panic and 10% social anxiety). 50% showed illness behaviour, 20% psychological manifestations and 20% personality syndrome. Only 30% of patients did not report a diagnosis of either Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or Diagnostic Criteria for Psychosomatic Research (DCPR). 20% of the sample reported only one psychosomatic syndrome (somatization and conversion syndromes). The mean levels of psychological well-being were significantly lower in masked hypertension patients than those of the general population: autonomy (29.9 ± 6.87 versus 37.14 ± 6.96), environmental mastery (26.70 ± 2.75 versus 38.15 ± 7.41), personal growth (32.10 ± 3.93 versus 38.40 ± 6.93), positive relations (31.20 ± 4.92 versus 40.57 ± 6.96), purpose in life (26.72 ± 5.32 versus 38.40 ± 6.98) and self-acceptance (25.80 ± 5.37 versus 38.12 ± 8.20). The mean scores Psychosocial Index subscales were significantly higher than those reported by the general population: psychological distress (13 ± 6.43 versus 5.54 ± 3.60), abnormal illness behavior (1.10 ± 1.20 versus 0.50 ± 0.82) and stress (4.40 ± 1.51 versus 2.30 ± 1.81). On the contrary, the mean scores of well-being dimension were significantly lower (6 ± 1.33 versus 7.42 ± 1.64). Conclusions: A high percentage of patients with masked hypertension showed high levels of psychological and psychosomatic distress. A psychosomatic assessment including both distress and psychological well-being impairments should be implemented in patients with masked hypertension in order to recognize potential vulnerability factors for both medical and psychiatric syndromes.