Evaluating Depressive Symptoms Among Low-Socioeconomic-Status African American Women Aged 40 to 75 Years With Uncontrolled Hypertension : A Secondary Analysis of a Randomized Clinical Trial

It has long been known that depression is associated with hypertension but whether depression is a risk factor for hypertension incidence is still inconclusive. To assess whether depression increases the incidence of hypertension. Literatures were searched from PubMed, EMBASE, Cochrane and PsycINFO without language restrictions. Any prospective cohort study was included, which reported the correlation between depression and incidence of hypertension in apparently healthy normotensive individuals. At baseline, the studies which had at least one self-report or interview-based assessment on depressive symptoms/disorders were selected. The definition of hypertension was defined as a repeatedly elevated blood pressure exceeding 140 (systolic) and/or over 90  mmHg (diastolic) determined in interview, use of antihypertensive medications, or self-reported or recorded diagnosed hypertension. Studies with cross-sectional or case-control design were excluded. Data abstraction was conducted independently by two authors. Seventy-five full texts were initially searched, but only nine studies met our inclusion criteria, and they were comprised of 22 367 participants with a mean follow-up period of 9.6 years. We found that depression increased the risk of hypertension incidence [adjusted relative risk 1.42, 95% confidence interval (CI) 1.09 to 1.86, P = 0.009] and the risk was significantly correlated with the length of follow-up (P = 0.0002) and the prevalence of depression at baseline (P < 0.0001). Our meta-analysis supports that depression is probably an independent risk factor of hypertension. It is important to take depression into consideration during the process of prevention and treatment of hypertension. Further studies are needed to exclude the effects of other confounding factors.

Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview (n= 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination (p< .001) and increased levels of racial discrimination were positively related to depression (p< .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.