Psychological Risk Factors and Coping Strategies of Hypertension

Author: Memoona Shahid

Supervisor: Prof. Dr. Najma Najam

Degree: Ph.D

Year: 2012

University: Institute of Applied 0chology, Punjab University, Lahore, Pakistan

Hypertension has extensively been investigated in association with
numerous psychological, demographic and social factors. A
comparatively currently identified associate of hypertension is coping.
The current research aimed at finding how psychological variables like
depression, anxiety, stress and anger relate to hypertension in participants
suffering from hypertension. It further aimed to explore the coping
strategies used by participants suffering from hypertension. In the 1
hypothesis the relationship between psychological variables and
hypertension was explored. Moreover, coping strategies used by
hypertensive patients were also found. It was also hypothesized that there
is likely to be a difference in depression, anxiety, stress and anger
between hypertensive patients and non hypertensive controls. It also
aimed to explore the strongest predictors of hypertension. The study also
investigated the impact of different demographic variables (age, gender,
education, occupation, monthly income, monthly expenditure, number of
children, number of dependents, and family history of hypertension,
spouse job, hospital visits and marital status) on hypertension
development. Test translation and validation was conducted to translate
State Trait Anger Expression Inventory by Spielberger, (1988) in Urdu.
Adapted protocol was then use to identify state anger, trait anger, anger
in, anger out, anger control, anger expression and anger total in
participants suffering from hypertension. Urdu translated versions of
Depression Anxiety and Stress Scale (Lovibond, 1995) by Potangaroa
(2005) and Brief Cope Scale (Carver, 1989) by Jibeen and Aftab (2008)
were previously accessible. Translated Urdu and English versions of
State Trait Anger Expression Inventory were administered on 50
bilinguals who were suffering from hypertension to confirm the
equivalence of both versions. Psychometric properties of the translated
Urdu version were identified. Initially a pilot study with sample of 50
participants hypertensive and 26 non-hypertensive was carried out. The
basic aim of the pilot study was to observe the direction of hypotheses. In
the main research participants suffering from hypertension and normal
healthy controls (n = 237) were matched on age, monthly income,
working hours and family history of hypertension. Urdu versions of all
protocols were used to collect data from hospital settings. Mantel
Haenzel Test of linear association revealed that there was relationship
between psychological variables and hypertension. Logistic regression
analysis was run in two stages. In the 1st stage of logistic regression
depression, anxiety, stress, trait anger, anger-out, anger control and anger
turned out to be the strongest psychological predictors for hypertension,
whereas, occupation, monthly expenditures, weight, new in city, joint
family system and working hours were found to be strongest
demographic predictors of hypertension in the 2nd stage of analysis.
Furthermore, independent samples t-test revealed that participants
suffering from hypertension were different in the use of coping strategies
and they used more active coping, substance use, instrumental social
support, positive reframing, acceptance, and self blame coping strategies,
while normal healthy controls used more planning, emotional support,
denial, religion, etc. Independent sample t-test was also applied to find
differences on psychological variables and statistically significant
differences were found on depression, anxiety, stress and anger between
hypertensive males and females. The conclusions support the role of
psychological risk factors in developing hypertension. Participants use
active coping, substance use, instrumental social support, positive
reframing, acceptance, and self blame coping strategies to meet with
stressful conditions of life. The findings of the present research have
significant inferences for clinical psychologists and medical
Keywords: Psychological risk factors, coping strategies, hypertension.

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Corresponding Address: Department of Applied 0chology, University of the Punjab, Lahore, Pakistan. Email:, Phone: 92-42-9231245

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