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Relationship of Depressive Symptoms to Hypertension in a Household Survey in Harlem

From the Divisions of Sociomedical Sciences (M.R., M.N.) and Epidemiology (S.S.), Joseph L. Mailman School of Public Health, Columbia University, New York, New York.

Address reprint requests to: Marian Reiff, PhD, Rosenthal Center for Complementary & Alternative Medicine Research, Department of Rehabilitation Medicine, Columbia College of Physicians & Surgeons, 600 West 168th Street, New York, NY 10032. Email: mr82{at}columbia.edu

OBJECTIVE: Two possible explanations for an hypothesized association between depression and hypertension were examined: (1) shared stress-related risk factors are associated with both depression and hypertension and (2) life-style factors associated with depression lead to hypertension.

METHODS: A predominantly black sample of 695 adults were interviewed in the Harlem Household Survey. Two measures of hypertension were used and compared—1) self-report and 2) elevated blood pressure (above 140/90 mm Hg)—on the basis of the mean of two blood pressure measures. Depressive symptoms were measured by use of a 24-item scale based on the Diagnostic Interview Schedule. Logistic regression models were used to test associations between hypertension and depressive symptoms, stressors, and life-style factors.

RESULTS: Depressive symptoms were associated with self-reported hypertension but not with elevated blood pressure. The association between self-reported hypertension and depressive symptoms was explained partly by shared stress-related risk factors but not by life-style factors. Several stressors and life-style variables were risk factors for elevated blood pressure independently of depressive symptoms. The findings are consistent with studies that have measured hypertension variously by either self-report or blood pressure. Possible explanations were explored (labeling and help-seeking) but were not supported by the data.

CONCLUSIONS: An association was found between self-reported hypertension and depressive symptoms, which was explained partly by shared stress-related risk factors. Elevated blood pressure was associated with stressors and life-style factors but not with depressive symptomatology. Research on illness representations and cultural dimensions of health suggest avenues for further investigation.

Key Words: hypertension • depression • self-report • blood pressure • stress • African American

Abbreviations: BMI = body mass index;; DIS = diagnostic interview schedule;; OR = odds ratio.

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