The prevalence of psychological disorders—particularly stress, depression, and anxiety—among hypertensive patients is alarmingly high, and significant negative correlations exist between these mental health conditions and hypertension self-care levels.
Key Findings
Results
The prevalence of depression, anxiety, and stress among hypertensive patients in Gonabad, Iran was very high.
62.5% of hypertensive patients exhibited depression
75.2% of hypertensive patients exhibited anxiety
59.3% of hypertensive patients exhibited stress
Data were collected in 2024–2025 from 509 hypertensive patients using the DASS-21 (Depression, Anxiety, and Stress Scale)
Participants were selected through cluster random sampling; the majority were female and older persons (age > 60 years)
Results
Depression and anxiety were each significantly negatively associated with hypertension self-care levels.
Depression and self-care: r = -0.314, p < 0.001
Anxiety and self-care: r = -0.330, p < 0.001
Correlations were assessed using Pearson's correlation analysis
Self-care was measured using the Self-Care of Hypertension Inventory (SC-HI V3)
No statistically significant correlation coefficient for stress and self-care was reported separately in the abstract
Results
Depression and anxiety were significantly negatively correlated with age at hypertension onset.
A significant negative correlation was observed between depression/anxiety and the age at hypertension onset
This suggests younger age at hypertension diagnosis was associated with higher levels of depression and anxiety
Correlation analysis method was Pearson's correlation
Results
Marital status was significantly associated with levels of depression, anxiety, and stress among hypertensive patients.
Marital status showed a significant association with all three psychological distress outcomes: depression, anxiety, and stress
Statistical tests used included independent t-tests and ANOVA
The study population consisted of 509 hypertensive patients in Gonabad, Iran
Results
Age group, marital status, education level, and occupation were significantly correlated with hypertension self-care levels and all three of its subscales.
All four demographic variables (age group, marital status, education level, occupation) showed significant correlations with overall hypertension self-care
These associations extended to all three subscales of the SC-HI V3
Statistical tests used for these associations included independent t-tests and ANOVA
Results
Depression, anxiety, stress, age, education, and income together predicted 15% of the variance in hypertension self-care.
Multiple Linear Regression analysis indicated that these six variables collectively accounted for 15% of self-care of hypertension variance
Predictor variables included: depression, anxiety, stress, age, education, and income
The model was analyzed using SPSS v25
What This Means
This research suggests that psychological distress is extremely common among people living with high blood pressure (hypertension) in Gonabad, Iran. In a study of 509 hypertensive patients, more than three-quarters reported symptoms of anxiety (75.2%), nearly two-thirds reported depression (62.5%), and about six in ten reported stress (59.3%). These rates are notably high and point to a widespread mental health burden in this population.
The study also found that higher levels of depression and anxiety were linked to poorer self-care behaviors—such as taking medications, monitoring blood pressure, and maintaining healthy habits—among people with hypertension. The stronger the psychological distress, the less likely patients were to engage in effective self-care. Demographic factors such as age, marital status, education level, and occupation also played a role in self-care levels. Together, psychological and sociodemographic factors explained about 15% of the variation in how well patients managed their own condition.
This research suggests that mental health is closely intertwined with how effectively people manage hypertension, and that ignoring psychological well-being may undermine physical health outcomes. It points to a need for healthcare systems to screen hypertensive patients for depression, anxiety, and stress, and to integrate mental health support into routine hypertension care. Addressing psychological distress could potentially improve patients' ability to follow recommended self-care practices and reduce complications from uncontrolled blood pressure.
Naddafi F, Jafari A, Nejatian M, Tehrani H. (2026). Psychological distress in hypertension: Prevalence and links to self-care in Gonabad, Iran.. PloS one. https://doi.org/10.1371/journal.pone.0352892