Predictors of Psychological Stress in Bhutanese Hypertensive Adults
DOI:
https://doi.org/10.31584/jhsmr.2021781Keywords:
hypertension, illness perception, psychological stress, religiosity, social supportAbstract
Objective: To examine the prediction of illness perception, religiosity, and social support on psychological stress among adults with hypertension in Bhutan
Material and Methods: A predictive correlational design was used, from 120 adults with hypertension; recruited from Jigme Dorji Wangchuk National Referral Hospital, using the simple random sampling technique. Data were self-reported through a demographic data questionnaire, Perceived Stress Scale (PSS, Cronbach’s α=0.76), Brief Illness Perception Questionnaire (Brief IPQ, Cronbach’s α=0.81), Belief into Action Scale (BIAC, Cronbach’s α=0.87) and Multidimensional Scale of Perceived Social Support (MSPSS, Cronbach’s α=0.91); between March, 2020 and April, 2020. Data were analyzed using descriptive statistics, Pearson’s product moment correlations and Standard Multiple Regression.
Results: Regression analysis revealed that psychological stress was predicted by illness perception (β=0.70, p-value< 0.001) and social support (β=-0.15, p-value<0.037). Religiosity was not a significant predictor of psychological stress (β= -0.02, p-value>0.738). The model explained 67.0% of the total variance for psychological stress. (R2 =0.67, p-value< 0.001). The mean scores were; psychological stress (20.23±5.58), illness perception (44.50±12.31), religiosity (53.48± 16.01), and social support (61.61±12.08).
Conclusion: The findings support the role of illness perception and social support in explaining psychological stress among hypertensive people. Therefore, illness perception and social support may be considered in interventions to manage psychological stress in hypertension patients.
References
World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: WHO; 2009.
Danaei G, Lu Y, Singh GM, Carnahan E, Stevens GA, Cowan MJ, et al. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014;2:634-47.
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 2016;134:441-50.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23.
Ministry of Health. National health survey 2012 report [monograph on the internet]. Thimphu: Ministry of Health; 2012 [cited 2019 Sep 12]. Available from: https://evaw-globaldatabase.unwomen.org/-/media/files/un%20women/vaw/ vaw%20survey/bhutan%20nationalhealthsurvey2012.pdf? vs=544
World Health Organization. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan-2014. New Delhi: WHO; 2015.
World Health Organization. Noncommunicable diseases country profiles 2018 report [monograph on the internet]. Geneva: WHO; 2018. [cited 2019 Sept 15]. Available from: https://www.who. int/nmh/countries/2018/btn_en.pdf?ua=1
Malan L, Schutte CE, Alkerwi AA, Stranges S, Malan NT. Hypothalamic-pituitary-adrenal-axis dysregulation and double product increases potentiate ischemic heart disease risk in a Black male cohort: the SABPA study. Hypertens Res 2017;40: 590-7.
Sarkar A, Roy D, Chauhan MM, Dave P, Makwana NR, Parmar DV. A lay epidemiological study on coexistent stress in hypertension: Its prevalence, risk factors, and implications in patients’ lives. J Family Med Prim Care 2019;8:966.
Palagini L, Bruno RM, Cheng P, Mauri M, Taddei S, Ghiadoni L, et al. Relationship between insomnia symptoms, perceived stress and coping strategies in subjects with arterial hypertension: psychological factors may play a modulating role. Sleep Med 2016;19:108-15.
Richardson S, Shaffer JA, Falzon L, Krupka D, Davidson KW, Edmondson D. Meta-analysis of perceived stress and its association with incident coronary heart disease. Am J Cardiol 2012;110:1711-6.
Gallo LC, Roesch SC, Fortmann AL, Carnethon MR, Penedo FJ, Perreira K, et al. Associations of chronic stress burden, perceived stress, and traumatic stress with cardiovascular disease prevalence and risk factors in the HCHS/SOL Sociocultural Ancillary Study. Psychosom Med 2014;76:468.
Redmond N, Richman J, Gamboa CM, Albert MA, Sims M, Durant RW, et al. Perceived stress is associated with incident coronary heart disease and all cause mortality in low but not high income participants in the Reasons for Geographic and Racial Differences in Stroke Study. J Am Heart Assoc 2013;2: e000447.
Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet 2010;375:938-48.
Munakata M. Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings. Hypertens Res 2018;41:553-69.
Vaccarino V, Shah AJ, Rooks C, Ibeanu I, Nye JA, Pimple P, et al. Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction. Psychosom Med 2014;76:171.
Naziron NS, Hamzah NA. Psychological well being and self care practices of patient with hypertension/Siti Khuzaimah Ahmad Sharoni, Nurul Syakila Naziron, Nurul Ashikin Hamzah, and Siti Rohaida Mohamed. Int J Undergrad Stud 2013;2:13-8.
Qi Q. The association between perceived stress and worse adherence to medical discharge instructions after acute myocardial infarction. New Haven: Yale University; 2014.
Momeni J, Omidi A, Raygan F, Akbari H. The effects of mindfulness-based stress reduction on cardiac patients' blood pressure, perceived stress, and anger: a single-blind randomized controlled trial. J Am Soc Hypertens 2016;10:763- 71.
Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, Ingle K, et al. Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial. Circulation 2016;133:1341-50.
Lu X, Juon HS, He X, Dallal CM, Wang MQ, Lee S. The Association Between Perceived Stress and Hypertension Among Asian Americans: Does Social Support and Social Network Make a Difference?. J Community Health 2019;44:451- 62.
Vasunilashorn S, Lynch SM, Glei DA, Weinstein M, Goldman N. Exposure to stressors and trajectories of perceived stress among older adults. J Gerontol B-Psychol 2015;70:329-37.
Leventhal H, Phillips LA, Burns E. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J Beha Med 2016;39:935- 46.
Sadeghi M, Alavi M, Mohammadi M, Roohafza H, Mahmoodi A, Visentin D, et al. Perceptions of illness as predictive factors for perceived stress in patients participating in a cardiac rehabilitation program. Nurs Health Sci 2019;21:508-14.
Pai HC, Li CC, Tsai SM, Pai YC. Association between illness representation and psychological distress in stroke patients: a systematic review and meta-analysis. Int J Nurs Stud 2019; 94:42-50.
Milas G, Klarić IM, Malnar A, Šupe-Domić D, Slavich GM. Socioeconomic status, social-cultural values, life stress, and health behaviors in a national sample of adolescents. Stress Health 2019;35:217-24.
Brummett BH, Babyak MA, Mark DB, Clapp-Channing NE, Siegler IC, Barefoot JC. Prospective study of perceived stress in cardiac patients. Ann Behav Med 2004;27:22-30.
Lee JS, Koeske GF, Sales E. Social support buffering of acculturative stress: a study of mental health symptoms among Korean international students. Int J Intercult Relat 2004;28: 399-414.
Ivtzan I, Chan CP, Gardner HE, Prashar K. Linking religion and spirituality with psychological well-being: Examining selfactualisation, meaning in life, and personal growth initiative. J Relig Health 2013;52:915-29.
Koenig HG. Religion and mental health: Research and clinical applications. San Diego: Academic Press; 2018.
Dorji N, Dunne MP, Seib C, Dep S. Health-related quality of life and co-morbidities among older adults in Bhutan. Bhutan Health J 2018;4:15-24.
Komasi S, Soroush A, Saeidi M, Brugnera A, Rabboni M, Fulcheri M, et al. Subjective correlates of stress management in outpatient cardiac rehabilitation: the predictive role of perceived heart risk factors. J Cardiovasc Thorac Res 2018; 10:104.
Saunders M, Lewis P, Thornhill A. Research methods for business students. 5th ed. Essex: Prentice Hall: 2003.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983:385-96.
Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res 2006;60:631-7.
Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess 1990;55:610-7.
Koenig HG, Wang Z, Al Zaben F, Adi A. Belief into action scale: a comprehensive and sensitive measure of religious involvement. Religions 2015;6:1006-16.
Rai D, Deenan A, Krungkraipetch N. Factors Influencing selfmanagement of End-stage Renal Disease (ESRD) Patients Undergoing Hemodialysis in Bhutan. Thai Pharm Health Sci J 2019;14:26-34.
Nyaaba GN, Agyemang C, Masana L, Aikins AD, Beune E, Larrea-Killinger C, Stronks K. Illness representations and coping practices for self-managing hypertension among subSaharan Africans: a comparative study among Ghanaian migrants and non-migrant Ghanaians. Patient education and counseling 2019;102:1711-21.
Hornstein EA, Eisenberger NI. Unpacking the buffering effect of social support figures: social support attenuates fear acquisition. PloS One 2017;12. doi: 10.1371/journal.pone.0175891.
Danaei G, Lu Y, Singh GM, Carnahan E, Stevens GA, Cowan MJ, et al. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014;2:634-47.
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 2016;134:441-50.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23.
Ministry of Health. National health survey 2012 report [monograph on the internet]. Thimphu: Ministry of Health; 2012 [cited 2019 Sep 12]. Available from: https://evaw-globaldatabase.unwomen.org/-/media/files/un%20women/vaw/ vaw%20survey/bhutan%20nationalhealthsurvey2012.pdf? vs=544
World Health Organization. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan-2014. New Delhi: WHO; 2015.
World Health Organization. Noncommunicable diseases country profiles 2018 report [monograph on the internet]. Geneva: WHO; 2018. [cited 2019 Sept 15]. Available from: https://www.who. int/nmh/countries/2018/btn_en.pdf?ua=1
Malan L, Schutte CE, Alkerwi AA, Stranges S, Malan NT. Hypothalamic-pituitary-adrenal-axis dysregulation and double product increases potentiate ischemic heart disease risk in a Black male cohort: the SABPA study. Hypertens Res 2017;40: 590-7.
Sarkar A, Roy D, Chauhan MM, Dave P, Makwana NR, Parmar DV. A lay epidemiological study on coexistent stress in hypertension: Its prevalence, risk factors, and implications in patients’ lives. J Family Med Prim Care 2019;8:966.
Palagini L, Bruno RM, Cheng P, Mauri M, Taddei S, Ghiadoni L, et al. Relationship between insomnia symptoms, perceived stress and coping strategies in subjects with arterial hypertension: psychological factors may play a modulating role. Sleep Med 2016;19:108-15.
Richardson S, Shaffer JA, Falzon L, Krupka D, Davidson KW, Edmondson D. Meta-analysis of perceived stress and its association with incident coronary heart disease. Am J Cardiol 2012;110:1711-6.
Gallo LC, Roesch SC, Fortmann AL, Carnethon MR, Penedo FJ, Perreira K, et al. Associations of chronic stress burden, perceived stress, and traumatic stress with cardiovascular disease prevalence and risk factors in the HCHS/SOL Sociocultural Ancillary Study. Psychosom Med 2014;76:468.
Redmond N, Richman J, Gamboa CM, Albert MA, Sims M, Durant RW, et al. Perceived stress is associated with incident coronary heart disease and all cause mortality in low but not high income participants in the Reasons for Geographic and Racial Differences in Stroke Study. J Am Heart Assoc 2013;2: e000447.
Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet 2010;375:938-48.
Munakata M. Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings. Hypertens Res 2018;41:553-69.
Vaccarino V, Shah AJ, Rooks C, Ibeanu I, Nye JA, Pimple P, et al. Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction. Psychosom Med 2014;76:171.
Naziron NS, Hamzah NA. Psychological well being and self care practices of patient with hypertension/Siti Khuzaimah Ahmad Sharoni, Nurul Syakila Naziron, Nurul Ashikin Hamzah, and Siti Rohaida Mohamed. Int J Undergrad Stud 2013;2:13-8.
Qi Q. The association between perceived stress and worse adherence to medical discharge instructions after acute myocardial infarction. New Haven: Yale University; 2014.
Momeni J, Omidi A, Raygan F, Akbari H. The effects of mindfulness-based stress reduction on cardiac patients' blood pressure, perceived stress, and anger: a single-blind randomized controlled trial. J Am Soc Hypertens 2016;10:763- 71.
Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, Ingle K, et al. Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial. Circulation 2016;133:1341-50.
Lu X, Juon HS, He X, Dallal CM, Wang MQ, Lee S. The Association Between Perceived Stress and Hypertension Among Asian Americans: Does Social Support and Social Network Make a Difference?. J Community Health 2019;44:451- 62.
Vasunilashorn S, Lynch SM, Glei DA, Weinstein M, Goldman N. Exposure to stressors and trajectories of perceived stress among older adults. J Gerontol B-Psychol 2015;70:329-37.
Leventhal H, Phillips LA, Burns E. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J Beha Med 2016;39:935- 46.
Sadeghi M, Alavi M, Mohammadi M, Roohafza H, Mahmoodi A, Visentin D, et al. Perceptions of illness as predictive factors for perceived stress in patients participating in a cardiac rehabilitation program. Nurs Health Sci 2019;21:508-14.
Pai HC, Li CC, Tsai SM, Pai YC. Association between illness representation and psychological distress in stroke patients: a systematic review and meta-analysis. Int J Nurs Stud 2019; 94:42-50.
Milas G, Klarić IM, Malnar A, Šupe-Domić D, Slavich GM. Socioeconomic status, social-cultural values, life stress, and health behaviors in a national sample of adolescents. Stress Health 2019;35:217-24.
Brummett BH, Babyak MA, Mark DB, Clapp-Channing NE, Siegler IC, Barefoot JC. Prospective study of perceived stress in cardiac patients. Ann Behav Med 2004;27:22-30.
Lee JS, Koeske GF, Sales E. Social support buffering of acculturative stress: a study of mental health symptoms among Korean international students. Int J Intercult Relat 2004;28: 399-414.
Ivtzan I, Chan CP, Gardner HE, Prashar K. Linking religion and spirituality with psychological well-being: Examining selfactualisation, meaning in life, and personal growth initiative. J Relig Health 2013;52:915-29.
Koenig HG. Religion and mental health: Research and clinical applications. San Diego: Academic Press; 2018.
Dorji N, Dunne MP, Seib C, Dep S. Health-related quality of life and co-morbidities among older adults in Bhutan. Bhutan Health J 2018;4:15-24.
Komasi S, Soroush A, Saeidi M, Brugnera A, Rabboni M, Fulcheri M, et al. Subjective correlates of stress management in outpatient cardiac rehabilitation: the predictive role of perceived heart risk factors. J Cardiovasc Thorac Res 2018; 10:104.
Saunders M, Lewis P, Thornhill A. Research methods for business students. 5th ed. Essex: Prentice Hall: 2003.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983:385-96.
Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res 2006;60:631-7.
Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess 1990;55:610-7.
Koenig HG, Wang Z, Al Zaben F, Adi A. Belief into action scale: a comprehensive and sensitive measure of religious involvement. Religions 2015;6:1006-16.
Rai D, Deenan A, Krungkraipetch N. Factors Influencing selfmanagement of End-stage Renal Disease (ESRD) Patients Undergoing Hemodialysis in Bhutan. Thai Pharm Health Sci J 2019;14:26-34.
Nyaaba GN, Agyemang C, Masana L, Aikins AD, Beune E, Larrea-Killinger C, Stronks K. Illness representations and coping practices for self-managing hypertension among subSaharan Africans: a comparative study among Ghanaian migrants and non-migrant Ghanaians. Patient education and counseling 2019;102:1711-21.
Hornstein EA, Eisenberger NI. Unpacking the buffering effect of social support figures: social support attenuates fear acquisition. PloS One 2017;12. doi: 10.1371/journal.pone.0175891.
Downloads
Published
2021-06-01
How to Cite
1.
Gyeltshen D, Deenan A, Wacharasin C. Predictors of Psychological Stress in Bhutanese Hypertensive Adults. J Health Sci Med Res [Internet]. 2021 Jun. 1 [cited 2024 Dec. 23];39(4):263-72. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/250153
Issue
Section
Original Article
