Associations of depression with hypertension and citizenship among U.S. adults: A cross-sectional study of the interactions of hypertension and citizenship

Emmanuel A Odame; Paul H Atandoh; Lohuwa Mamudu; David Adzrago; Ishmael Tagoe; Saanie Sulley; Maureen Boms; Erasmus Tetteh-Bator; Timothy S McNeel; Faustine Williams

doi:10.1016/j.pmedr.2023.102523

Associations of depression with hypertension and citizenship among U.S. adults: A cross-sectional study of the interactions of hypertension and citizenship

Prev Med Rep. 2023 Nov 23:36:102523. doi: 10.1016/j.pmedr.2023.102523. eCollection 2023 Dec.

Authors

Affiliations

¹ Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
² Department of Mathematics, Mercer University, Macon, GA, USA.
³ Department of Public Health, California State University, Fullerton, CA, USA.
⁴ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
⁵ Division of Health Services, College of Nursing and Advanced Health Professions, The Chicago School of Professional Psychology, IL, USA.
⁶ National Healthy Start Association, Washington, DC, USA.
⁷ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Department of Mathematics and Statistics, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.
⁹ Information Management Services, Inc, Calverton, MD, USA.

Abstract

With the increasing prevalence of hypertension-related cardiovascular deaths and depression, this study examined the associations of depression with hypertension, citizenship status, and interaction of hypertension and citizenship status among U.S. adults. Data from the 2015-2018 National Health Interview Survey (NHIS), including 63,985 individuals, were analyzed. Depression status was the outcome, with hypertension and U.S. citizenship status as the main independent variables. Using odds ratio (OR) estimates, we evaluated the associations between hypertension and depression, and citizenship status. The result indicates that a higher proportion of U.S. adults with hypertension reported depression compared to those who did not have hypertension (42.9 % vs. 37.5 %). In terms of U.S. citizenship status, a higher proportion of U.S. citizens reported depression than non-citizens (39.6 % vs. 31.6 %). However, non-citizens with hypertension were more likely to report depression compared to U.S. citizens without hypertension (OR = 1.46; 95 % CI = 1.15, 1.86). While hypertension marginally increased the odds of depression among the general U.S. population, being a non-U.S. citizen with hypertension significantly increased the risk of depression by 46 %. The findings imply that the healthy immigrant paradox, in the context of hypertension-depression prevention and control, may not apply to non-citizens with hypertension. We therefore recommend community-based screenings and more tailored interventions to address these health disparities while taking into consideration the unique cultural norms, behaviors and healthcare barriers encountered by specific immigrant communities.

Keywords: Citizenship; Comorbidity; Depression; Hypertension; Immigrant.