Psychology And Biology Mechanism Of The Depression Affecting The Prognosis Of The Hypertension

PartⅠThe use of the Cognitive Emotion Regulation Questionnaire (CERQ) in the hypertensive subjectObjective:The aim of the study was to develop a the Cognitive Emotion Regulation Questionnaire(CERQ) and to examine its psychometric properties in both hypertensive and normative subjects.Methods:This study included 434 hypertensive patients and 462 normative subjects.All of the subjects completed the Cognitive Emotion Regulation Questionnaire-Chinese version,(CERQ-C);Dysfunctional Attitude Scale,(DAS);Mood and Anxiety Symptom Questionnaire-Short Form,(MASQ-SF);Center for Epidemiologic Studies Depression Scale,(CES-D).We calculated the mean inter-item correlations for the total CERQ and for each of the subscales.Cronbach's alpha coefficient was used to analyze the inter-correlations and reliability.We utilized confirmatory factor analysis to examining the nine-factor model,the measurement model consisted of nine first-order factors(self-blame, acceptance,rumination,positive refocus,and refocus on planning, positive reappraisal,putting into perspective,catastrophizing,and blaming others).A one-way multivariate analysis of variance(MANOVA) was computed to examine the effects of gender. Results:(1) The Cognitive Emotion Regulation strategies of hypertension patients and normative sample most frequently used were positive reappraisal.Hypertensive group reported significantly higher scores than that of normative sample on rumination(12.19±2.51/11.51±2.60,p＜0.001) and catastrophizing(8.82±2.19/8.11±2.70, p＜0.001 ),blaming others(10.76±2.11/9.88±2.48,p＜0.001 ) and significantly lower scores than that of normative sample on positive reappraisal(13.80±3.55/14.71±4.11,p＜0.001)(2) Reliability:In hypertension group the Cronbach's alpha for the total CERQ was 0.80, and the Cronbach's alpha coefficient for the nine subscale ranged from 0.71(self-blame) to 0.90(rumination).And in normative group the Cronbach's alpha for the total CERQ was 0.79,and the Cronbach's alpha coefficient for the nine subscale ranged from 0.71(positive reappraisal) to 0.90(rumination).The mean inter-item correlation coefficient for the nine subscale ranged from 0.21-0.42(hypertension group)/0.19-0.32 (normative group).In hypertension group,the test-retest reliability of the total scale was 0.82,the test-retest reliability of nine subscales ranged from 0.73 to 0.92;And in normative group,the test-retest reliability of the total scale was 0.79,the test-retest reliability of nine subscales ranged from 0.71 to 0.88.(3) Confirmatory factor analysis:The results of our CFA suggested that the nine first-order factors data fitted the both two sample well.(χ~2/(df)=2.28,p＜0.001,CFI=0.91,IFI=0.92,RMSEA= 0.05,TLI=0.944)/(χ~2/(df)=2.34,p＜0.001,CFI=0.91,IFI=0.91, RMSEA = 0.08,TLI = 0.90).(4)Convergent and discriminate validity:In hypertensive group self-blame(γ=0.14,p＜0.01),catastrophizing (γ=0.55,p＜0.001),blaming others(γ=0.47,p＜0.001) were positively correlated with the total scores of Dysfunctional Attitude Scale.and positive refocusing(γ=-0.21,p＜0.01 ),putting into perspective(γ=-0.27, p＜0.01) were negatively correlated with the total scores of Dysfunctional Attitude Scale.In normal group,self-blame(γ=0.37,p＜0.001),rumination (γ=0.61,p＜0.001),catastrophizing(γ=0.67,p＜0.001),blaming others (γ=0.49,p＜0.001) were positively correlated with the total scores of Dysfunctional Attitude Scale.refocus on planning(γ=-0.27,p＜0.001), putting into perspective(γ=-0.33,p＜0.001) were negatively correlated with the total scores of Dysfunctional Attitude Scale.Conclusion:The properties that CERQ met the psychometrics standard indicated that it is a reliable and valid assessment of cognitive emotion regulation strategies,and can be considered as an appropriate tool for assessing Part 2 Study on the Cognitive Emotion Regulation strategies of the hypertension patients with depressionObjective:We studied on the cognitive emotion regulation strategies and dysfunctional attitudes of the hypertension patients with or with not depression.Following a psychosocial perspective to study in the onset of depression.Methods:Recruiting 1400 hypertension patients from those patients recorded in the "Family of Hypertensive patients" and the out-patients with essential hypertension.Screening hypertension sufferers with the Hospital Anxiety and Depression Scale(HAD),the subjects with positive results(HAD≥9) were evaluated with HAMA and HAMD.250 patients enter the hypertension with depression group from 263 patients with positive screened result(HAMD≥20,HAMA＜14).And 250 hypertension patients with no depression(HAD＜9) as the members of hypertension with no depression group.250 normative subjects from 462 normative subjects as the members of normative group.All of the them completed the Hospital Anxiety and Depression Scale,(HAD),Cognitive Emotion Regulation Questionnaire,(CERQ),Dysfunctional Attitude Scale,(DAS),Hamilton Anxiety Scale,(HAMA),Hamilton Depression Scale,(HAMD).Results:Significant differences were found in the use of Cognitive Emotion Regulation Questionnaire between the three groups(Wilks' Lambda =0.79,P=0.001,Hotelling's Trace=0.04,P=0.001 ).On the self-blame,positive reappraisal,normative group was reported the highest scores,hypertension with no depression group was ranked the second,and hypertension with depression group was reported the lowest score.On acceptance,refocus on planning factors,it was lower in hypertension with depression group than normative group and higher than hypertension with no depression group.On rumination and catastrophizing factors,it was lower in normative group than hypertension with depression group and higher than hypertension with no depression group.On positive refocusing,was lower in normative group than hypertension with no depression group and higher than hypertension with depression group.On putting into perspective,was lower in hypertension with depression group than hypertension with no depression group and was higher than normative group.On the blaming others factor, was lower in hypertension with no depression group than hypertension with depression group and was higher than normative group.Significant differences were also found in the dysfunctional attitude between the three groups.(Wilks' Lambda =0.67,P=0.001,Hotelling's Trace=0.05, P=0.001 )A comparison among the two competitive models using SEM showed that the model-2 was the optimal model,with better fit indexes than the others(X~2/df(1.882),RMSEA(0.063),CFI(0.932), IFI(0.911),GFI(0.921) ),and with the most parsimonious path(p＜0.01).Conclusion:Patients of hypertension with depression always use negative cognitive emotion regulation strategies,such as rumination, catastrophizing and blame others et al and they existed as dysfunctional attitudes. Part 3 Effects of Antidepressant and Psychological Intervention On Cognitive Emotion Regulation the Quality of Life and Blood Pressure of Hypertension Patients with DepressionObjective:To investigate the effects of antidepressant and psychological intervention on the blood pressure,cognitive emotion regulation and quality of life in hypertension patients with depression were investigatedMethods:After evaluating 1400 patients with essential hypertension by Hospital Anxiety and Depression Scale(HAD), patients with HAD≥9 were evaluated with Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale(HAMA).The subjects with HAMD≥20 and HAMA＜14 were randomly divided into antidepressant and psychological intervention group(n=30,routine drugs treatment, mental state intervention and the usage of antidepressant(seroxat)) and control group(n=30,only routine drugs treatment).CERQ-scores,blood pressure control levels,the quality of life and the level of depression were compared between 2 groups.Results The depression symptoms were significantly improved in intervention group compared to control group.The HAMD score fell from 30.03±1.83 at time of entrance to 17.43±1.96 at time of the study end;The blood pressure control were more effective with antidepressant and psychological intervention,The mean systolic blood pressure(SBP) and diastolic blood pressure(DBP) decreased by 26.17 mmHg and 13.63 mmHg in intervention group,while there were only 14.32 mmHg and 7.18 mmHg decrease in SBP and DBP respectively in control group;And the antidepressant and psychological intervention group was higher score quality of life than that of control group.The total score of GQOLI-74 was raised from 65.97±4.68 before treatment to 71.20±5.13 after treatment.In intervention group the positive cognitive emotion regulation strategies of patients after treatment was improved than before treatment (p＜0.05).Conclusion:The treatment of psychological intervention and usage of antidepressant could increase the positive cognitive emotion regulation strategies;improve the control of blood pressure and quality of life in hypertension patients.Meanwhile decrease the level of CRP.