| Hypertension is one of the most common chronic diseases in the aging population.Given its high prevalence,peniciousness and resource consumption,it has become a major impact factor to quality of life in older adults.Community is a main place of older people's daily living.and the most effective approach for controlling hypertension is community-based long-term care.However,the current community-based care for hypertension is solely focusing on individuals'physical health,with ignoring their mental and social needs,and thus results in poor hypertension control in older patients.With the long-term goal of improving health conditions in older patients with hypertension,we proposed a new community-based psychological intervention to manage their hypertension.The purposes of the present dissertation are to establish the theoretical model of the psychological intervention and examine its effectiveness.The dissertation includes six studiesIn study I,we investigated 10389 rural older patients with hypertension aged 60 or more.their mean age was 71.5±8.1 years old.Measurements included demographic characteristics such as sex and age,blood pressure and the Patient Health Questionnaire-9(PHQ-9).The prevalence of depression in the population was 12.8%.and the rate is much higher in those with uncontrolled hypertension than in those controlled(32.8%vs 5.3%,?2?8.701,p<0.01).Additionally,age.sex.systolic blood pressure and hypertension control are risk factors of depressionThe study 2 was aimed to examine the mediation of treatment adherence in the association between depression and hypertension control.Subjects included 2362 older patients aged 60 or more with both hypertension and depression,and the evaluations included demographic characteristics,blood pressure,the 17-item Hamilton Depression Rating Scale(HDRS-17),the 8-item Medication Adherence Scale(MAS-8)and Charlson Comorbidity Index(CCI).Compared to those with controlled hypertension,older patients with uncontrolled hypertension had higher HDRS-17 scores(t=5.76.p<0.01)and lower treatment adherence(t=3.81.,p<0.01).The mediation analysis for binary outcomes showed that the association between depression and hypertension control was partially mediated by treatment adherence(Zab=2.44,p<0.01)The study 3 explored the impacts of social support on depression and hypertension control Subjects included 2351 older patients aged 60 or more with both hypertension and depression.and the evaluations included demographic characteristics,blood pressure,the HDRS-17,the Medical Outcomes Study Social Support Survey(MOS-SSS)and CCI.The results showed that social support and its four dimensions were all significantly associated with hypertension control.which relationship was partially mediated by depression(Zab=-3.86,P<0.01)The study 4 examined the psychosocial modelfor managing hypertension which was established based on study 2 and 3.In general,the results of structural equation model(SEM)analysis supported the proposed psychosocial model,but also suggested there existed a pathwaN between social support and treatment adherence.which relationship was consistent with previous studiesBased on the psychosocial model,we proposed a community-based psychosocial intervention for older adults with hypertension,which integrated the care provided by a community doctor with that delivered by an aging worker,supervised by a psychiatrist consultant to achieve bet-ter outcomes of managing depression.The study 5 is a randomized control trial to test the effectiveness of the intervention compared to care as usual.Subj ects included 2365 older patients with comorbid hypertension and depression,and the intervention last for 12 months.Data collection was conducted at baseline.3-,6-,9,and 12-month.The measurements included blood pressure,HDRS-17.MAS-8,MOS-SSS and some covariates.The results of the Generalized Linear Mixed Model showed that,compared to the CAU group,those in the intervention group achieved better outcomes on social support,depression,treatment adherence and hypertension control.To deeply understand the mechanism of the intervention,in study 6 we performed SEM to test the validity,of the psychosocial model in a longitudinal data context.The results indicated acceptable validity and degree of fitting of the modelIn a word,both depression and social support are important to one's treatment adherence and hypertension,approaches for managing hypertension should address depression and social support as well.The psvchosocial intervention integrating the care provided by a community doctor with that delivered by an aging worker is effective in managing hypertension,which could be disseminate to other cities in china in the future. |
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