Cultural coping as a risk for depression and hypertension: the SABPA prospective study

Abstract

Objectives: In past studies, a lack of social support has been associated with cardiovascular disease (CVD) risk, particularly in black Africans. However, whether or not coping strategies have beneficial effects on blood pressure (BP) and emotional well-being is not clear. We therefore assessed the relationship between BP levels, depression and coping strategies. Methods: A prospective bi-ethnic cohort followed 359 black and white South African school teachers (aged 20-65 years) over a three-year period. Data on ambulatory 24-hour blood pressure, depression, coping strategies (defensiveness, social support, avoidance) and culture-specific coping scores (cognitive/emotional debriefing, spiritual-, collectivistic and ritualcentred) were obtained. Results: Over three years, chronic depression (38 vs 19%) and hypertension (68 vs 35%) were apparent in blacks (d-values > 0.3) as opposed to whites. In both groups, depression was accompanied by more avoidance (loss-of-control) coping. Consistent spiritual and increasing collectivistic coping were apparent in whites. Over time, increasing defensiveness (OR 1.08, p ≤ 0.05) and ritual coping (OR 1.27, p ≤ 0.01; d-values > 0.5), predicted chronic depression in blacks. The change in their symptoms of depression predicted 24-hour hypertension (OR 1.11, p = 0.04). No similar associations existed in whites. Conclusions: Blacks showed increasing defensiveness and ritual-and spiritual-centred coping in an attempt to combat chronic depression, which may be costly, as reflected by their chronic hypertensive status. Whites showed consistent spiritual-centred coping while utilising avoidance or loss-of-control coping, with a trend of seeking less social support or isolation as a coping mechanism. During counselling of depressed patients with hypertension, the beneficial effects of social support and spiritual coping may be of great importance.

Associations of conscientiousness with cardiac troponin T and stress coping responses in a teacher cohort: the SABPA prospective cohort study

“…This is in agreement with other findings that social support networks can increase the efficacy of DefS. 4,53 As a collectivistic culture, Africans tend to depend more on each other, explaining their tendency to make use of social support systems. 3,6,53,54 The Caucasians by contrast showed flexibility with regard to DefS and avoidance coping, rather than utilising social support seeking coping.…”

“…4,53 As a collectivistic culture, Africans tend to depend more on each other, explaining their tendency to make use of social support systems. 3,6,53,54 The Caucasians by contrast showed flexibility with regard to DefS and avoidance coping, rather than utilising social support seeking coping. In the Caucasians' individualistic culture, independency is regarded as important and may therefore explain why these individuals do not rely on social support coping.…”

“…In the Caucasians' individualistic culture, independency is regarded as important and may therefore explain why these individuals do not rely on social support coping. 3,6,53,54 For Africans, the decrease in social support systems and individualism that accompanies an urbanised Western culture may leave them more emotionally distressed, which may explain their higher neuroticism score, compared to Caucasians. 3,6,53 Despite a higher neuroticism score, Africans also scored lower in conscientiousness compared to Caucasians.…”

“…3,6,53,54 For Africans, the decrease in social support systems and individualism that accompanies an urbanised Western culture may leave them more emotionally distressed, which may explain their higher neuroticism score, compared to Caucasians. 3,6,53 Despite a higher neuroticism score, Africans also scored lower in conscientiousness compared to Caucasians. In both races, neuroticism was associated inversely and conscientiousness positively with DefS.…”

Interaction of anxiety, depression and hypertension on quality of life in patients with gynecological tumor and the moderating effect of social support

“…This showed that the problem of hypertension in patients with gynecological tumor can not be ignored. Epidemiological studies showed that the incidence rate of hypertension and depression is more than 4.95% [22]. A survey in Ghana found that 56.0% of hypertensive patients had anxiety symptoms [23].…”