Severe depressive symptoms in patients with hypertension: Are antihypertensive medications implicated?

OBJECTIVE: This study examined whether antihypertensive medications and other patient characteristics are associated with severe depressive symptoms in patients with hypertension. METHODS: Patients with a diagnosis of hypertension were recruited from the internal medicine outpatient clinics of a hospital in Amman, Jordan, into this cross-sectional study. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9); anxiety by the General Anxiety Disorder-7; sleep quality by the Insomnia Severity Index; and psychological stress by the Perceived Stress Scale. Multivariable binary logistic regression was used to examine the association between the different classes of antihypertensive medication and depressive symptoms. RESULTS: Of the 431 participants, 282 (65.4%) were men; 240 (55.7%) reported having type 2 diabetes; 359 (83.3%) had dyslipidemia; 142 (32.9%) were on beta-blockers; 197 (45.2%) were on ACE inhibitors or angiotensin receptor blockers; 203 (47.1%) were on metformin; and 133 (30.9%) were taking sulfonylurea. Severe depressive symptoms, indicated by scoring above the cut-off of 14 on the PHQ-9, were present in 165 (38.3%) patients. Severe depression was associated with younger age (<55 years) (OR = 3.15, 95% CI = 1.83-5.41, P < 0.001), unemployment (OR = 2.15, 95% CI = 1.15-4.00, P = 0.01), diabetes (OR = 1.81, 95% CI = 1.09-3.02, P = 0.02), severe anxiety (OR = 6.40, 95% CI = 3.64-11.28, P < 0.001), and severe insomnia (OR = 4.73, 95% CI = 2.85-7.82, P < 0.001). CONCLUSION: Severe depressive symptoms were not associated with antihypertensive medications or other drugs used by hypertensive patients. Younger age, diabetes, anxiety, and insomnia were the primary correlates of depression.

Anxiety, stress, and quality of life among Iraqi refugees in Jordan: A cross sectional survey.

This study was conducted to identify the predictors, levels, and prevalence of anxiety and stress and to assess the relationship between these factors and quality of life in recently displaced Iraqis. A cross-sectional design was used. A convenience sample of 171 Iraqi refugees was recruited. The results indicated that more than half of the sample suffered from high anxiety levels, while 42.8% reported high stress. The regression model explained 46.3% of the variance in levels of quality of life. Unemployment, fewer than three family members, and high anxiety significantly predicted low-level quality of life. These three predictors need to be taken into consideration when developing health-related interventions to improve the quality of life of Iraqi refugees.

Dysmenorrhea severity in war refugees with hypertension: a cross-talk with antihypertensives and analgesics.

Background: Dysmenorrhea is the most common gynecological condition among women of reproductive age. Investigating the cross-talk between hypertension and dysmenorrhea is attractive and understudied, moreover, menstrual health is poorly studied in refugees. Objectives: The present study aims at examining the association between dysmenorrhea severity and antihypertensives and analgesics namely acetaminophen and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) used by traumatized Syrian war refugees with hypertension. Methods: This is a cross-sectional study recruiting Syrian female refugees with hypertension. A structured questionnaire probed their demographics and clinical data. Dysmenorrhea severity was assessed using the WaLIDD (working ability, location, intensity, days of pain, dysmenorrhea) self-report scale. Results: Data were analysed from 125 patients, almost half were diabetic, 47 (37.6%) had dyslipidemia, 59 (47%) reported using ß-blockers, 56 (44.8%) reported using ACEIs/ARBs, 43 (34.2) reported using CCBs and 30 (25%) were using diuretics. According to the multivariate binary logistic regression, severe dysmenorrhea was associated with acetaminophen OR 6.5, 95%CI (1.39-30.55), p=0.02 and NSAIDs use OR 2.97, 95%CI (1.28-6.89), p=0.02. Antihypertensive drugs were not associated with dysmenorrhea severity. Conclusion: Determinants of severe dysmenorrhea in patients with hypertension need more study, herein we report that analgesics but not antihypertensives are not associated with dysmenorrhea severity.

Evaluation of the antinociceptive effect of valerian and hops combination in experimental animal models: Involvement of the opioid system.

Pain is a common undertreated worldwide complaint. The need to explore the antinociceptive potential of alternative herbal products is essential. Although used as a mild sedative, limited evidence focused on the potential antinociceptive effect of valerian and hops combination. The present study was carried out to evaluate the in vivo anti-nociceptive effect of the valerian-hops combination to justify its use as an effective and safe analgesic agent. Anti-nociceptive effects of valerian-hops combination (50, 100, and 200 mg/kg) were assessed in swiss albino mice for performing the acetic acid-induced writhing test, the paw licking test using formalin, the paw licking test using glutamate, and the tail immersion test. The effects were compared to those of diclofenac or morphine in the presence or absence of the opioid receptor antagonist naloxone. Valerian-hops" extract of 100 and 200 mg/kg demonstrated a significant reduction in the number of writhing episodes induced by acetic acid compared to the control (p < 0.05), a significant reduction in the licking number at doses of 100 and 200 mg/kg in the late phase formalin-induced paw licking, significantly reduced the number of lickings after glutamate injection compared to control (p < 0.05). And significantly increased pain reaction after 60 and 90 min of tail immersion test, this effect was opposed by naloxone treatment. The valerian-hops combination produced a significant antinociceptive effect that involved the opioid system. Further studies are required to fully uncover the underlying active constituents and their mechanisms.

Relationship between anxiety, post-traumatic stress, insomnia and fibromyalgia among female refugees in jordan: A cross-sectional study.

WHAT IS KNOWN ON THE SUBJECT?: Fibromyalgia (FM) is a syndrome of chronic widespread pain, typically associated with fatigue, sleep, cognitive dysfunction and disordered mood. FM may limit an individual's ability to participate in everyday work and social activities, thereby making it difficult to maintain normal relationships with other individuals. While it has been studied in different populations and settings, the impact of FM and associated psychological factors has not been previously studied among female war refugees. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The study showed the high impact of FM on female refugees in Jordan; approximately three quarters of the participants had a moderate to severe FM impact. Refugees settled in Irbid city, Iraq, showed increased age, anxiety and post-traumatic stress disorder correlated with a higher FM impact. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study recommends evaluation of the impact of FM among all female refugees living in Jordan, along with its neighbouring countries hosting refugees. Healthcare providers, including mental health nurses, should be aware of the role of PTSD and anxiety on the impact of FM. Accordingly, healthcare workers should design appropriate mental health treatment plans to help to decrease the impact of FM. Mental health nurses should evaluate FM impact among all refugees worldwide. Nurses in Jordan are recommended to share their experience with nurses outside of Jordan as this may help with funds being obtained and the implementation of advanced psychological interventions. ABSTRACT: INTRODUCTION: Fibromyalgia (FM) is a syndrome of chronic widespread pain. While it has been studied in different populations and settings, the impact of FM and its associated psychological factors has not been previously studied among female war refugees. AIM: To assess the impact of FM and its associated factors in female refugees. METHODS: A cross-sectional study was conducted. The impact of FM, anxiety, post-traumatic stress (PTSD) and insomnia was investigated. RESULTS: 288 refugees previously diagnosed with FM were recruited. The results showed that 73.62% of the participants had a moderate to severe FM impact. Refugees settled in Irbid city were six times more likely to have a higher FM impact than refugees settled in Zarqa, and Iraqi refugees were more likely to have a higher impact than Syrian. Increased age, anxiety and PTSD were correlated with a greater impact. CONCLUSION: Mental health nursing services should be directed towards female refugees, particularly those with increased age, anxiety and PTSD. IMPLICATIONS FOR PRACTICE: Mental health nurses should evaluate the FM impact among all refugees worldwide. Furthermore, nurses in Jordan are recommended to share their experiences with nurses outside of Jordan, as this may help to raise funds and implement advanced psychological interventions.

The prevalence and the predictors of insomnia among refugees.

This study aimed to investigate the prevalence of insomnia and associated sociodemographic factors among refugees in Jordan. A cross-sectional survey was undertaken with a representative sample of 373 refugees. The majority of refugees had moderate to severe insomnia (n = 196, 52.2%). Older age, living in the city of Mafraq, having secondary education or below, unemployed, and lacking easy access to medication were the predictors of higher insomnia. More attention by health care providers including nurses should be given to older refugees and those with a lower level of education, as these groups tend to be more liable to suffer from insomnia.

Predictors of Coping Strategies Employed by Iraqi Refugees in Jordan.

The purpose of this study was to examine coping strategies used by Iraqi refugees in Jordan based on their demographic details. A cross-sectional design was used. A representative sample of 333 refugees living in Jordan participated in the study. The Cope inventory and the demographic details were compiled to produce and collate the relevant data. Being older, female, educated, single, and living with more than three family members was associated with greater use of the problem solving coping strategy. Being female, educated, and unemployed was associated with greater use of the active emotional coping strategy. In addition, being older, male, illiterate, unemployed, and living with less than three family members was associated with greater use of the avoidant emotional coping strategy. This study recommends a multidisciplinary approach intervention as being the best method of addressing and fulfilling the health and socioeconomic needs of older, male, illiterate, unemployed people.

Salivary Nitric Oxide, a Biomarker for Stress and Anxiety?

OBJECTIVE: To investigate if salivary nitrate correlates to the daily psychological stress and anxiety in a group of human subjects. METHODS: The convenient sample recruitment method was employed; data from seventy three subjects were analyzed. The Perceived Stress Scale (PSS) and Hamilton Anxiety Rating Scale (HAM-A) inventories were used to determine stress and anxiety scores respectively. Salivary nitric oxide was measured through nitrate (NOx) levels using the Griess reaction method. RESULTS: Although stress and anxiety were correlated. No significant correlation exists between salivary nitrate and daily psychological stress and anxiety in the study's participants. CONCLUSION: While all previous studies focused NOx levels in acute stress models. This is the first study to investigate the correlation between salivary nitrates and daily psychological stress and anxiety. Although stress and anxiety were correlated, there is no correlation between salivary nitrates and daily psychological stress and anxiety. Further studies are required to investigate this correlation using other biological samples such as plasma.

Efficacy of single dose antihistamine vs. single dose valerian-hops in subjective sleep measures among war refugees: a comparison trial

Abstract Background Many sedatives and anxiolytics are used in single dose or chronically to aid sleep. Clinically important sedatives include valerian-hops and antihistamines as they are used over the counter and are highly accessible and safe agents. Objectives To evaluate and compare a single dose of chlorpheniramine versus valerian-hops combination in modulating subjective sleep measures in insomniac war refugees. Methods Insomnia among refugees was screened using the Insomnia Severity Index (ISI). Insomniac subjects were randomized to received a single dose valerian-hops (320/80 mg) (n = 65), or chlorpheneramine (4 mg) (n = 50) or placebo (n = 76) two hours prior sleeping. Participants were instructed to complete Leeds Sleep Evaluation Questionnaire (LSEQ), visual analogue scales of anxiety and sedation. Also sleep latency, total hours slept and self-rated improvement were obtained. Results Almost 75% of screened refugees had insomnia. Chlorpheneramine reduced sleep latency and anxiety significantly, however it resulted in poor sleep quality. Valerian-hops group showed marked anxiolysis one hour after dosing, a sleep quality similar to placebo and better than chlorpheneramine, and better alertness compared to placebo. Participants satisfaction was higher with chlorpheneramine and there was no difference in the total hours slept. Discussion Valerian-hops combination may provide better sleep quality than antihistamines.