Analysis Of Factors Influencing Anxiety And Depression In Middle-aged And Young Hypertensive Patients During COVID-19 And Evaluation Of Comprehensive Psychological Intervention

Objective:To investigate and analyze the psychological status and main influencing factors of middle-aged and young hypertensive patients during the COVID-19 epidemic,and to explore the effects of comprehensive psychological interventions on the improvement of anxiety,depression and blood pressure control in young and middle-aged patients with hypertension during the COVID-19 epidemic.To provide theoretical basis for blood pressure control and improvement of psychological disorders in young and middle-aged patients with hypertension during the epidemic period.Methods:Part Ⅰ:The Chinese and English databases were searched,supplemented by manual retrieval and literature traceability.Keywords and free words were used in the retrieval method.Two researchers independently screened literatures,extracted data,and evaluated the quality of included studies.Meta-analysis was performed using Revman 5.3 software.Part Ⅱ:A cross-sectional survey was conducted among young and middle-aged hypertension patients during the epidemic period.The results were statistically analyzed by SPSS 25.0 software.Part Ⅲ:A total of 172 middle-aged and young hypertensive patients recruited from the above investigation were selected as research objects,and were divided into psychological disorders group(n=122)and no psychological disorders group(n=50)according to whether they were combined with anxiety and depression.Convenience sampling was adopted.A total of 122 middle-aged and young patients with hypertension complicated with psychological disorders were randomly divided into intervention group(n=61)and control group(n=61).Patients in the intervention group received routine anti-hypertensive therapy on the basis of comprehensive psychological intervention measures.SPSS 25.0 software was used to analyze the differences of blood pressure level and anxiety and depression scale scores among the three groups before and after intervention.Results:Part Ⅰ:Fifteen literatures were included,including 11515 subjects,and meta-analysis results showed that the incidence of anxiety in young and middle-aged hypertension patients before COVID-19 was 28.57%(95%CI:14.53%,48.45%).The incidence of depression was 21.26%(95%CI:11.50%,35.06%).Part Ⅱ:During the epidemic period,73 young and middle-aged patients with hypertension were accompanied with anxiety symptoms,including 67 patients(38.95%)with mild anxiety,5 patients(2.91%)with moderate anxiety,and 1 patient(0.58%)with severe anxiety.49(28.49%)were accompanied by depression,,including 47 patients(27.33%)with mild depression and 2 patients(1.16%)with moderate depression.Multivariate Logistic regression analysis showed that age,drinking history,sleep quality,education level,income level,attention to the epidemic and fear of COVID-19 were the main influencing factors of anxiety in middle-aged and young hypertension patients during the epidemic(P<0.05).Age,gender,drinking history,income level and attention to epidemic situation were the main influencing factors of depression in middle-aged and young hypertension patients during epidemic period(P<0.05).Part Ⅲ:Before intervention,there was no significant difference in mean systolic blood pressure,mean diastolic blood pressure,SAS score and SDS score between the intervention group and the control group(P>0.05).At the end of the 8th week of intervention,there were significant differences in mean systolic blood pressure(144.67±7.62 vs 128.64±6.99,P<0.01),mean diastolic blood pressure(82.69±8.56 vs 75.54±6.45,P<0.01),SAS score(50.07±7.56 vs 41.12±3.80,P<0.01),SDS score(50.08±6.22 vs 40.66±4.88,P<0.05)before and after intervention;There were significant differences in mean systolic blood pressure(128.64±6.99 vs 136.68±6.17,P<0.01),SAS score(41.12±3.80 vs 48.88±3.86,P<0.01),SDS score(40.66±4.88 vs 48.55±5.03,P<0.01)between the intervention group and the control group,but there was no significant difference in mean diastolic blood pressure(75.54±6.45 vs 78.10±8.08,P>0.05)between the two groups;There was significant difference in SAS score(41.12±3.80 vs 32.02±3.91,P<0.01)and SDS score(40.66±4.88 vs 33.12±3.71,P<0.01)between the intervention group and the disorder group,but there was no significant difference in mean systolic blood pressure(128.64±6.99 vs 124.04±6.25,P>0.05)and mean diastolic blood pressure(75.54±6.45 vs 65.88±4.07,P>0.05)between the two groups.Conclusion:1.The detection rates of anxiety and depression in young and middle-aged hypertension patients during COVID-19 are higher than those before the epidemic.Among them,age,drinking history,sleep quality,education level,income level,attention to the epidemic and fear of COVID-19 were the main factors influencing the anxiety of middle-aged and young hypertension patients during the epidemic.Age,gender,drinking history,income level and attention to the epidemic were the main influencing factors for depression in middle-aged and young hypertension patients during the epidemic period.2.Comprehensive psychological intervention on the basis of conventional anti-hypertensive treatment can effectively reduce the blood pressure level of young and middle-aged hypertension patients during the epidemic period and improve the anti-hypertensive effect.Moreover,it can effectively improve the anxiety and depression symptoms of middle-aged and young hypertension patients during the epidemic.