Factors associated with common mental disorder symptoms and lived experiences among adults with hypertension in Nepal: a mixed-methods study

Abstract

Background In hypertension care, common mental disorder (CMD) symptoms such as depression and anxiety shape adherence, self-management, and outcomes. Evidence from low- and middle-income settings on factors associated with CMD symptom severity and patients’ lived experiences remains limited. This study aimed to examine factors associated with depressive and anxiety symptom severity among adults with hypertension in Nepal and to explore how patients’ lived experiences contextualize the quantitative findings. Methods We conducted a community-based, explanatory sequential mixed-methods study in Budhanilkantha Municipality (Kathmandu, Nepal). Quantitatively, 327 adults with hypertension were selected via systematic random sampling. Depressive and anxiety symptom severity were measured with Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) and modeled as continuous outcomes using linear regression in prespecified blocks (socio-demographic; health/medication; lifestyle) and a fully adjusted model. Qualitatively, we conducted in-depth interviews with 16 purposively selected participants (with and without depressive/anxiety symptoms). Transcripts were thematically analyzed and interpreted using a Biopsychosocial framework. We integrated quantitative and qualitative findings across conceptually related domains to identify areas of convergence, complementarity, and contextual elaboration. Results In fully adjusted models, sleeping ≥6 h per day was associated with lower depressive and anxiety symptom scores. Non-high-caste group was associated with higher depressive symptom scores, whereas older age was associated with lower anxiety symptom scores. Consumption of >2 servings of fruits and vegetables per day was associated with lower depressive symptom scores. Higher household income and controlled blood pressure showed borderline inverse associations with anxiety symptom scores. Qualitatively, hypertensive patients with CMD symptoms reported persistent insomnia, bothersome medication side-effects, activity restriction, loneliness/stigma, anger/fear, low confidence, and financial strain, whereas those without symptoms described adaptation to medicines, stronger family support, and greater self-efficacy. Mixed-methods integration showed strong convergence for sleep, while qualitative findings complemented quantitative patterns related to financial burden and medication experiences and provided contextual elaboration of perceived hypertension symptoms. Discussion Sleep duration, social position, age, diet, and socioeconomic circumstances were associated with CMD symptom severity among adults with hypertension in Nepal. The integrated findings highlight the importance of considering sleep, treatment experiences, financial circumstances, and social support within hypertension care.