Association Between Depressive Symptom Severity and Treatment Adherence Among Primary Care Patients with Hypertension in Taizhou, East China: A Multicenter Cross-Sectional Study
- 1Department of Pulmonary and Critical Care Medicine, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, 310022, People’s Republic of China
- 2Geriatric Medicine Center, Department of Geriatric Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People’s Republic of China
Abstract
Background: Depressive symptoms are common among adults with hypertension and may interfere with the medication-taking and lifestyle behaviours required for long-term treatment. Evidence from Chinese primary care is limited, and most previous studies assessed medication-taking alone rather than overall treatment adherence.
Methods: In this multicenter cross-sectional study conducted from January to December 2023, 2892 adults with physician-diagnosed hypertension were included from 12 primary health-care centres in Taizhou, Zhejiang Province, East China. Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9), and treatment adherence was measured using the Hypertension Treatment Adherence Scale (TASHP). Sequentially adjusted logistic regression was used to estimate associations, and restricted cubic splines described the dose-response relationship.
Results: Of the 2892 participants (mean age 70.9 ± 10.4 years; 54.6% women), 1304 (45.1%) reported poor treatment adherence and 643 (22.2%) had PHQ-9 scores ≥5. In the fully adjusted model, a PHQ-9 score of ≥5 was associated with higher odds of poor adherence than a PHQ-9 score of 0–4 (adjusted odds ratio [aOR] 1.93, 95% confidence interval [CI] 1.59–2.33, P < 0.001). In a model with a linear term, each 1-point increase in PHQ-9 score was associated with a 12% increase in odds (aOR 1.12, 95% CI 1.09–1.16). Compared with scores of 0–4, the aOR was 1.89 (95% CI 1.56–2.30) for scores of 5–9 and 2.61 (95% CI 1.31–5.20) for scores of ≥10; the dose-response relationship was non-linear (P for non-linearity < 0.001).
Conclusion: Greater depressive symptom severity was associated with poorer self-reported treatment adherence among Chinese primary care patients. Prospective and interventional studies are warranted before depression screening or integrated care can be recommended to improve adherence.
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BibTeX
@article{liu2026association,
title = {{Association Between Depressive Symptom Severity and Treatment Adherence Among Primary Care Patients with Hypertension in Taizhou, East China: A Multicenter Cross-Sectional Study}},
author = {Qingqing Liu and Li Zhang and Dongsheng Sun and Jianhong Xie and Dibo Lao and Lin Wang},
journal = {Patient preference and adherence},
year = {2026},
month = oct,
doi = {10.2147/ppa.s642856},
url = {https://doi.org/10.2147/ppa.s642856},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association Between Depressive Symptom Severity and Treatment Adherence Among Primary Care Patients with Hypertension in Taizhou, East China: A Multicenter Cross-Sectional Study
AU - Qingqing Liu
AU - Li Zhang
AU - Dongsheng Sun
AU - Jianhong Xie
AU - Dibo Lao
AU - Lin Wang
PY - 2026
DA - 2026/10/31
JO - Patient preference and adherence
DO - 10.2147/ppa.s642856
UR - https://doi.org/10.2147/ppa.s642856
AB - Background: Depressive symptoms are common among adults with hypertension and may interfere with the medication-taking and lifestyle behaviours required for long-term treatment. Evidence from Chinese primary care is limited, and most previous studies assessed medication-taking alone rather than overall treatment adherence. Methods: In this multicenter cross-sectional study conducted from January to December 2023, 2892 adults with physician-diagnosed hypertension were included from 12 primary health-care centres in Taizhou, Zhejiang Province, East China. Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9), and treatment adherence was measured using the Hypertension Treatment Adherence Scale (TASHP). Sequentially adjusted logistic regression was used to estimate associations, and restricted cubic splines described the dose-response relationship. Results: Of the 2892 participants (mean age 70.9 ± 10.4 years; 54.6% women), 1304 (45.1%) reported poor treatment adherence and 643 (22.2%) had PHQ-9 scores ≥5. In the fully adjusted model, a PHQ-9 score of ≥5 was associated with higher odds of poor adherence than a PHQ-9 score of 0–4 (adjusted odds ratio [aOR] 1.93, 95% confidence interval [CI] 1.59–2.33, P < 0.001). In a model with a linear term, each 1-point increase in PHQ-9 score was associated with a 12% increase in odds (aOR 1.12, 95% CI 1.09–1.16). Compared with scores of 0–4, the aOR was 1.89 (95% CI 1.56–2.30) for scores of 5–9 and 2.61 (95% CI 1.31–5.20) for scores of ≥10; the dose-response relationship was non-linear (P for non-linearity < 0.001). Conclusion: Greater depressive symptom severity was associated with poorer self-reported treatment adherence among Chinese primary care patients. Prospective and interventional studies are warranted before depression screening or integrated care can be recommended to improve adherence.
SN - 1177-889X
ER -