Introduction: Cardio vascular diseases (CVD) are the leading cause of mortality worldwide, and are significantly associated with multiple cormobid disorders including mental disorders. At increased risk of psychological distress (PD) is the sub-category of patients that not only require chronic therapy but the need for follow up with continuous blood tests and dose adjustments (like the patients on warfarin). A number of factors have been shown to be associated with PD including factors which are a direct result of the underlying CVD, those resulting from issues pertaining to therapy and also other wider determinants of PD. However, not much has been done to ascertain the burden of PD among patients on warfarin in Uganda.
Objective: The objective of this study was to determine the prevalence and factors associated with PD among patients on anticoagulation with warfarin at the Uganda Heart Institute (UHI).
Methods: In this descriptive cross-sectional study, 197 participants were sampled from adults on warfarin attending the Uganda Heart Institute (UHI) out patient clinic.The Self Reporting Questionnaire (SRQ-20) was used to assess the patients for PD, and a socio-demographic questionnaire to document the socio-demographic characteristics of the subjects. Additional questions including the underlying CVD diagnosis, medications used (besides warfarin) and presence of chronic illnesess were also assessed. Frequencies and proportions were used to describe the sample characteristics. Bi-variable and multi-variabe analysis techniques were used to examine the associations between the dependent and independent variables.
Results: The prevalence of PD was 32%. The unemployed participants were 4.5 times more likely to have PD (aOR 4.56 [1.12-18.62]p=0.04). Participants who had experienced social stressors were more likely to have PD (aOR11.38 [3.60-36.04]p<0.01). A shorter length of time on warfarin was associated with PD (aOR 0.03 [0.07-0.74]p=0.04). Presence of other chronic comorbidities was associated with PD (aOR 3.69 [1.24-11.02]p=0.02) as well as concomitant use of loop diuretics (aOR 4.13 [1.67-10.19]p<0.01).
Conclusion: The prevalence of PD was high among patients on warfarin in this low income setting and there is a need to characterize the specific psychiatric disorders in patients with CVD. Interventions that address the high burden of PD are urgently needed in this setting.