Association between psychosocial distress and a history of cardiovascular events among adults with hypertension in the SAVA Region, Madagascar : a multicenter cross-sectional study

Background In the SAVA Region, data on the association between psychosocial factors and cardiovascular events among adults with hypertension remain limited, despite a potentially unfavorable health and socioeconomic context. This study aimed to identify psychosocial factors associated with a history of cardiovascular events and to determine whether these associations persisted independently of major traditional cardiovascular risk factors. Methods This secondary analysis used data from a multicenter cross-sectional study conducted between December 2024 and February 2025 among adults with hypertension recruited from four referral hospitals in the SAVA Region, Madagascar. Socioeconomic characteristics and history of cardiovascular events were collected using the World Health Organization STEPwise questionnaire. Psychosocial factors were assessed using validated instruments, including the 10-item Perceived Stress Scale (PSS-10), the Hospital Anxiety and Depression Scale (HADS), the 6-item Lubben Social Network Scale (LSNS-6), the 6-item De Jong Gierveld Loneliness Scale, and the 6-item Social Support Questionnaire (SSQ6). Bivariate analyses and multivariable logistic regression were performed using SPSS version 25.0. Statistical significance was set at p < 0.05. Results A total of 394 adults with hypertension were included. The mean age was 53.03 ± 14.3 years, and 57.6% were women. Overall, 31.47% reported a history of cardiovascular events. In bivariate analyses, perceived stress, anxiety, depression, anxiety-depressive disorders, social isolation, and social support were significantly associated with a history of cardiovascular events. After adjustment for potential confounders, perceived stress, anxiety, and anxiety-depressive disorders remained significantly associated with a history of cardiovascular events. Conclusions Perceived stress, anxiety, and anxiety-depressive disorders remained associated with a history of cardiovascular events after adjustment for major cardiovascular risk factors. These findings support the potential value of incorporating psychosocial assessment into the comprehensive care of adults with hypertension.