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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018
366
AFRICA
Cultural coping as a risk for depression and
hypertension: the SABPA prospective study
S Le Roux, GA Lotter, HS Steyn, L Malan
Abstract
Objectives:
In past studies, a lack of social support has been
associated with cardiovascular disease (CVD) risk, particular-
ly in black Africans. However, whether or not coping strategies
have beneficial effects on blood pressure (BP) and emotional
well-being is not clear. We therefore assessed the relationship
between BP levels, depression and coping strategies.
Methods:
A prospective bi-ethnic cohort followed 359 black
and white South African school teachers (aged 20–65 years)
over a three-year period. Data on ambulatory 24-hour blood
pressure, depression, coping strategies (defensiveness, social
support, avoidance) and culture-specific coping scores (cogni-
tive/emotional debriefing, spiritual-, collectivistic and ritual-
centred) were obtained.
Results:
Over three years, chronic depression (38 vs 19%) and
hypertension (68 vs 35%) were apparent in blacks (
d
-values
>
0.3) as opposed to whites. In both groups, depression was
accompanied by more avoidance (loss-of-control) coping.
Consistent spiritual and increasing collectivistic coping were
apparent in whites. Over time, increasing defensiveness (OR
1.08,
p
≤
0.05) and ritual coping (OR 1.27,
p
≤
0.01;
d
-values
>
0.5), predicted chronic depression in blacks. The change in
their symptoms of depression predicted 24-hour hypertension
(OR 1.11,
p
=
0.04). No similar associations existed in whites.
Conclusions:
Blacks showed increasing defensiveness and
ritual- and spiritual-centred coping in an attempt to combat
chronic depression, which may be costly, as reflected by their
chronic hypertensive status. Whites showed consistent spiritu-
al-centred coping while utilising avoidance or loss-of-control
coping, with a trend of seeking less social support or isola-
tion as a coping mechanism. During counselling of depressed
patients with hypertension, the beneficial effects of social
support and spiritual coping may be of great importance.
Keywords:
coping, religion, social support, hypertension, depres-
sion
Submitted 7/5/18, accepted 21/7/18
Published online 22/8/18
Cardiovasc J Afr
2018;
29
: 366–373
www.cvja.co.zaDOI: 10.5830/CVJA-2018-045
Over the last decade, sub-Saharan Africa (SSA) has been
experiencing globally unprecedented rates of hypertension,
and a large proportion of the hypertensive SSA population
remains undiagnosed, and untreated or inadequately treated.
1,2
Recent findings have raised further concern about the rise in
incidence of hypertension, a non-communicable disease, globally
responsible for an estimated 45% of deaths due to heart disease
and 51% of deaths due to stroke, and the seemingly ineffective
management of high blood pressure (BP) levels.
3-5
Stress coping methods have been studied and analysed for
some time, but studies have also identified the need to focus on
the influence of culture on coping styles.
6
The devastating health
effects of hypertension have also caused an increase in studies,
such as this one, that specifically examined the possible link
between high BP and differing cultural coping styles.
7,8
This study defined coping as an individual’s own conscious
skills, strategies and mechanisms, such as defensiveness,
emotional avoidance or seeking social support, to handle, deal
with, solve, master, minimise or tolerate stressful situations
in life.
9
In this study, we expand culture-specific coping into
various coping norms (cognitive/emotional debriefing, spiritual-,
collectivistic and ritual-centred coping) among black and white
South African teachers.
6
Spiritual coping, particularly, was defined as an individual’s
ability to utilise faith in God and Judeo-Christian religious
beliefs and active practices in order to appraise, understand, and
effectively cope with stressful life events.
10
Various recent studies
have provided considerable findings speculating that in cultures
where spiritual coping is included as a coping method, beneficial
effects on BP levels can be assessed.
Koenig’s findings over the last two decades have strongly
inferred that cultures that embrace spiritual coping have seen
salutary effects on health and well-being.
9,10
Some studies
systematically analysed the relationship between multiple
dimensions of cultural coping and several biological markers,
including hypertension and depression.
9-11
Findings also asserted
that the association between spiritual coping and hypertension
is not uniform for all ethnic groups, and that there is a
higher prevalence of hypertension among blacks than whites,
as revealed by measures of diastolic blood pressure (DBP) and
systolic blood pressure (SBP).
3,12,13
Three different coping mechanisms during chronic stress
have previously been identified, namely active defensive coping
(DefS), referring to ways of coping that focus on trying to
control a perceived stressor or continuing to function despite
Faculty of Theology, North-West University, Potchefstroom,
South Africa
S le Roux, MDiv
GA Lotter, ThD
Statistical Consultation Services, North-West University,
Potchefstroom, South Africa
HS Steyn, DSc
Hypertension in Africa Research Team (HART), Centre of
Excellence, North-West University, Potchefstroom, South
Africa
L Malan, RN, PhD,
leone.malan@nwu.ac.za