Urban, Peri‐Urban, and Rural Differences in Sociodemographic Correlates of Stress, Anxiety, and Depression Among Hypertensive Adults in Ashanti, Ghana

Background Hypertension is increasingly recognized as a chronic condition influenced by biological, psychosocial, and contextual factors. Yet, evidence on geographic and sociodemographic disparities in mental health among hypertensive populations in sub‐Saharan Africa is limited. This study examined urban, peri‐urban, and rural differences in the sociodemographic correlates of stress, anxiety, and depression among hypertensive adults in the Mampong Municipality. Method A facility‐based cross‐sectional study was conducted among 332 adults with diagnosed hypertension from urban (Mampong Central), peri‐urban (Kofiase), and rural (Adidwan) settlements. Differences across settlements were assessed using chi‐square tests, while multivariable logistic regression was used to identify independent predictors of psychological outcomes. Results Significant variations in stress, anxiety, and depression were observed across settlements (all p < 0.05). Higher proportions of moderate‐to‐severe stress, anxiety, and depression were recorded in peri‐urban and rural settlements compared with the urban setting. In adjusted analyses, residence in Mampong Central was associated with lower odds of stress (adjusted odds ratio [AOR] = 0.20 and p = 0.012) and depression (AOR = 0.12 and p = 0.001) relative to Adidwan. Residence in Kofiase significantly increased the odds of anxiety (AOR = 6.29 and p = 0.007). Younger age (18–35 years) was consistently associated with lower odds of all psychological outcomes ( p < 0.05). Male sex was protective against stress and depression, while unemployment increased the odds of stress, anxiety, and depression ( p < 0.01). Low monthly income (<GHS 999) independently predicted depression (AOR = 3.68 and p = 0.009). Conclusion Psychological distress among hypertensive adults is shaped by pronounced spatial and socioeconomic inequalities. Integrating routine mental health screening and targeted psychosocial interventions into hypertension care, particularly in peri‐urban and rural settings and among economically disadvantaged groups, may improve both mental health and chronic disease outcomes in low‐resource settings.