Association Between Symptoms of Depression, Anxiety, and Stress and Hypertension Status Among Adult Women in a Rural Clinical Setting, Malang Regency

Background: Hypertension remains a critical global health challenge with significant implications for cardiovascular morbidity. Adult women represent a highly vulnerable demographic due to distinct fluctuations in hormonal profiles and psychosocial role demands. Beyond physical risk factors, psychological stressors including depression and anxiety adversely affect blood pressure regulation by stimulating the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. However, studies specifically examining the relationship between these remain limited, particularly in Malang Regency. Objective: This research was conducted to evaluate the relationship between depression, anxiety, and stress levels and hypertension among adult women attending a rural clinic in Malang Regency. Methods: A cross-sectional study was executed at the the clinical setting (Malang Regency) during the July–August 2025 period, utilizing consecutive sampling. Data collection involved the validated indonesian version of the DASS-21 questionnaire to screen psychological distress. Blood pressure was measured in millimeters of mercury (mmHg) using a calibrated sphygmomanometer for three-fold blood pressure assessment. The association between variables was subsequently analyzed using the contingency coefficient, where results were considered statistically significant at p<0.05. Results: The findings indicate that while depression levels were significantly associated with hypertension (p < 0.001), anxiety and stress did not demonstrate a measurable relationship with blood pressure status (p = 0.975 and p = 0.988, respectively). This suggests that among the psychological factors studied, depression is the primary correlate of hypertension in this population. Conclusion: This study suggests a potential association between depression levels and hypertension status among adult women in this specific clinical setting. However, given the small sample size and skewed data, these findings should be interpreted with caution and require further large-scale validation.