Point prevalence of depression in persons with active epilepsy and impact of methodological moderators: A systematic review and meta-analysis.

Journal: Epilepsy & Behavior : E&B

Objectives: The aim of this study was to determine the pooled prevalence of depression in persons with epilepsy and assess the methodological moderators affecting the prevalence estimates.

Methods: Five electronic databases PubMed, The Cochrane Library, EMBASE, WHO Global Index Medicus, and Clinicaltrial.gov were searched for studies reporting prevalence of depression in PWE ≥ 18 years of age in any setting.

Results: Out of 13,873 studies, after deduplication and screening, 56 studies with 10,527 PWE met the eligibility criteria. The overall pooled prevalence of depression in PWE was 32% (95%confidence interval [CI] 28-35%) and significant heterogeneity (Chi-square = 1171.53, p = 0.00; τ2 = 0.02; I2 = 94.36%). Prevalence has doubled in the recent years (16% in 2000-2005 vs. 35% in 2016-2020), was higher in Asia than in Europe (coefficient 0.899, 95%CI: 0.809-0.999; p = 0.049). Among assessment methods, prevalence was highest in HAM-D scale (54%, 95%CI: 27-82%) and lowest in MINI (22%, 95%CI: 19-26%). Sensitivity analysis also corroborated findings when MINI was excluded (35%, 95%CI: 31-38%).

Conclusions: A significant proportion of PWE have depression. Though there is substantial heterogeneity due to various methodological moderators, it is unlikely to affect the routine screening of PWE for depression. Use of a screening tool should be based on ease of administration, and cutoff selection should ensure identification of minimal depression as well.

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