Highlights
- •The first meta-analysis of risk factors for depression for PWE
- •51 cross-sectional studies included
- •9 variables are significantly related with depression for PWE.
- •Underlying mechanisms for the comorbidity should be explored.
- •Related health promotion and prevention strategies should be formulated.
Abstract
Background
Depression is common and associated with reduced quality of life (QoL) in people with
epilepsy (PWE). Although multiple studies have investigated the relevant predictors,
the results have been inconsistent. This meta-analysis aimed to investigate the risk
factors that might increase the possibility of depression in this population.
Methods
Medline, The Cochrane Library, Web of Science, and Embase were comprehensively searched
for cross-sectional studies on the occurrence of depression in PWE. A random effects
model was used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals
(95% CIs). Heterogeneity between the study results and the probability of publication
bias were also assessed.
Results
Fifty-one cross-sectional studies with sample sizes ranging from 36 to 1763 were included
in this meta-analysis. The significant factors associated with an increased risk of
depression were older age (odds ratio [OR]: 1.02, 95% CI: 1.00–1.04; p = 0.019), female gender (OR: 1.58, 95% CI: 1.30–1.93; p < 0.001), low education level (OR: 3.38, 95% CI: 2.86–4.00; p < 0.001), not being employed (OR: 1.61, 95% CI: 1.08–2.38; p = 0.019), poor antiepileptic drug (AED) adherence (OR: 2.84, 95% CI: 1.94–4.16; p < 0.001), polytherapy (OR: 2.25, 95% CI: 1.48–3.41; p < 0.001), stigma (OR: 2.22, 95% CI: 1.71–2.88; p < 0.001), and anxiety (OR: 2.21, 95% CI: 1.66–2.94; p < 0.001). A shorter epilepsy duration was significantly associated with a lower risk
of depression (OR: 0.99, 95% CI: 0.99–0.99; p < 0.001), whereas marital status (OR: 1.07, 95% CI: 0.90–1.20; p = 0.684), economic level (OR: 1.01, 95% CI: 0.95–1.08; p = 0.684), age at seizure onset (OR: 0.99, 95% CI: 0.75–1.29; p = 0.912), and seizure control (OR: 1.03, 95% CI: 0.65–1.63; p = 0.900) did not increase the risk of depression.
Conclusion
This meta-analysis defined several factors related to an increased risk of depression
in PWE and can contribute to better prevention and screening strategies for depression
in this group. The mechanisms behind this comorbidity remain to be further investigated
to determine individually appropriate and targeted interventions.
Keywords
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Article info
Publication history
Published online: April 02, 2020
Accepted:
March 4,
2020
Received in revised form:
February 4,
2020
Received:
November 2,
2019
Footnotes
☆Founding: This work was supported by the Program of Lanzhou Science and Technology Bureau (No. 2015-RC-25).
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
