Depression in epilepsy: a systematic review and meta-analysis

Abstract

Objective: To estimate the prevalence of depression in persons with epilepsy (PWE) and the strength of association between these 2 conditions.

Methods: The MEDLINE (1948-2012), EMBASE (1980-2012), and PsycINFO (1806-2012) databases, reference lists of retrieved articles, and conference abstracts were searched. Content experts were also consulted. Two independent reviewers screened abstracts and extracted data. For inclusion, studies were population-based, original research, and reported on epilepsy and depression. Estimates of depression prevalence among PWE and of the association between epilepsy and depression (estimated with reported odds ratios [ORs]) are provided.

Results: Of 7,106 abstracts screened, 23 articles reported on 14 unique data sources. Nine studies reported on 29,891 PWE who had an overall prevalence of active (current or past-year) depression of 23.1% (95% confidence interval [CI] 20.6%-28.31%). Five of the 14 studies reported on 1,217,024 participants with an overall OR of active depression of 2.77 (95% CI 2.09-3.67) in PWE. For lifetime depression, 4 studies reported on 5,454 PWE, with an overall prevalence of 13.0% (95% CI 5.1-33.1), and 3 studies reported on 4,195 participants with an overall OR of 2.20 (95% CI 1.07-4.51) for PWE.

Conclusions: Epilepsy was significantly associated with depression and depression was observed to be highly prevalent in PWE. These findings highlight the importance of proper identification and management of depression in PWE.

Figures

Figure 1. Flow chart of studies

OR = odds ratio; prev = prevalence.

Figure 2. Overall prevalence of active depression among persons with epilepsy

CCHS = Canadian Community Health Survey; CI = confidence interval; GP = general practitioners; GPRD = General Practice Research Database; NFO = National Family Opinion.

Figure 3. Overall odds ratio of active depression

CCHS = Canadian Community Health Survey; CHIS = California Health Interview Survey; CI = confidence interval; GP = general practitioners; GPRD = General Practice Research Database; NFO = National Family Opinion; OR = odds ratio.

Figure 4. Overall prevalence of active depression among persons with epilepsy by depression diagnostic tool

CCHS = Canadian Community Health Survey; CES-D = Center for Epidemiologic Studies–Depression Scale; CI = confidence interval; CIDI-SFMD = Composite International Diagnostic Interview Short Form for Major Depression; GPRD = General Practice Research Database; HAD = Hospital Anxiety and Depression Scale; NFO = National Family Opinion.

Figure 5. Overall odds ratio of active depression by depression diagnostic tool

CES-D = Center for Epidemiologic Studies–Depression Scale; CHIS = California Health Interview Survey; CI = confidence interval; CIDI-SFMD = Composite International Diagnostic Interview Short Form for Major Depression; GPRD = General Practice Research Database; K-6 = Kessler-6; NFO = National Family Opinion; OR = odds ratio.