School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
Department of Psychology, eCentreClinic, Macquarie University, Sydney, New South Wales, Australia.
Epilepsia. 2017 Jun;58(6):973-982. doi: 10.1111/epi.13769. Epub 2017 May 3.
Comorbid anxiety and depressive disorders in people with epilepsy (PWE) are highly prevalent and associated with various adverse outcomes. However, the prevalence of anxiety disorders in PWE across studies is highly variable. Our aim was to estimate the prevalence and moderating factors of anxiety and depressive disorders in PWE.
Following prospective registration (PROSPERO; CRD42015027101), electronic databases were searched for studies that reported the prevalence of both anxiety and depressive disorders in samples of PWE up until July 2016. Data extracted included the prevalence of anxiety and depressive disorders, and moderators of interest (e.g., method of diagnosis, prevalence of drug-resistant epilepsy). Meta-analysis of the overall pooled prevalence of anxiety and depressive disorders was conducted.
The search yielded 8,636 unique articles, with 27 studies meeting final inclusion criteria (3,221 PWE). The pooled prevalence of anxiety and depressive disorders was 20.2% (95% confidence interval [CI] 15.3-26.0%) and 22.9% (95% CI 18.2-28.4%), respectively. Method of diagnosis significantly moderated anxiety disorder prevalence (Q statistic with one degree of freedom [Q ] = 36.29, p < 0.0001); the prevalence of anxiety disorders based on unstructured clinician assessment was 8.1% (95% CI 5.7-11.4%), compared to a prevalence of 27.3% (95% CI 22.1-33.3%) based on a structured clinical interview. There were no significant moderators of depressive disorder diagnosis.
Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.
癫痫患者（PWE）合并焦虑和抑郁障碍的患病率很高，与各种不良结局相关。然而，不同研究中 PWE 焦虑障碍的患病率差异很大。我们的目的是评估 PWE 中焦虑和抑郁障碍的患病率及其调节因素。
根据前瞻性注册（PROSPERO；CRD42015027101），检索截至 2016 年 7 月报告 PWE 样本中焦虑和抑郁障碍患病率的研究。提取的数据包括焦虑和抑郁障碍的患病率以及感兴趣的调节因素（例如，诊断方法、耐药性癫痫的患病率）。对焦虑和抑郁障碍总体合并患病率进行了荟萃分析。
搜索结果产生了 8636 篇独特的文章，其中 27 项研究最终符合纳入标准（3221 例 PWE）。焦虑和抑郁障碍的合并患病率分别为 20.2%（95%置信区间[CI] 15.3-26.0%）和 22.9%（95% CI 18.2-28.4%）。诊断方法显著调节了焦虑障碍的患病率（Q 统计量，自由度[Q]为 36.29，p <0.0001）；基于非结构化临床医生评估的焦虑障碍患病率为 8.1%（95% CI 5.7-11.4%），而基于结构化临床访谈的患病率为 27.3%（95% CI 22.1-33.3%）。抑郁障碍诊断无显著调节因素。
研究结果表明，PWE 中焦虑和抑郁障碍的患病率相当，且研究中焦虑障碍患病率的差异部分归因于诊断方法。这些结果还对广泛存在的假设提出了挑战，即精神病合并症在耐药性癫痫患者中更为常见。未来的研究应旨在提高 PWE 中这些合并症的检出率和管理水平，特别是焦虑障碍，因为目前对其关注相对较少。
