Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Beijing Children's Hospital, Capital Medical University, Beijing, China.
Epilepsy Behav. 2020 May;106:107030. doi: 10.1016/j.yebeh.2020.107030. Epub 2020 Apr 2.
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.
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.
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.
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.
抑郁症在癫痫患者中较为常见，且与生活质量降低有关。尽管多项研究已经调查了相关的预测因素，但结果并不一致。本荟萃分析旨在探讨可能增加该人群发生抑郁症风险的因素。
全面检索 Medline、The Cochrane Library、Web of Science 和 Embase 中关于癫痫患者发生抑郁症的横断面研究。使用随机效应模型计算合并的风险比（HRs）和 95%置信区间（95% CIs）。还评估了研究结果之间的异质性和发表偏倚的可能性。
本荟萃分析纳入了 51 项样本量在 36 至 1763 之间的横断面研究。与抑郁症风险增加相关的显著因素包括年龄较大（OR：1.02，95%CI：1.00-1.04；p=0.019）、女性（OR：1.58，95%CI：1.30-1.93；p<0.001）、教育程度较低（OR：3.38，95%CI：2.86-4.00；p<0.001）、无业（OR：1.61，95%CI：1.08-2.38；p=0.019）、抗癫痫药物（AED）依从性差（OR：2.84，95%CI：1.94-4.16；p<0.001）、联合用药（OR：2.25，95%CI：1.48-3.41；p<0.001）、耻辱感（OR：2.22，95%CI：1.71-2.88；p<0.001）和焦虑（OR：2.21，95%CI：1.66-2.94；p<0.001）。癫痫持续时间较短与抑郁症风险较低显著相关（OR：0.99，95%CI：0.99-0.99；p<0.001），而婚姻状况（OR：1.07，95%CI：0.90-1.20；p=0.684）、经济水平（OR：1.01，95%CI：0.95-1.08；p=0.684）、发病年龄（OR：0.99，95%CI：0.75-1.29；p=0.912）和癫痫发作控制情况（OR：1.03，95%CI：0.65-1.63；p=0.900）与抑郁症风险增加无关。
本荟萃分析确定了与癫痫患者抑郁症风险增加相关的几个因素，有助于为该人群制定更好的抑郁症预防和筛查策略。这种共病的潜在机制仍需进一步研究，以确定针对个体的适当和有针对性的干预措施。
