Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle-Upon-Tyne, UK.
Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
J Affect Disord. 2023 Mar 15;325:656-674. doi: 10.1016/j.jad.2023.01.068. Epub 2023 Jan 18.
BACKGROUND: There is rapid growth of older people in Low- and Middle- Income Countries (LMICs). The aim of this review was to assess the literature on prevalence of anxiety and depression in this demographic, which to our knowledge, has not yet been conducted. METHODS: Databases including Medline, PsychInfo, Embase, Scielo and African Journals Online were searched for terms including "mental disorders", "neurotic disorders", "mood disorders" and "anxiety disorders". Studies published between 1990 and 2020 providing data on older people (≥50 years) in LMICs (defined by World Bank Criteria) were included and quality-assessed. Meta-analysis was conducted on a subset of higher-quality studies to derive pooled prevalence estimates of depression. RESULTS: One hundred and forty relevant studies were identified, of which thirty-two were included in meta-analysis. One hundred and fifteen studies reported depression prevalence only, 19 reported both depression and anxiety, and six reported anxiety only. In all studies identified, depression prevalence ranged from 0.5 % to 62.7 %, and Generalised Anxiety Disorder prevalence ranged from 0.2 % to 32.2 %. The pooled prevalence of depression on meta-analysis was 10.5 % (95 % CI, 8.9 % - 11.2 %). Reported prevalence rates of depression were significantly different in studies using ICD-10 compared with DSM criteria, and between community and clinical settings. LIMITATIONS: The search strategy contained bias towards English language papers and high income country (HIC) publications. There is significant heterogeneity within the meta-analysis. DISCUSSION: A wide range of methodologies and clinical criteria are used in prevalence studies of depression and anxiety in older people. Studies using screening tools found higher prevalence rates; clinicians and researchers should ensure diagnosis is made with gold-standard clinical criteria. Meta-analysis data suggest that rates of depression are similar in older people in LMICs compared to HICs but mental healthcare resources are limited, suggesting a large potential treatment gap.
背景：低收入和中等收入国家（LMICs）的老年人数量迅速增长。本研究旨在评估这一人群中焦虑和抑郁的患病率文献，据我们所知，这方面的研究尚未开展。
方法：检索了 Medline、PsychInfo、Embase、Scielo 和 African Journals Online 等数据库，使用了包括“精神障碍”、“神经症”、“心境障碍”和“焦虑障碍”等术语。纳入了发表于 1990 年至 2020 年期间、提供了 LMICs（按世界银行标准定义）老年人（≥50 岁）数据的研究，并对其进行了质量评估。对一些高质量研究进行了荟萃分析，以得出抑郁症的 pooled prevalence estimates。
结果：共确定了 140 项相关研究，其中 32 项纳入荟萃分析。115 项研究仅报告了抑郁症的患病率，19 项研究同时报告了抑郁症和焦虑症，6 项研究仅报告了焦虑症。在所有确定的研究中，抑郁症的患病率范围为 0.5%至 62.7%，广泛性焦虑症的患病率范围为 0.2%至 32.2%。荟萃分析中抑郁症的 pooled prevalence 为 10.5%（95%CI，8.9%-11.2%）。使用 ICD-10 与 DSM 标准的研究以及社区和临床环境中的研究报告的抑郁症患病率有显著差异。
局限性：检索策略存在偏向于英语文献和高收入国家（HIC）出版物的偏见。荟萃分析中存在很大的异质性。
讨论：在老年人中焦虑和抑郁的患病率研究中，使用了多种方法和临床标准。使用筛查工具的研究发现了更高的患病率；临床医生和研究人员应确保使用金标准临床标准进行诊断。荟萃分析数据表明，LMICs 中老年人的抑郁症发病率与 HICs 相似，但精神卫生资源有限，表明存在很大的潜在治疗差距。
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