Errazuriz Antonia, Avello-Vega Dalia, Ramirez-Mahaluf Juan P, Torres Rafael, Crossley Nicolas A, Undurraga Eduardo A, Jones Peter B
Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Millennium Institute for Research on Depression and Personality-MIDAP, Santiago, Chile.
Lancet Reg Health Am. 2023 Sep 6;26:100587. doi: 10.1016/j.lana.2023.100587. eCollection 2023 Oct.
Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: . systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, . report pooled regional, country, and sex-specific prevalence estimates, and . test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR).
We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI's critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054).
Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%-14.16%); 5.30% (4.55-6.06%), and 3.12% (2.22-4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR.
We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region.
Pfizer Independent Medical Education Grant.
抑郁症是全球导致残疾的主要原因之一；然而，在拉丁美洲，其患病率以及与不平等和犯罪的关联尚未得到充分描述。本研究旨在：1. 系统回顾拉丁美洲基于人群的国际疾病分类/精神疾病诊断与统计手册（ICD/DSM）抑郁症患病率研究；2. 报告汇总的区域、国家和按性别划分的患病率估计值；3. 检验其与四个国家层面发展指标的关联：人类发展指数（HDI）、收入（基尼系数）、性别不平等指数（GII）和故意杀人率（IHR）。
我们对1990年至2023年拉丁美洲报告ICD/DSM抑郁症患病率原始数据的基于人群的研究进行了系统回顾和荟萃分析，不限语言。我们检索了PubMed、PsycINFO（心理学文摘数据库）、Cochrane图书馆、SciELO（区域数据库）、LILAC（区域数据库）以及现有的灰色文献。使用澳大利亚 Joanna Briggs 循证卫生保健中心（JBI）的批判性评价工具评估研究质量。我们采用随机效应荟萃分析生成汇总估计值；使用 I² 统计量评估异质性。荟萃回归分析用于检验抑郁症患病率与不平等和人类发展指标之间 的关联。该研究已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42019143054）。
利用拉丁美洲40项研究的数据，计算出ICD/DSM抑郁症的终生患病率、12个月患病率和当前患病率分别为12.58%（95%置信区间11.00%-14.16%）；5.30%（4.55%-6.06%）和3.12%（2.22%-4.03%）。终生患病率、12个月患病率、当前患病率、性别和国家之间的异质性都很高。12个月患病率和当前患病率与较高的基尼系数和性别不平等指数相关，12个月患病率与较低的人类发展指数相关，当前患病率与较高的故意杀人率相关。
我们发现拉丁美洲ICD/DSM抑郁症的患病率很高，并且与不平等和发展指标存在统计学上的显著关联。在患病率时间段内发现的高异质性以及国家代表性方面的重大差距凸显了加大努力改善拉丁美洲心理健康服务可及性和研究能力的必要性。系统、可比的患病率估计将为该地区更有效的决策提供依据。
辉瑞独立医学教育基金。
