Background
Methods
Search strategy
Inclusion and exclusion criteria
Data extraction and quality assessment
Outcome measures
Statistical analyses
Results
Search results
Study characteristics
Study ID | Country | Disease duration, mean ± SD/median (range) | Women, % | Sample size | Age, mean ± SD/median (range), years | Criteria for detection of anxiety (cutoff) | Anxiety prevalence, % | Criteria for detection of depression (cutoff) | Depression prevalence, % | NOS |
---|---|---|---|---|---|---|---|---|---|---|
Abdul-Sattar 2015 | Egypt | 10.0 ± 4.6 years | 95% | 80 | 30.9 ± 11.7 | CES-D (>16.7) | 43.75 | 2 | ||
Appenzeller 2009 | Brazil | 64.5 ± 48.5 months | 94.6% | 167 | 32.1 ± 11.0 | 21 Item-BDI (≥10) | 20.9 | 2 | ||
Bachen 2009 | USA | 15.4 ± 9.7 years | 100% | 326 | 47.9 ± 11.3 | DSM-IV | 64 | DSM-IV | Major depressive disorder: 42.4, dysthymic disorder: 2.9 | 5 |
Bogdanovic 2015 | Serbia | 6.8 ± 2.9 years | 100% | 60 | 43.4 ± 12.8 | 21 Item-BDI (≥16/≥20/≥30) | 91.7/70/3.3 | 2 | ||
Calderon 2014 | Chile | Median: 32.0 (0–243.0) months | 100% | 82 | Median: 36.0 (17.0–64.0) | HADS (≥8) | 37 | 2 | ||
Cho 2014 | South Korea | NS | 90.1% | 201 | 41.3 ± 13.2 | CES-D (≥16) | 39.3 | 3 | ||
Chin 1993 | Malaysia | 4.1 ± 3.5 years | 95% | 79 | 31.1 ± 9.1 | ICD-9 and DSM-III | 7.6 | ICD-9 and DSM-III | Major depressive disorder: 6.3, dysthymic disorder: 32.9 | 2 |
Da Costa 2005 | Canada | 13.8 ± 10.1 years | 100% | 100 | 45.4 ± 14.0 | CES-D (≥16) | 31 | 3 | ||
Doria 2004 | Italy | 9.9 ± 6.3 years | 87.3% | 126 | 38.9 ± 11.9 | HAS (≥6/≥15) | 74.6/27 | HDS (≥8/≥16) | 40.5/2.4 | 2 |
Duvdevany 2011 | Israel | 11.4 ± 9.1 years | 88% | 100 | 37.0 ± 11.8 | HADS (≥8) | 20 | HADS (≥8) | 37 | 4 |
García-Carrasco 2011 | Mexico | 106.5 ± 85.5 months | 100% | 106 | 40.5 ± 12.0 | CES-D (≥16) | 38.8 | 2 | ||
García-Carrasco 2013 | Mexico | 10.5 ± 7.4 years | 100% | 105 | 43.6 ± 11.3 | CES-D (≥16) | 33 | 2 | ||
Greco 2009 | USA | 16.3 ± 7.0 years | 100% | 161 | 50.1 ± 10.0 | CES-D (≥16) | 27 | 2 | ||
Hanly 2015 | Canada | 5.6 ± 4.8 years | 88.9% | 1827 | 35.1 ± 13.3 | DSM-IV | 12.7 | 4 | ||
Harrison 2006 | USA | 15.3 ± 3.2 years | 100% | 93 | 43.3 ± 13.7 | CES-D (>27) | 16.1 | 2 | ||
Huang 2007 | China | 7.5 ± 6.9 years | 91.5% | 129 | 37.4 ± 10.7 | HADS (≥8) | 32 | HADS (≥8) | 20 | 2 |
Iverson 2002 | Canada | NS | NS | 103 | NS | 21 Item-BDI (≥17) | 39.8 | 1 | ||
Jarpa 2011 | Chile | Median: 5.0 (0.1–40.0) years | 90.8% | 87 | Median: 39.0 (16.0–27.0) | DSM-IV | 18.1 | DSM-IV | Major depressive disorder: 21.7, dysthymic disorder: 4.8 | 2 |
Julian 2011 | USA | 15.8 ± 9.3 years | 93% | 150 | 48.8 ± 12.3 | ICD-10 and DSM-IV | Major depressive disorder: 17, dysthymic disorder: 4, minor depression: 6 | 3 | ||
Jung 2015 | Korea | 6.8 ± 4.4 years | 93% | 100 | 40.6 ± 10.3 | 21 Item-BDI (≥21) | 13 | 2 | ||
Katz 2011 | USA | 13.6 ± 8.5 years | 100% | 716 | 48.1 ± 12.6 | CES-D (≥24) | 25 | 3 | ||
Karol 2013 | USA | NS | 93% | 127 | 38.1 ± 12.3 | 21 Item-BDI (≥18) | 41.7 | 2 | ||
Karimifar 2013 | Iran | 4.1 ± 0.5 years | 80% | 100 | 34.8 ± 10.9 | 21 Item-BDI (≥14) | 60 | 2 | ||
Kheirandish 2015 | Iran | 9.0 ± 7.7 years | 92.2% | 166 | 33.1 ± 11.1 | Cattell questionnaire (≥21) | 84.9 | 21 Item-BDI (≥5/≥30) | 64.5/9 | 2 |
Kotsis 2014 | Greece | 13.2 ± 9.1 years | 84% | 75 | 44.1 ± 13.3 | PHQ-9 (≥10) | 29.3 | 2 | ||
Kim 2015 | USA | 12.0 ± 8.0 years | 93% | 89 | 39.0 ± 15.0 | CES-D (≥16) | 63 | 3 | ||
Lapteva 2006 | USA | 13.8 ± 10.2 years | 75% | 60 | 41.0 ± 13.0 | DSM-IV | Major depressive disorder: 16.6 | 2 | ||
Lisitsyna 2014 | NS | 134.9 ± 8.8 months | 85.6% | 180 | 34.6 ± 0.93 | ICD-10 | Major depressive disorder: 24.4, dysthymic disorder: 25.6, adjustment disorders: 18.9 | 2 | ||
Mak 2011 | Singapore | 54.9 ± 70.7 months | 88% | 60 | 40.5 ± 12.9 | HADS (≥8) | 38 | HADS (≥8) | 22 | 2 |
Maneeton 2013 | Thailand | 6.1 ± 4.8 years | 98% | 62 | 31.8 ± 9.0 | HAS (≥14) | 37.1 | HDS (≥11) | 45.2 | 2 |
Mirbagher 2016 | Iran | 8.3 ± 3.8 years | 100% | 77 | 36.5 ± 10.1 | HADS (≥8) | 71.4 | HADS (≥8) | 46.1 | 3 |
Monaghan 2007 | Australia | 10.2 ± 8.7 years | 97% | 60 | 44.4 ± 12.2 | HADS (≥8) | 44 | HADS (≥8) | 36 | 3 |
Montero-Lo’pez 2016 | Spain | 0.2 ± 0.7 years | 100% | 97 | 38.6 ± 9.3 | SCL-90-R | 4.1 | SCL-90-R | 5.2 | 2 |
Nery 2008 | Brazil | 9.8 ± 6.5 years | 100% | 71 | 34.8 ± 10.1 | SCID for DSM-IV | 46.5 | SCID for DSM-IV | Major depressive disorder: 40.8 | 2 |
Neville 2014 | Canada | 10.2 ± 9.5 years | 92.4% | 612 | 46.8 ± 16.7 | PHQ-2 (≥3) | 28.1 | 4 | ||
Palagini 2014 | Italy | 15.0 ± 8.0 years | 100% | 81 | 43.6 ± 11.2 | SAS (>44) | 17.3 | 21 Item-BDI (≥11) | 34.6 | 3 |
Panopalis 2010 | USA | 13.8 ± 8.9 years | 91% | 807 | 47.6 ± 13.1 | CES-D (≥16) | 38.5 | 5 | ||
Pettersson 2015 | Sweden | Median: 12.0 years | 92% | 305 | Median: 48 | HADS (≥8) | 34 | HADS (≥8) | 51 | 4 |
Postal 2016 | Brazil | Median: 9.0 (0–33.0) years | 96.7% | 153 | Median: 30.0 (10.0–62.0) | 21 Item-BAI (≥8/≥16/≥26) | 60.7/43.1/18.3 | 21 Item-BDI (≥14/≥20/≥29) | 45.7/30.7/18.9 | 2 |
Radhakrishan 2011 | India | NS | 100% | 100 | 18-60 | SCID for DSM-IV | 51 | SCID for DSM-IV | Major depressive disorder: 46, adjustment disorder: 21, dysthymic disorder: 9 | 2 |
Roebuck-Spencer 2006 | USA | 13.8 ± 10.2 years | 80% | 60 | 41.3 ± 12.8 | 21 Item-BDI (≥14) | 20 | 2 | ||
Segal 2012 | USA | 12.0 ± 2.3 years | 93% | 71 | 41.7 ± 1.5 | CES-D (≥16) | 39 | 2 | ||
Sehlo 2013 | Saudi Arabia | 6.9 ± 4.2 years | 100% | 80 | 34.8 ± 11.2 | SCID for DSM-IV | Major depressive disorder: 11.25 | 2 | ||
Sfikakis 1998 | Greece | 7.8 ± 6.4 years | 91.5% | 71 | 37.0 ± 13.0 | HAS (>17) | 23.9 | HDS (>17) | 19.7 | 2 |
Shakeri 2015 | Iran | NS | 92.5% | 160 | 30.1 ± 6.2 | 21 Item-BAI (≥8/≥16/≥26) | 81.2/51.9/18.1 | 21 Item-BDI (≥21/≥31/>40) | 69.3/38.7/20.6 | 2 |
Shen 2015 | China | NS | 91.2% | 156 | 32.9 ± 10.2 | Zung SAS (≥50) | 20.51 | Zung SDS (≥53) | 33.33 | 3 |
Skare 2014 | Brazil | 8.2 ± 6.9 years | 93% | 100 | 39.2 ± 12.5 | 21 Item-BDI (≥19/≥ 30) | 21/2 | 2 | ||
Shorta1l 1995 | England | 11.0 ± 7.1 years | 95% | 80 | 41.0 ± 11.2 | HADS (≥8) | 39 | HADS (≥8) | 26 | 2 |
Stoll 2001 | Switzerland | 11.4 ± 9.0 years | 90% | 60 | 44.5 ± 15.4 | HADS (≥8) | 16 | 3 | ||
Tam 2008 | China | 9.7 years | 95.9% | 291 | 42.0 ± 12.0 | HADS (≥8) | 22 | HADS (≥8) | 18.2 | 3 |
Tay 2015 | Singapore | 72.3 ± 81.1 months | 86.4% | 110 | 38.7 ± 12.6 | HADS (≥8) | 40.9 | HADS (≥8) | 15.5 | 2 |
Tench 2000 | England | Median: 36.0 (12.0–79.5) months | 100% | 120 | Median: 38.0 (32.0–45.0) | HADS (≥8) | 60 | HADS (≥8) | 37 | 2 |
Tjensvoll 2010 | Norway | 12.3 ± 8.6 years | 87% | 63 | 43.4 ± 13.3 | 21 Item-BDI (≥13) | 23.8 | 2 | ||
Utset 2014 | USA | Median: 9 years | 95% | 344 | >18 | CES-D (>10) | 54.5 | 4 | ||
van Exel 2013 | Netherlands | 7.8 ± 7.0 years | 88.2% | 102 | 44.4 ± 12.5 | 21 Item-BDI (≥14) | 27 | 3 | ||
Vina 2015 | USA | 143.2 ± 117.8 months | 93% | 343 | 44.4 ± 12.9 | CES-D (≥17) | 47.2 | 4 | ||
Weder-Cisneros 2004 | USA | Mean: 97.0 (6–348) months | 91.4% | 81 | 31.2 ± 9.7 | 21 Item-BDI (≥14) | 40.7 | 3 | ||
Xie 2012 | China | Median: 1.3 years | 93.7% | 285 | 34.0 ± 13.0 | 21 Item-BDI (≥5/14/≥21) | 59.3/40.7/19.3 | 4 | ||
Zakeri 2012 | Iran | NS | 90.5% | 71 | >18 | 21 Item-BDI (≥16/≥32) | 60/9.4 | 2 |
Tool | Definition/cutoff | No. of studies | No. of participants | Prevalence, % (95% CI) | Heterogeneity I2, % |
---|---|---|---|---|---|
DSM and/or ICD | |||||
Major depressive disorder | 10 | 2960 | 24 (16, 31) | 95.2 | |
Dysthymic disorder | 6 | 922 | 12 (5, 18) | 93.4 | |
Adjustment disorder | 2 | 280 | 20 (15, 24) | 0.0 | |
Minor depression | 1 | 150 | 6 (2, 10) | - | |
HADS | ≥8 | 12 | 1474 | 30 (22, 38) | 91.6 |
CES-D | >10 | 1 | 344 | 55 (49, 60) | - |
≥16 | 8 | 1640 | 38 (32, 44) | 81.3 | |
>16.7 | 1 | 80 | 44 (33, 55) | - | |
≥17 | 1 | 343 | 47 (42, 52) | - | |
≥24 | 1 | 716 | 25 (22, 28) | - | |
>27 | 1 | 93 | 16 (9, 24) | - | |
21 Item-BDI | ≥5 | 2 | 451 | 61 (56, 66) | 17.7 |
≥10 | 1 | 167 | 21 (15, 27) | - | |
≥11 | 1 | 81 | 35 (24, 45) | - | |
≥13 | 1 | 63 | 24 (13, 34) | - | |
≥14 | 6 | 781 | 39 (29, 49) | 88.2 | |
≥16 | 2 | 131 | 76 (45, 107) | 95.4 | |
≥17 | 1 | 103 | 40 (30, 49) | - | |
≥18 | 1 | 127 | 42 (33, 50) | - | |
≥19 | 1 | 100 | 21 (13, 29) | - | |
≥20 | 2 | 213 | 50 (12, 89) | 96.8 | |
≥21 | 3 | 545 | 34 (2, 65) | 98.8 | |
≥29 | 1 | 153 | 19 (13, 25) | - | |
≥30 | 3 | 326 | 5 (0, 9) | 72.1 | |
≥31 | 1 | 160 | 39 (31, 46) | - | |
≥32 | 1 | 71 | 9 (3, 16) | - | |
>40 | 1 | 160 | 21 (14, 27) | - | |
HDS | ≥8 | 1 | 126 | 41 (32, 49) | - |
≥11 | 1 | 62 | 45 (33, 58) | - | |
≥16 | 1 | 126 | 2 (0, 5) | - | |
>17 | 1 | 71 | 20 (10, 29) | - | |
PHQ-9 | ≥10 | 1 | 75 | 29 (19, 40) | - |
PHQ-2 | ≥3 | 1 | 612 | 28 (25, 23) | - |
SCL-90-R | 1 | 97 | 5 (1, 10) | - | |
Zung SDS | ≥53 | 1 | 156 | 33 (26, 41) | - |
Tool | Definition/cutoff | No. of studies | No. of participants | Prevalence, % (95% CI) | Heterogeneity I2, % |
---|---|---|---|---|---|
DSM and/or ICD for anxiety disorder | 5 | 663 | 37 (12, 63) | 98.3 | |
HADS | ≥8 | 10 | 1332 | 40 (30, 49) | 93.0 |
21 Item-BAI | ≥8 | 2 | 313 | 71 (51, 91) | 94 |
≥16 | 2 | 313 | 48 (39, 56) | 59.2 | |
≥26 | 2 | 313 | 18 (14, 22) | 0 | |
HAS | ≥6 | 1 | 126 | 75 (67, 82) | - |
≥14 | 1 | 62 | 37 (25, 49) | - | |
≥15 | 1 | 126 | 27 (19, 35) | - | |
>17 | 1 | 71 | 24 (14, 34) | - | |
Cattell questionnaire | ≥21 | 1 | 166 | 85 (79, 90) | - |
SCL-90-R | 1 | 97 | 4 (0, 8) | - | |
Zung SAS | >44 | 1 | 81 | 17 (9, 26) | - |
≥50 | 1 | 156 | 21 (14, 27) | - |
Prevalence of depression among SLE patients
Prevalence of anxiety among SLE patients
Sensitivity and subgroup analyses
Depression definition (cutoff) | Anxiety definition (cutoff) | ||||||||
---|---|---|---|---|---|---|---|---|---|
Major depressive disorder (DSM and/or ICD) | Dysthymic disorder (DSM and/or ICD) | HADS (≥8) | CES-D (≥16) | 21 Item-BDI (≥14) | 21 Item-BDI (≥21) | 21 Item-BDI (≥30) | HADS (≥8) | Anxiety disorder (DSM and/or ICD) | |
Primary analysis | 24 (16, 31) I2 = 95.2% 10 studies 2960 patients | 12 (5, 18) I2 = 93.4% 6 studies 922 patients | 30 (22, 38) I2 = 91.6% 12 studies 1474 patients | 38 (32, 44) I2 = 81.3% 8 studies 1640 patients | 39 (29, 49) I2 = 88.2% 6 studies 781 patients | 34 (2, 65) I2 = 98.8% 3 studies 545 patients | 5 (0, 9) I2 = 72.1% 3 studies 326 patients | 40 (30, 49) I2 = 93.0% 10 studies 1332 patients | 37 (12, 63) I2 = 98.3% 5 studies 663 patients |
Sensitivity analyses | |||||||||
Excluding studies with less sample representativeness | 24 (6, 42) I2 = 98.2% 3 studies 2303 patients | 3 (2, 5) I2 = 0% 2 studies 476 patients | 29 (15, 44) I2 = 82.7% 3 studies 220 patients | - | 36 (27, 45) I2 = 72.4% 3 studies 468 patients | - | - | 31 (8, 55) I2 = 90.1% 2 studies 160 patients | - |
Excluding studies with less comparable respondent and non-respondent comparability | - | - | 45 (37, 54) I2 = 68.1% 3 studies 482 patients | 44 (29, 59) I2 = 91.9% 3 studies 996 patients | - | - | - | 42 (17, 66) I2 = 96.9% 3 studies 482 patients | - |
Excluding studies only using female sample | 16 (11, 21) I2 = 79.8% 6 studies 2383 patients | 16 (4, 28) I2 = 95.0% 4 studies 496 patients | 27 (17, 36) I2 = 92.9% 9 studies 1195 patients | 44 (35, 54) I2 = 85.6% 4 studies 1168 patients | 39 (29, 49) I2 = 88.2% 6 studies 781 patients | 34 (2, 65) I2 = 98.8% 3 studies 545 patients | 5 (−2, 12) I2 = 85.9% 2 studies 266 patients | 33 (27, 39) I2 = 79.4% 8 studies 1135 patients | 12 (2, 23) I2 = 76.5% 2 studies 166 patients |
Subgroup analyses | |||||||||
Sample size | |||||||||
<200 | 22 (14, 31) I2 = 90.5% 8 studies 807 patients | 14 (5, 23) I2 = 93.3% 5 studies 596 patients | 29 (22, 36) I2 = 81.1% 10 studies 878 patients | 38 (28, 48) I2 = 86.3% 6 studies 1008 patients | 39 (25, 52) I2 = 90.5% 5 studies 496 patients | 41 (−14, 96) I2 = 99.2% 2 studies 260 patients | 5 (0, 9) I2 = 72.1% 3 studies 326 patients | 43 (31, 55) I2 = 91.8% 8 studies 736 patients | 30 (9, 52) I2 = 96.0% 4 studies 337 patients |
≥200 | 27 (2, 57) I2 = 99.1% 2 studies 2153 patients | - | 35 (2, 67) I2 = 98.8% 2 studies 596 patients | 39 (36, 42) I2 = 0.0% 2 studies 632 patients | - | - | - | 28 (16, 40) I2 = 90.8% 2 studies 596 patients | - |
Overall quality | |||||||||
<3 points (low quality) | 23 (13, 34) I2 = 91.8% 7 studies 657 patients | 18 (6, 29) I2 = 93.2% 4 studies 446 patients | 26 (18, 33) I2 = 77.5% 6 studies 581 patients | 34 (28, 40) I2 = 45.5% 4 studies 443 patients | 42 (21, 63) I2 = 93.8% 3 studies 313 patients | 41 (−14, 96) I2 = 99.2% 2 studies 260 patients | 5 (0, 9) I2 = 72.1% 3 studies 326 patients | 42 (32, 52) I2 = 82.5% 5 studies 499 patients | 30 (9, 52) I2 = 96.0% 4 studies 337 patients |
≥3 points (high quality) | 26 (6, 42) I2 = 98.2% 3 studies 2303 patients | 3 (2, 5) I2 = 0% 2 studies 476 patients | 34 (20, 48) I2 = 95.0% 6 studies 893 patients | 42 (33, 52) I2 = 87.9% 4 studies 1197 patients | 36 (27, 45) I2 = 72.4% 3 studies 468 patients | - | - | 38 (23, 53) I2 = 95.5% 5 studies 833 patients | - |
Publication year | |||||||||
1990s | - | - | - | - | - | - | - | - | - |
2000s | 33 (17, 50) I2 = 91.0% 3 studies 457 patients | - | 25 (17, 33) I2 = 81.3% 5 studies 660 patients | 28 (23, 34) I2 = 0.0% 2 studies 261 patients | 30 (10, 51) I2 = 86.8% 2 studies 141 patients | - | - | 39 (22, 57) I2 = 95.0% 4 studies 600 patients | 56 (39, 73) I2 = 86.3% 2 studies 397 patients |
2010- | 21 (14, 29) I2 = 91.5% 6 studies 2424 patients | 11 (2, 19) I2 = 92.0% 4 studies 517 patients | 35 (22, 48) I2 = 93.1% 6 studies 734 patients | 42 (35, 48) I2 = 78.6% 6 studies 1379 patients | 43 (32, 55) I2 = 88.5% 4 studies 640 patients | 34 (2, 65) I2 = 98.8% 3 studies 545 patients | 5 (0, 9) I2 = 72.1% 3 studies 326 patients | 41 (26, 56) I2 = 93.8% 5 studies 652 patients | 34 (2, 67) I2 = 96.1% 2 studies 187 patients |
Country of origin | |||||||||
North America | 22 (8, 37) I2 = 97.3% 4 studies 2363 patients | 3 (2, 5) I2 = 0% 2 studies 476 patients | - | 38 (31, 45) I2 = 83.9% 7 studies 1439 patients | 30 (10, 51) I2 = 86.8% 2 studies 141 patients | - | - | - | - |
Asia | 21 (0, 41) I2 = 96.0% 3 studies 259 patients | 21 (−3, 44) I2 = 93.7% 2 studies 179 patients | 26 (18, 34) I2 = 85.4% 6 studies 767 patients | - | 50 (31, 69) I2 = 91.3% 2 studies 385 patients | 34 (2, 65) I2 = 98.8% 3 studies 545 patients | - | 37 (23, 51) I2 = 94.4% 6 studies 767 patients | 29 (−13, 72) I2 = 98.2% 2 studies 179 patients |
Europe | - | - | 33 (17, 49) I2 = 93.8% 4 studies 565 patients | - | - | - | - | 44 (28, 61) I2 = 91.9% 3 studies 505 patients | - |
South America | 31 (12, 50) I2 = 85.3% 2 studies 158 patients | - | - | - | - | - | - | - | 32 (4, 60) I2 = 93.5% 2 studies 158 patients |
Associated study variables
Study characteristic | Depression prevalence estimate | Anxiety prevalence estimate | ||||
---|---|---|---|---|---|---|
No. of studies |
r
|
P
| No. of studies |
r
|
P
| |
Female, % | 59 | 0.03 | 0.84 | 24 | 0.07 | 0.76 |
Mean/medium age, year | 55 | −0.13 | 0.35 | 23 | −0.18 | 0.94 |
Mean/medium disease duration, year | 53 | −0.07 | 0.64 | 21 | 0.24 | 0.29 |
Representativeness | 59 | 0.03 | 0.85 | 24 | 0.08 | 0.70 |
Sample size | 59 | 0.12 | 0.38 | 24 | 0.01 | 0.97 |
Comparability | 59 | 0.24 | 0.07 | 24 | −0.11 | 0.61 |
Overall quality | 59 | 0.13 | 0.33 | 24 | −0.10 | 0.64 |
Country of origin | 59 | 0.01 | 0.92 | 24 | −0.10 | 0.63 |
Publication year | 59 | 0.26*
| 0.04 | 24 | −0.04 | 0.84 |