ReviewRisk factors for depression in community-treated epilepsy: Systematic review
Introduction
Depression is one of the most common psychiatric comorbidities in epilepsy and arguably the most extensively researched [1]. Despite these facts, the factors that contribute to the increased rate of depression remain unclear [2], [3]. Comorbid depression has a range of adverse consequences, including decreased quality of life, diminished medication adherence, poorer treatment outcomes, increased health service use, increased cognitive complaints, and increased risk of other chronic diseases and suicide [4]. A better understanding of the risk factors for depression in epilepsy may inform efforts to reduce this important health disparity.
The rate of depression appears to rise as one moves from primary care to secondary care and tertiary care [5], [6]. This suggests that ascertainment bias may limit the generalizability of findings from secondary–tertiary samples to community-treated people with epilepsy. The use of systematic reviews in epilepsy research has confirmed the higher prevalence of depression in people with epilepsy and has demonstrated a consistent association between depression and impaired quality of life [7], [8], but this approach has not been utilized to identify risk factors for depression. The aim of this study was to review recent studies that examined depression in a community sample of adults with epilepsy to identify factors associated with depression.
Section snippets
Methods
A systematic review to identify factors associated with depression in adult patients with community-treated epilepsy was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
Study selection
The search strategies identified 222 publications. Many were rejected as they did not include people with epilepsy, and 83 were selected for a full-text review. Fifty-seven studies did not meet the inclusion criteria (see Fig. 1), with failure to measure depression or any risk factors followed by potential selection bias due to reliance on hospital-derived samples being the most common reasons for exclusion. Some studies did not explicitly analyze risk factors for depression, but, where
Discussion
This systematic review found that the most consistent risk factors associated with depression were sociodemographic factors, despite the fact that most studies focus on epilepsy-related factors. Very few studies assessed a range of sociodemographic, disease-related, psychological, treatment-related, and genetic risk factors. Furthermore, none of these studies appeared designed to specifically address depression in epilepsy, and none adopted a systematic approach arising from best available
Ethical publication statement
We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Disclosure of conflicts of interest
Assoc. Prof. D'Souza has received travel, investigator-initiated, and speaker honoraria from UCB Pharma; educational grants from Novartis Pharmaceuticals, Pfizer Pharmaceuticals, and Sanofi-Synthelabo; educational, travel, and fellowship grants from GSK Neurology Australia; and honoraria from SciGen Pharmaceuticals. Dr. Cameron Lacey has received a research grant from Pfizer Pharmaceuticals. The remaining author has no conflicts of interest.
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Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery
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Correlates of depression and quality of life among patients with epilepsy in Nigeria
2020, Epilepsy Research