Prevalence of Depression and Anxiety in Medical and Surgical Inpatients: A Systematic Review

Abstract

Objective: The objective of the present study was to perform a systematic review of studies that investigated the prevalence of anxiety and depression in medical inpatients. Method: A search was conducted in Pubmed Medline, ISI Web of Science, PsychINFO, CINAHL, EMBASE, Irandoc, IranPsych, IranMedex, and dissertations. In the next step, the original studies which reported the prevalence of anxiety and/or depression in medical inpatients were included and then evaluated. These evaluations included two parts. The first part was the qualitative evaluation of the articles, which was carried out using a checklist. The second part was data extraction, performed with two researchers for each document. Results: Thirty nine studies (13 articles and 26 dissertations) were finally included. Only in seven studies, diagnostic interview was used to diagnose patients with anxiety and depression. Results of the qualitative evaluation of articles showed that a high percentage of them lacked the appropriate methodology. The maximum and minimum prevalence of depression in the reviewed studies was 91.7% and 17% respectively. The maximum and minimum prevalence of anxiety in the reviewed articles was 78.33% and 6% respectively. The prevalence of depression and anxiety in all studies which had reported prevalence according to sex was higher in females. Meta-analysis with Random effect model indicates the heterogeneity of studies, so we just perform meta- analysis in two groups of patients, chronic renal failure patients and patients with ischemic heart disease. The combined estimation of the prevalence of depression and anxiety in patients with chronic renal failure according to this meta-analysis was 55.91 (confidence interval=37.14-74.69) and 46.72 (confidence interval=20.31-73.13) respectively. The combined estimation of the prevalence of depression and anxiety in patients with ischemic heart disease was 52.54 (confidence interval=42.82-62.26) and 30.92 (confidence interval=1.21-60.64) respectively. Conclusion: The presence of heterogeneity in prevalence of anxiety and depression can be due to the nature of observational studies, which could result in diverse results from different aspects Some of these differences include the difference in instruments and their cutting points, difference in populations under study, dissimilar and non-standard methods, difference in clinical signs and symptoms, and difference in the times of evaluations. Many of the mentioned factors are also responsible for disparities in prevalence in the present study, with the difference in the somatic illnesses being among the most important reasons. However, in subgroups with similar somatic illnesses such as ischemic heart disease and chronic renal failure this difference is also observed. Considering the low quality of articles with regard to methodology, there is a possibility that this factor could have had a more decisive role in the differences observed in similar subgroups.