Review articlePrevalence of depression in cardiovascular patients in Iran: A systematic review and meta-analysis from 2000 to 2017
Introduction
In both developed and developing countries, cardiovascular disease is on the rise, representing nowadays one of the main challenges for the health systems worldwide. This increase generates relevant costs (Ford and Capewell, 2007, Roger et al., 2012). According to the World Health Organization (WHO), 31% of people die every year because of cardiovascular disease, which is responsible for more than 75% of deaths in low-income and middle-income countries (World Health Organization, 2017a).
Depression is the most common mental illness worldwide and affects many people, impairing their personal, social and family activities. About 800,000 people die of suicidal thoughts every year (World Health Organization, 2017b).
In chronic-degenerative diseases such as diabetes, chronic obstructive pulmonary disease, asthma and cardiovascular disease, the risk of depression is two to three times higher than in other people. When depression occurs in patients with these diseases, physical, social and physical functions deteriorate further. Depression is one of the major implications for cardiovascular patients in various studies (Moussavi et al., 2007, Nicholson et al., 2006, Whooley, 2006).
In a meta-analysis study in China, based on 27 studies, the prevalence of depression was 51% in cardiovascular patients (Ren et al., 2014). In a cohort study in Germany, after 5 years of follow-up, the prevalence of depression was 21.8% for people with cardiovascular disease and 14.25% for non-patients (Konrad et al., 2016). In another study in Japan, the prevalence of depression in cardiovascular patients was 22% (Suzuki et al., 2011). Also, in Pakistan, 37% of cardiovascular patients suffered from depression (Bokhari et al., 2002). In another study in the United States, a figure of 9.3% was reported (Lichtman et al., 2008). In another study in Sweden, the prevalence of depression in cardiovascular patients was 15% (Sowden et al., 2010).
Cardiovascular patients in Iran are also prone to depression, which can cause serious problems for patients, the family, the community and the health system. Several studies have been done to determine the extent of depression in cardiovascular patients, and this can provide a better and more transparent viewpoint for policy-and decision-makers, in that an early diagnosis of depression and its treatment reduces the costs and saves resources for the health sector.
Therefore, the aim of this study was to conduct a systematic and meta-analytical review of the prevalence of depression in cardiovascular patients in Iran.
Section snippets
Literature search
Articles written in English and Persian were searched from January 2000 to July 2017 in different databases (PubMed/Medline, Embase, CINAHL, Scopus, ISI Web of Science, PsycINFO, Irandoc, MagIran and SID). The search strategy was performed using Boolean operators (AND, OR) and keywords related to Prevalence, Depression, Cardiovascular disease, and Iran. The search was carried out independently by two authors (Supplementary).
Inclusion criteria
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Observational studies (cross-sectional, cohort and case-control
Search results
The results of the current investigation were reported according to the PRISMA items (Supplementary). After initial search, 117 studies were found. 44 duplicate articles were deleted and 73 articles were considered. The abstracts and full texts of 26 pertinent studies were reviewed by two authors, and finally 12 studies were selected based on inclusion criteria (Abbasi et al., 2016, Araste, 2008, Bayani et al., 2011, Etesami pour and Amirpour, 2014, Ghaleiha et al., 2011, Kheirabadi et al., 2013
Discussion
Depression is often found in patients with chronic illnesses, according to the WHO report, which found a rate between 9.3% and 23% (Moussavi et al., 2007). The results of a cohort study in the United States showed that the prevalence of depression in cardiovascular, diabetic and hypertensive patients was 9.3%, 9.3%, 8%, and 4.8%, respectively (Lichtman et al., 2008). The present study aimed to investigate the prevalence of depression in Iranian cardiovascular patients. This study is the first
Conclusion
The current systematic review and meta-analysis estimated the prevalence of depression among cardiovascular patients in Iran. The prevalence found is higher than the figures computed in developed countries. Depression with cardiovascular disease causes many problems for these patients, and early diagnosis and treatment significantly helps in improving quality of life, as well as saving costs and resources. This has practical implications for both health-care providers and decision- and
Acknowledgements
NA
Conflict of interest
The authors declare that there is no conflict of interests.
Funding/Support
Iran University of Medical Sciences, Tehran, Iran (Grant No: 30048-193-01–96)
References (40)
- et al.
Meta-analysis in clinical trials
Control Clin. Trials
(1986) - et al.
Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates
J. Am. Coll. Cardiol.
(2007) - et al.
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Lancet
(2007) - et al.
Prevalence of anxiety and depression symptoms and their relationship with other coronary artery disease risk factors: a population-based study on 5900 residents in Southeast Iran
Asian J. Psychiatr.
(2016) - et al.
Detection of depression in cardiac inpatients: feasibility and results of systemic screening
Am. Heart J.
(2010) Gender disparity in prevalence of depression among patient population: a systematic review
Ethiop. J. Health Sci.
(2013)- et al.
Factors associated with depressive symptoms in young adults with coronary artery disease: Tehran Heart Center's premature coronary atherosclerosis cohort (THC-PAC) study
Iran. J. Psychiatry
(2016) Comparison of the prevalence and intensity of depression in patients admitted after acute coronary syndrome and patient with cataract
J. Fundam. Ment. Health
(2008)- et al.
Symptoms of depression, acute myocardial infarction, and total mortality in a community sampl
Circulation
(1996) - et al.
Exploring the association between well-being and psychopathology in adolescents
Behav. Genet
(2013)
Depression and Anxiety in a Cardiovascular Outpatient Clinic: a descriptive study
Iran. J. Psychiatry
Prevalence of depression in patients with coronary artery disease in a tertiary care hospital in Pakistan
J. Pak. Med Assoc.
Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model
Arch. Gen. Psychiatry
Prevalence and risk factors for depression and anxiety in hospitalized cardiac patients in pakistan
Psychiatry (Edgmont)
Bias in meta-analysis detected by a simple, graphical test
BMJ
Comparison of resiliency and depression in cardiac patients and normal people
RJMS
Depression and other psychological risks following myocardial infarction
Arch. Gen. Psychiatry
A survey on the frequency of depression and anxiety in the patients with acute coronary syndrome, Ekbatan hospital of Hamadan City
Sci. J. Hamadan Univ. Med Sci.
Measuring inconsistency in meta-analyses
BMJ
Is there any association of anxiety-depressive symptoms with vascular endothelial function or systemic inflammation?
J. Res Med Sci.
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