Elsevier

Journal of Affective Disorders

Volume 227, February 2018, Pages 149-155
Journal of Affective Disorders

Review article
Prevalence of depression in cardiovascular patients in Iran: A systematic review and meta-analysis from 2000 to 2017

https://doi.org/10.1016/j.jad.2017.10.026Get rights and content

Highlights

  • The prevalence of depression among cardiovascular patients in Iran is higher than the figures found in developed countries.

  • The relative risk (RR) of depression in cardiovascular patients yielded a value of 1.30 [95% confidence interval 1.05–1.62] with P < 0.001.

  • Women are more at risk for depression than men.

Abstract

Background

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. The aim of this study was to conduct a systematic and meta-analytical review of the prevalence of depression in cardiovascular patients in Iran.

Methods

Articles written in English and Persian were searched from January 2000 to July 2017 in different scholarly databases.

Results

12 studies were retained and included in the current meta-analysis. Selected studies were published between 2008 and 2016. The number of patients participating in these studies was 9292. Based on the random-effects model, the prevalence of depression in cardiovascular patients in Iran was 47% [95% confidence interval or CI 38–56], I2=98.2% with P = 0.000. The relative risk (RR) of depression in cardiovascular patients yielded a value of 1.30 [95%CI 1.05–1.62] with P < 0.001. Women are more at risk for depression than men.

Conclusion

The current meta-analysis estimated the prevalence of depression among cardiovascular patients in Iran. The prevalence found computed by the present study is higher than the figures found 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.

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

  • 1.

    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)

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    Contact information: Lorestan University of Medical Sciences, Anooshirvan Rezaei Square, Khorramabad, Lorestan, Iran. Postal code: 6813833946.

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