The Magnitude of Depression and Factors Associated with it among Epileptic Patients in Ethiopia: A Systematic Review and Meta-Analysis

ABSTRACT Background: The co-occurrence of depression and epilepsy increases the suicide risk by 32 times. Depression in epileptic patients affects medication adherence, increases seizure frequency, and finally reduces the patient’s life quality. Despite this, epileptic individuals are not evaluated for depressive illness in most instances. The aim of the current systematic review and meta-analysis is therefore to give concrete evidence on the magnitude and determinants of depression in epileptic patients in Ethiopia. Methods: A search of databases on Pub Med, Psych-info, Scopus, and EMBASE was conducted systematically. Random effects and quality-effects models were used to illustrate the pooled magnitude of depression and odds ratios of associated factors with a 95% confidence interval. Heterogeneity detected between studies using Cochran’s Q- and the I2test. Subgroup and sensitivity analyses were conducted. The presence of publication bias in the study was also checked with Egger’s test and funnel plot. Result: Nineteen full-text articles were assessed for eligibility. Only ten studies were incorporated in the final meta-analysis. The prevalence of depression among patients with epilepsy ranges from 28.3% to 70.8%. The pooled magnitude of depression within epileptic patients in Ethiopia was found to be 43.14 (35.97, 50.31). The pooled prevalence of depression in the Oromia region 46.15% (95% CI (39.97, 52.32), P<0.001), in the Southern Nation Nationality peoples region was 52.07 %, in Central Ethiopia and Amhara region was also obtained to be 36.58%. The pooled prevalence of depression among patients with epilepsy using PHQ-9 was found to be 44.27. the pooled adjusted odds ratio of low educational level 2.64, 95%CI(1.38, 3.90), High perceived stigma AOR 3.22, 95%CI(1.30, 5.14), more than one seizure/ month AOR 4.82, 95%CI(2.59, 7.05), and poor medication adherence AOR 3.33,95%CI (1.93, 4.73), Conclusion: The pooled prevalence of depression among patients with epilepsy in Ethiopia was huge. The pooled adjusted odds ratio of associated factors with depression was low educational level, poor medication adherence to antiepileptic drugs, high perceived stigma, and seizure frequency more than once per month.

Abstract

Background: The co-occurrence of depression and epilepsy increases the suicide risk by 32 times. Depression in epileptic patients affects medication adherence, increases seizure frequency, and finally reduces the patientâ??s life quality. Despite this, epileptic individuals are not evaluated for depressive illness in most instances. The aim of the current systematic review and meta-analysis is therefore to give concrete evidence on the magnitude and determinants of depression in epileptic patients in Ethiopia. Methods: A search of databases on Pub Med, Psych-info, Scopus, and EMBASE was conducted systematically. Random effects and quality-effects models were used to illustrate the pooled magnitude of depression and odds ratios of associated factors with a 95% confidence interval. Heterogeneity detected between studies using Cochranâ??s Q- and the I2test. Subgroup and sensitivity analyses were conducted. The presence of publication bias in the study was also checked with Eggerâ??s test and funnel plot. Result: Nineteen full-text articles were assessed for eligibility. Only ten studies were incorporated in the final meta-analysis. The prevalence of depression among patients with epilepsy ranges from 28.3% to 70.8%. The pooled magnitude of depression within epileptic patients in Ethiopia was found to be 43.14 (35.97, 50.31). The pooled prevalence of depression in the Oromia region 46.15% (95% CI (39.97, 52.32), P<0.001), in the Southern Nation Nationality peoples region was 52.07 %, in Central Ethiopia and Amhara region was also obtained to be 36.58%. The pooled prevalence of depression among patients with epilepsy using PHQ-9 was found to be 44.27. the pooled adjusted odds ratio of low educational level 2.64, 95%CI(1.38, 3.90), High perceived stigma AOR 3.22, 95%CI(1.30, 5.14), more than one seizure/ month AOR 4.82, 95%CI(2.59, 7.05), and poor medication adherence AOR 3.33,95%CI (1.93, 4.73), Conclusion: The pooled prevalence of depression among patients with epilepsy in Ethiopia was huge. The pooled adjusted odds ratio of associated factors with depression was low educational level, poor medication adherence to antiepileptic drugs, high perceived stigma, and seizure frequency more than once per month.