| کلیدواژههای انگلیسی مقاله |
Depression, Thalassemia, Prevalence, Meta-analysis, Iran, What&,rsquo s Known The psychological health of patients with beta-thalassemia major is of great importance, as it has been linked to their treatment compliance and long-term survival. Depression is the most common psychiatric disorder among patients with beta-thalassemia major and may lead to mental disorders. What&,rsquo s New Nearly half of Iranian patients with beta-thalassemia major suffer from depression. Mild depression is more common (16%) in patients with beta-thalassemia major. IntroductionThalassemia is the most common form of inherited anemia worldwide. 1, Beta-thalassemia (BT) major is a thalassemia type characterized by anomalies in the synthesis of the beta chains of hemoglobin, which results in various phenotypes ranging from clinically asymptomatic to severe anemia. 2, The World Health Organization (WHO) in 2019 reported that around 50,000 infants were born with BT every year. 3, Iran, with a thalassemia gene prevalence rate of 4%, is among the countries located on the thalassemia belt. It is estimated that there are between two to three million BT carriers and 25,000 patients in Iran. 4, Patients with BT suffer from various physical and psychiatric problems. Although various aspects of physical health have been considered in these patients, little attention has been paid to their psychological status. 5, The psychological health of patients with BT is of great importance, as it has been linked to their treatment compliance and long-term survival. Depression is the most common psychiatric disorder among these patients 6, and could occur due to the chronic nature of the disease, prolonged treatment periods, expectations of premature death, changes in appearance, and feelings of deprivation. 7, Depression may cause sadness, loss of interest or pleasure, feelings of guilt or low self-esteem, sleep or appetite disorders, feelings of tiredness, and poor concentration in affected patients. 8, The prevalence of depression among patients with BT varies from 10% to 35% in different regions of the world. 1, , 9, - 13, In Iran, there is a huge variation in the prevalence of depression in this population. It is reported that 12% to 100% of Iranian patients with BT experience depression. 14, - 16, Previous studies in some regions of Iran have shown that patients with BT have a low quality of life, and a high percentage of them suffer from moderate-to-severe depression, anxiety, and stress. 17, , 18, As BT is a relatively rare disease, most studies conducted on this population have small sample sizes, which in turn decrease the precision of estimates. Accordingly, the main objective of this systematic review and meta-analysis was to assess the prevalence of depression among Iranian patients with BT. Furthermore, we addressed factors that may introduce heterogeneity in the prevalence. The results of this review may be beneficial to policy-making regarding the early detection of depression in this population. Materials and Methods Study Protocol The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. 19, The search steps, the selection of studies, quality assessment, and data extraction were independently performed by two researchers (J. Z. and A. Z.) to avoid bias, and in the case of controversies, the issue was referred to a third person (Sh. A.). Search Strategy Google Scholar and PubMed search engines and Scopus, Web of Science (ISI), and Embase databases were searched to find English articles. Additionally, Iranian databases such as Scientific Information Database (SID), Magiran, and the Iranian Research Institute for Information Science and Technology (IranDoc) were searched to find Farsi articles. The search date was restricted to articles published from 1991 until June 2019. The key Medical Subject Headings (MeSH) were combined using Boolean operators, (depression OR ",mental health&,raquo OR &,ldquo depressive disorder&,rdquo OR &,ldquo mental health&,rdquo ) AND (thalassemia OR &,ldquo beta-thalassemia major&,rdquo ) AND (prevalence OR epidemiology) AND (Iran). Since Iranian databases do not allow for a search using Boolean operators, we performed a search in these databases by using only the keywords. Inclusion and Exclusion Criteria Cross-sectional or cohort studies that reported the prevalence of depression in individuals with BT and were published in either English or Farsi were eligible. Studies were excluded, if they had the following criteria, 1) they were published before 1991, 2) the prevalence was not reported or could not be calculated based on the data (e.g., studies that only reported the mean depression score), 3) their full-text was inaccessible, and 4) they were duplicated. Two independent reviewers (S. N. and A. Z.) meticulously scanned all the titles, abstracts, and keywords of every published article for their relevance and eligibility. Any disagreement between the two reviewers was resolved by further investigation and discussion among the authors. If the information in the title or abstract was insufficient, the full text was reviewed. Quality Assessment For the quality assessment of the articles, the Newcastle-Ottawa Scale (NOS) checklist was used. 20, This checklist contains seven items in three sections, 1) Selection of the Study (four items), 2) Comparability (one item), and 3) Outcome (two items). In this study, two authors (A. Z. and S. N.) reviewed the full text of the articles. Studies with NOS scores of seven or greater were regarded as high-quality, studies with a score of 5-6 were considered moderate-quality, and studies with a score of less than five were deemed poor-quality and were excluded from the meta-analysis. Data Extraction The data extraction procedure was performed by two reviewers (J. Z. and Sh. A.) using a digital data extraction form. The extracted data were ",study location and setting",, ",publication year",, ",participants&,rsquo characteristics", (gender and age), ",sample size",, ",reported prevalence of depression and its 95% confidence interval (CI) ",, ",year of study",, ",type of study",, and ",type of questionnaire used for depression measurement",. Definition The main outcome was defined as the diagnosis of depression in patients with BT based on the following questionnaires, the Beck Depression Inventory (Beck), 21, , 22, the General Health Questionnaire (GHQ-28), 23, the Depression Anxiety Stress Scale (DASS), 24, the Hospital Anxiety Depression Scale (HADS), 22, the Children Depression Inventories (CDI), 25, the Children Depression Scale (CDS), 26, and the Kiddie-SadS (K-SADS). 27, Statistical Analysis Pooled prevalence was calculated using the &,ldquo metaprop&,rdquo command in Stata software, version 14 (StataCorp LP, 1985&,ndash 2015, USA). The standard error of prevalence was calculated for each study based on the binomial distribution formula. For the assessment of heterogeneity across the studies, Cochran&,rsquo s Q test and the I2 statistic were calculated. For I2 values over 50%, the random-effects model was employed to estimate the pooled measures and 95% CIs. The effect of heterogeneity on depression prevalence was addressed through sub-groups analyses based on geographical regions, quality of studies, and type of questionnaire. In addition, a meta-regression model was used to control the effect of geographical regions, quality of studies, and type of questionnaire on depression prevalence. The possibility of publication bias was addressed through the depiction of a funnel plot illustrating the standard error. All the analyses were performed using Stata software, version 14 (Stata Corp LP, 1985-2015, USA), and P values of less than 0.05 were considered significant. The funnel plot was drawn using Microsoft MedCalc Software, version 19.1.7 (MedCalc software Ltd., Ostend, Belgium).Results Literature Search Result The initial search identified 1175 articles, of which 385 duplicates were excluded. The remaining 790 studies underwent title and abstract screening, which resulted in the identification of 43 eligible articles. At this stage, 10 articles were excluded, because their full-text was inaccessible. After the review of the full text of the remaining 33 articles, 18 articles with medium or high quality were entered into the meta-analysis process (figure 1,). Overall, these articles recruited 3053 Iranian patients at a mean age of 22.21 years (95% CI, 19.46% to 24.95%). The sample size of the studies varied from 33 to 480 patients. The most commonly used type of questionnaire was Beck (35%) (table 1,).Figure 1. This figure shows the flow diagram of study selection in this systematic review and meta-analysis of depression prevalence among Iranian patients with beta-thalassemia major.Author Publication YearStudy DesignPlaceSample SizeAge (mean&,plusmn SD)QuestionnaireQuality Scores (NOS)*,Prevalence of Depression (%)**,Hooshmandi and colleagues 7, 2015Cross-sectionalBushehr17723.45&,plusmn 5.59Becka,745Shafiee and colleagues 28, 2014Cross-sectionalTehran56-Beck638Naderi and colleagues 16, 2012Cross-sectionalZahedan16418.70&,plusmn 2.20GHQ-28b,712Salehi and colleagues 29, 2014Cross-sectionalGorgan16319.60&,plusmn 5.30GHQ-28740Poormansouri and colleagues 18, 2016Cross-sectionalAhvaz14225&,plusmn 5.13DASSc,660Adib-Hajbaghery and colleagues 17, 2015Cross-sectionalAhvaz17323.34&,plusmn 5.90DASS858Maheri and colleagues 30, 2018Cross-sectionalTehran38930.23&,plusmn 8.30HADSd,720Azizzadeh Forouzi and colleagues 14, 2015Cross-sectionalKerman48022.60&,plusmn 4.50DASS751Mohammadzadeh and colleagues 31, 2018Cross-sectionalBandar Abbas264-Beck842Izadyar and colleagues 32, 2006Cross-sectionalTehran135-CDIe,626Izadyar and colleagues 32, 2006Cross-sectionalTehran33-Beck612Ghanizadeh and colleagues 6, 2006Cross-sectionalShiraz110-K-SADSf,749Moafi and colleagues 33, 2008Cross-sectionalIsfahan5014.80&,plusmn 2.85Beck552Haji SeyedJavadi and Shafikhani 34, 2017Cross-sectionalQazvin147-HADS559Ghafari Saravi and colleagues 35, 2004Cross-sectionalSari165CDSg,614Aziznejad and colleagues 36, 2008Cross-sectionalBabol100-Beck539Hashemi and colleagues 37, 2012Cross-sectionalYazd34-Beck529Marvasti and colleagues 38, 2006Cross-sectionalShiraz208-Beck547Khamoushi and colleagues 15, 2015Cross-sectionalKermanshah63-DASS6100*Newcastle-Ottawa Scale ** Proportion test was used by &,ldquo metaprop&,rdquo command in Stata software. aBeck Depression Inventory bGeneral Health Questionnaire cDepression Anxiety Stress Scale dHospital Anxiety Depression Scale eChildren Depression Inventories f Kiddie-Sads gChildren Depression Scale |