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      Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis

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          Systemic lupus erythematosus (SLE) patients are at high risk for depression and anxiety. However, the estimated prevalence of these disorders varies substantially between studies. This systematic review aimed to establish pooled prevalence levels of depression and anxiety among adult SLE patients.


          We systematically reviewed databases including PubMed, Embase, PsycINFO, and the Cochrane database library from their inception to August 2016. Studies presenting data on depression and/or anxiety in adult SLE patients and having a sample size of at least 60 patients were included. A random-effect meta-analysis was conducted on all eligible data.


          A total of 59 identified studies matched the inclusion criteria, reporting on a total of 10828 adult SLE patients. Thirty five and thirteen methods of defining depression and anxiety were reported, respectively. Meta-analyses revealed that the prevalence of major depression and anxiety were 24% (95% CI, 16%-31%, I 2 = 95.2%) and 37% (95% CI, 12%–63%, I 2 = 98.3%) according to clinical interviews. Prevalence estimates of depression were 30% (95% CI, 22%–38%, I 2 = 91.6%) for the Hospital Anxiety and Depression Scale with thresholds of 8 and 39% (95% CI, 29%–49%, I 2 = 88.2%) for the 21-Item Beck Depression Inventory with thresholds of 14, respectively. The main influence on depression prevalence was the publication years of the studies. In addition, the corresponding pooled prevalence was 40% (95% CI, 30%–49%, I 2 = 93.0%) for anxiety according to the Hospital Anxiety and Depression Scale with a cutoff of 8 or more.


          The prevalence of depression and anxiety was high in adult SLE patients. It indicated that rheumatologists should screen for depression and anxiety in their patients, and referred them to mental health providers in order to identify effective strategies for preventing and treating depression and anxiety among adult SLE patients.

          Trial registration

          Current Meta-analysis PROSPERO Registration Number: CRD 42016044125. Registered 4 August 2016.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12888-017-1234-1) contains supplementary material, which is available to authorized users.

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          Most cited references 28

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               Andreas Stang (2010)

                Author and article information

                +86 13862937371 ,
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                14 February 2017
                14 February 2017
                : 17
                [1 ]Department of Nursing, The Second Affiliated Hospital of Nantong University, 6th Haierxiang Road, 226001 Nantong, People’s Republic of China
                [2 ]ISNI 0000 0000 9530 8833, GRID grid.260483.b, , School of Nursing, Nantong University, ; Nantong, People’s Republic of China
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: the College graduate research and innovation of Jiangsu Province
                Award ID: KYZZ15_0353
                Award Recipient :
                Funded by: the Nantong University Graduate Innovation Program
                Award ID: YKC15075
                Award Recipient :
                Funded by: the Natural Science Foundation of China
                Award ID: 81401124
                Award Recipient :
                Funded by: Science Foundation of Nantong City
                Award ID: MS22015003
                Award Recipient :
                Funded by: Preventive Medicine Projects from Bureau of Jiangsu Province
                Award ID: Y2012083
                Award Recipient :
                Funded by: “Top Six Types of Talents” Financial Assistance of Jiangsu Province
                Award ID: 10.WSN016
                Award Recipient :
                Funded by: the Humanistic Nursing Care Foundation of China
                Award ID: RW2016AM14
                Award Recipient :
                Funded by: Jiangsu Provincial Commission of Health and Family Planning Foundation
                Award ID: Z201622
                Award Recipient :
                Research Article
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                © The Author(s) 2017

                Clinical Psychology & Psychiatry

                systematic review, depression, anxiety, meta-analysis


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