Background/Purpose:  To systematically review the literature on the: 1) prevalence of depression and anxiety in SLE patients and 2) metrics of depression and anxiety.  

Methods : This review was conducted based on the recommendation of Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols statement. A literature search (1954-2016) was performed in Ovid Medline, Embase, Psyc INFO and CINAHL for articles on the prevalence of depression and/or anxiety in adult SLE patients or on the metrics of depression/anxiety. Included studies were critically appraised and analyzed. The prevalence of depression and anxiety was studied for all instruments and whenever possible Pooled Prevalence (PP) was determined in the commonly used instruments [Centre for Epidemiological Studies – Depression (CES-D), Beck Depression/Anxiety Inventory (BDI/BAI), Hospital Anxiety/Depression Scales (HADS-D/A), Hamilton Rating Scales for Depression/Anxiety (HAM-D/A)].  

Results: A total of 4394 references were identified, 278 were selected for detailed review and 121 were included in the final analysis. Depression: PP of Depression was 35.2% (95% CI: 30.1, 40.5%) (Figure 1A) based on data from 70 studies in 23399 patients. Anxiety: PP of Anxiety was 24.2% (95% CI: 17.9, 31.2%) (Figure 1B) based on data from 39 studies in 4495 patients.   CES-D: was utilized in 13 studies in 1856 patients. Depression PP was 41.5% (95% CI: 35.1, 48.1%). BDI/BAI: was utilized in 14 studies in 1355 patients and 3 studies in 489 patients respectively. Depression PP was 39.9% (95% CI: 31.1, 49.1%) and Anxiety PP was 38.4% (95% CI: 34.2, 42.8%). HADS-D/A: was utilized in 14 studies in 1238 patients and 12 studies in 1099 patients respectively. Depression PP was 24.4% (95% CI: 19.1, 30.1%) and Anxiety PP was 38.3% (95% CI: 29.1, -47.9%). HAM-D/A: was utilized in 5 studies in 323 patients and 5 studies in 269 patients respectively. Depression PP was 43% (95% CI: 27.9, 58.7%) and Anxiety PP was 37.3% (95% CI: 31.7, 43.2%). We found high variability in the prevalence of depression and anxiety, and high statistical heterogeneity (I²> 75%) which is attributed to the: 1) lack of standardization in the metrics and definitions of depression and anxiety in SLE, and 2) variability in other demographics such as patients age, education levels and other factors that  associate/predict depression and/or anxiety.  

Conclusion: The prevalence of depression/anxiety is high in patients with SLE, ranging from 5.7% to 78.6% and 1.1% to 71.4%, respectively. The CES-D, BDI, HAM-D yielded a similar prevalence of depression, ranging between 27.9% and 49.1%, whereas the prevalence of depression with the HADS-D was lower.(24.4%). All metrics (BAI, HADS-A, HAM-A) of anxiety yielded a similar prevalence of anxiety prevalence ranging between 29.1% and 47.9%.