title: The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  There is substantial uncertainty regarding the prevalence of depression in RA. We conducted a systematic review aiming to describe the prevalence of depression in RA.
  
  
  METHODS
  Web of Science, PsycINFO, CINAHL, Embase, Medline and PubMed were searched for cross-sectional studies reporting a prevalence estimate for depression in adult RA patients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed.
  
  
  RESULTS
  A total of 72 studies, including 13,189 patients, were eligible for inclusion in the review. Forty-three methods of defining depression were reported. Meta-analyses revealed the prevalence of major depressive disorder to be 16.8% (95% CI 10%, 24%). According to the PHQ-9, the prevalence of depression was 38.8% (95% CI 34%, 43%), and prevalence levels according to the HADS with thresholds of 8 and 11 were 34.2% (95% CI 25%, 44%) and 14.8% (95% CI 12%, 18%), respectively. The main influence on depression prevalence was the mean age of the sample.
  
  
  CONCLUSIONS
  Depression is highly prevalent in RA and associated with poorer RA outcomes. This suggests that optimal care of RA patients may include the detection and management of depression.
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. faith.matcham@kcl.ac.uk.
authors.forename: Faith
authors.initials: F
authors.lastname: Matcham
authors.forename: Lauren
authors.initials: L
authors.lastname: Rayner
authors.forename: Sophia
authors.initials: S
authors.lastname: Steer
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology*; D019263:Dysthymic Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence
keywords: depression; meta-analysis; prevalence; rheumatoid arthritis; systematic review