title: The Global Prevalence of Anxiety and Depressive Symptoms Among Caregivers of Stroke Survivors.
abstract: OBJECTIVE
  The global prevalence of depressive and anxiety symptoms among caregivers of stroke survivors is unknown. Given the high index of caregiver burden, this meta-analysis aims to evaluate the pooled prevalence of depressive and anxiety symptoms among caregivers of stroke survivors globally and to determine underlying moderators.
  
  
  METHODS
  The authors searched PubMed, Embase, PsychINFO, BIOSIS, Science Direct, and Cochrane CENTRAL databases from inception to June 2016, and relevant articles were selected in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We calculated the pooled prevalence proportion of depressive and anxiety symptoms among caregivers of stroke survivors. Meta-regression was performed to identify important moderators which contribute to heterogeneity.
  
  
  RESULTS
  The literature search generated 1259 records, and 34 full-text articles were reviewed in details. Twelve studies met the inclusion criteria and comprised of 1756 caregivers. The pooled prevalence of depressive symptoms was 40.2% (95% confidence interval 30.1%-51.1%) and anxiety symptoms 21.4% (95% confidence interval 11.6%-35.9%) among caregivers of stroke survivors based on the random-effects model. There was significant heterogeneity. Meta-regression was conducted to account for the heterogeneity of the prevalence. For depressive symptoms, female sex of caregivers and stroke survivors, as well as Caucasian ethnicity of caregivers were associated with high prevalence of depression. Spousal and child relationship of caregivers to stroke survivors were associated with low prevalence of depression. For anxiety symptoms, meta-regression could not be conducted because insufficient number of studies provided information on the moderators.
  
  
  CONCLUSIONS
  This meta-analysis has identified the high prevalence of depressive and anxiety symptoms among caregivers of stroke survivors, which were 40.2% and 21.4%, respectively. Meta-regression has identified that female sex of caregivers and stroke survivors as well as Caucasian race were associated with higher prevalence of depression. The findings of this study would help to guide interventions that aim to reduce psychiatric morbidity of caregivers of stroke survivors.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Alvona Z
authors.initials: AZ
authors.lastname: Loh
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Tan
authors.affiliation: Biomedical Global Institute of Healthcare Research and Technology, National University of Singapore, Singapore. Electronic address: Melvyn_wb_zhang@nuhs.edu.sg.
authors.forename: Melvyn W
authors.initials: MW
authors.lastname: Zhang
authors.affiliation: Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Roger C
authors.initials: RC
authors.lastname: Ho
mesh_terms: D001007:Anxiety / Q000453:epidemiology*; D017028:Caregivers / Q000523:psychology*; D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D020521:Stroke; D017741:Survivors
keywords: Caregiver; anxiety; depression; meta-analysis; prevalence; stroke; systematic review