Depression as acute and chronic manifestation of dengue and chikungunya: A systematic review and meta-analysis

Abstract

Background: Recent studies have provided information regard mental impairment in chronic chikungunya patients (CHIKV) when assessed quality of life (QoL) (e.g. SF-36). However, occurrence of depression during acute phase, as well on dengue (DENV) have been neglected, at systematic reviews and meta-analyses. Methods & Materials: A systematic review was conducted (PubMed/Scopus/Web of Science) up to November 1, 2017. The search strategy was “mental” or “psychiatric” or “depression” plus “AND” followed by “chikungunya” and “dengue”. Languages: English and Spanish. Observational studies that assessed at least self-reported depression (or using questionnaires) in patients with acute or chronic chikungunya or dengue, were included. Comprehensive Meta-Analysis 3.3.070® licensed, was used for this meta-analysis. Results: Our literature search yielded 241 citations. The pooled prevalence of depression associated to CHIKV/DENV in 8 selected studies among 1,649 patients was 39.3% (95%CI 36.6-42.1; τ2 = 1.471; I2 = 97.8; p < 0.001). When considering just CHIK studies (n = 6), among 911 patients, estimate was 25.1%(95%CI 22.0-28.5; τ2 = 1.338; I2 = 96.2; p < 0.001), while for DENV studies (n = 2) with 738 patients, estimate was 52.6%(95%CI 48.7-56.4; τ2 = 1.664; I2 = 98.9; p < 0.001). For studies at acute phase (n = 4 [2 DENV, 2 CHIKV]), with 798 patients, estimate was 51.3% (95%CI 47.5-55.1; τ2 = 1.730; I2 = 97.2; p < 0.001), whilst at chronic phase (n = 4, all CHIKV), with 851 patients, was 25.5% (95%CI 22.3-28.9; τ2 = 1.378; I2 = 97.6; p < 0.001). Globally, the funnel plot and the Egger's regression suggested bias publication (-7.46; p = 0.06) (confirmed with Duval and Tweedie's trim and fill). Conclusion: According to our results in the most conservative scenario, approximately one third of patients at any stage of DENV or CHIKV would report depression, being higher during acute phase and for dengue (around half of patients), in comparison to chronic chikungunya (a fifth). It is important to highlight that the findings suggest a clear need to increase the number of studies about depression and other mental disorders in these and other arboviral diseases, including also Zika, as well to use standardized and validate questionnaires, such as the Zung Self-Rating Depression Scale (SDS), Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI), among others, given consequently the implications for diagnosis and therapeutics.