Incorrect use of meta-analytic procedures.

Abstract

Sir, Maggu, et al.[1] described a systematic review and meta-analysis of the prevalence of depression and anxiety in children and adolescents during the COVID-19 pandemic. They stated in their abstract and text that the pooled prevalence of depression and anxiety was 27% and 25%, respectively. Given the importance of the subject, the paper was taken up for discussion in eJCIndia, a national network of nearly 900 psychiatric faculty, residents, and practitioners across the country.[2] The discussion in eJCIndia centered around one critical and other lesser points; these are briefly presented. The critical point is that the forest plots, which are key to the meta-analysis, were generated for rate ratios. The rate ratio is the wrong choice of the statistic when the outcome of interest is a prevalence because a rate ratio compares prevalences in two groups; in this meta-analysis, no groups were intended to be compared. If the wrong method was employed for meta-analysis, the results and hence the conclusions may be wrong. Other issues also need to be considered. For example, the horizontal axis in the forest plots was constructed along a logarithmic scale; more correctly, when the outcome is a prevalence, it should have been constructed along an arithmetic scale. Finally, there are discrepancies between the pooled values stated in the abstract and text (27% and 25%) and those evident in the forest plot (26% and 23%). Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.