Edinburgh Napier University

  Purpose: Depression is highly prevalent and persistent in patients with cardiovascular disease (CVD) (Cohen, Edmondson & Kronish, 2015). Patients with comorbid CVD and depressive symptoms are also at higher risk for recurrent cardiac events, mortality, and disability, and thus have poorer health-related and overall quality of life (Maqsood et al., 2017). Between 31% and 45% of patients with coronary artery disease (CAD), including those with stable CAD, unstable angina, or myocardial infarction, have clinically significant depressive symptoms, resulting in adverse cardiovascular outcomes and associated increased healthcare costs (Huffman, Celano, Beach, Motiwala, & Januzzi, 2013). The prevalence of depression is increasing specifically among CVD patients in South Asia (John, 2013). Patients experience various emotional issues during the different phases of CVD (Nasir, Shahid & Shabbir, 2015). Depression also complicates the optimal management of CVD by exacerbating cardiovascular risk factors and decreasing adherence to healthy lifestyles and evidence-based medical therapies (Bhatt, et al., 2015). The purpose of this review was to determine the prevalence of depression among patients with CVD in South Asia. Knowledge about the prevalence of depression among CVD patients in South Asia is essential to develop strategies for prevention, early detection, and appropriate management, resulting in improved outcomes.
Methods: A systematic review was conducted to identify, appraise, synthesize, and critically analyze the existing peer-reviewed literature on the prevalence of depression among patients with CVD in South Asia. Three scientific databases (PubMed, PsychINFO, and Cumulative Index to Nursing and Allied Health) were searched using several key words for original research studies written in English and published between January 2008 and November 2018. This resulted in 107 articles, of which 12 were potentially relevant. Of the 12, only the 8 addressing the prevalence of depression among South Asians with CVD were reviewed via MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. Initially, the research team members reviewed the articles independently based on study inclusion criteria using the Rayyan web application for systematic reviews, and this process was blinded. The team discussed the dissimilarities and reached consensus with regard to the selection of articles twice to ensure adequate sampling.
Results: Of the 8 studies, 5 were conducted in Pakistan, 2 were in North India, and 1 was in Bangalore. The prevalence of depression ranged from 23.8% to 47%, based on the sample size. Five studies that used a cross-sectional study design were included in the meta-analysis, with an overall effect size equaling 0.33 (95% CI 0.25–0.41). Thus, the prevalence of depression can be reported as 0.33%.
Conclusion: The findings showed that many South Asian patients with CVD experience depressive symptoms and emphasized the need for early screening for depression in patients with CVD for early identification and optimal management of depression to improve health outcomes. Appropriate management including cardiac rehabilitation and exercise programs, cognitive behavioral therapy, antidepressant medication, combined approaches, regular counseling services, or a referral for treatment can prevent further complications.