Prevalence of depression in childhood-onset systemic lupus erythematosus: a systematic review and meta-analysis

Objective Childhood-onset systemic lupus erythematosus (cSLE) is frequently associated with psychological symptoms, particularly depression. However, there remains a lack of quantitative evidence regarding the prevalence of screening-positive depressive symptoms based on the currently available evidence. In this context, we conducted a systematic review and meta-analysis addressing this important issue. Methods Three medical databases, including PubMed, Embase, Cochrane Library were utilized in this study. We included studies that reported on cSLE patients experiencing depression for a meta-analysis, without publication language restrictions. Anxiety were included as secondary outcomes. STATA software were employed to synthesize the results as well as to assess heterogeneity and publication bias. Results Totally 12 eligible studies encompassing 652 patients were incorporated into this meta-analysis. Each of the publications included exhibited commendable methodological rigor, with Newcastle-Ottawa scores no less than 6. The pooled prevalence was [32.6%] (95% CI: [24.5%–41.8%]). Between-study heterogeneity was moderate (I 2 = [73.66%]; τ 2 = [0.26] on the logit scale). Subsequent subgroup analysis indicated that the prevalence of depression varied according to the different screening tools used: it was found to be 26% with CDI (95% CI: 0.18–0.34, P = 0.023, I 2 = 61.8%), 41% with PHQ-9 (95% CI: 0.20–0.63, P < 0.001, I 2 = 90.7%), and 37% with other tools such as BSI, BDI, and CES-D (95% CI: 0.21–0.53, P = 0.031, I 2 = 71.3%). Furthermore, the Egger's test indicates that publication bias is insignificant among the studies included. For secondary outcome, pooled results indicated that the prevalence of anxiety among cSLE patients was 29.0% (95% CI: 0.19–0.42, P < 0.001), exhibiting relatively high heterogeneity (I 2 = 61.8%, τ 2 = [0.13] on the logit scale) Conclusions Approximately one-third of patients with cSLE screened positive for depressive symptoms, underscoring the critical need for routine mental health screening in clinical care. These prevalence estimates should be interpreted with caution due to methodological and clinical heterogeneity across studies and do not reflect the prevalence of clinically diagnosed major depressive disorder.