Depression and anxiety prevalence in people with cystic fibrosis and their caregivers: a systematic review and meta-analysis

Background Prevalence of depression and anxiety in people with cystic fibrosis (PwCF) and their caregivers is high, however, results have been inconsistent. This systematic review and meta-analysis aimed to estimate the prevalence of depression and anxiety in PwCF and their caregivers and explore sources of heterogeneity. Method MEDLINE, EMBASE, CINAHL plus and PsychINFO databases were searched from inception to January 2021. Studies were included if a specific psychometric tool (PT) to assess depression or anxiety (rather than quality of life) was used and did not involve a transitory patient state. Random-effects models were applied due to high anticipated heterogeneity and I 2 estimates were calculated. Sources of heterogeneity were explored through subgroup comparisons. The presence of small-study effects was investigated visually using funnel plots and statistically using the Egger test. Results A total of 94 articles (48 full-text publications, 46 abstracts) were included. Depression prevalence in adolescents aged 12–18 years ( n = 2386), adults ( n = 9206) and caregivers ( n = 6617) were 18.7% (95% CI 12.8–25.3%, I 2 = 89.2%), 27.2% (95% CI 23.6–31%, I 2 = 90.4%), and 32.8% (95% CI 27.9–37.9%, I 2 = 90.3%), respectively. Anxiety prevalence in adolescents aged 12–18 years ( n = 2142) was 26% (95% CI 19.6–33%, I 2 = 86.4%), 28.4% (95% CI 25–31.9%, I 2 = 85%) for adults ( n = 8175), and 38.4% (95% CI 30.8–46.2%, I 2 = 94.6%) for caregivers ( n = 5931). Prevalence differed by the PT used and study location. Discussion This comprehensive analysis found the prevalence of depression and anxiety in PwCF and their caregivers to be high, supporting recommendations for regular screening. Choice of PT significantly influenced prevalence, indicating a need for future studies to identify the optimal PT for each CF population to identify those most at risk.