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 I²estimates 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%, I² = 89.2%), 27.2% (95% CI 23.6–31%, I² = 90.4%), and 32.8% (95% CI 27.9–37.9%, I² = 90.3%), respectively. Anxiety prevalence in adolescents aged 12–18 years (n = 2142) was 26% (95% CI 19.6–33%, I² = 86.4%), 28.4% (95% CI 25–31.9%, I² = 85%) for adults (n = 8175), and 38.4% (95% CI 30.8–46.2%, I² = 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.