Epidemiology of depressive disorders in people living with hypertension in Africa: a systematic review and meta-analysis

OBJECTIVES: Better knowledge of epidemiology of depressive disorders in people living with hypertension can help to implement pertinent strategies to address its burden. The objective was to estimate the prevalence of depressive disorders and symptoms in people living with hypertension in Africa. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, African Index Medicus, African Journals OnLine were searched up to 31 January 2020, regardless of the language of publication. ELIGIBILITY CRITERIA: We included studies conducted among adult patients with hypertension (≥18 years) living in Africa and reporting the prevalence of depressive disorders and symptoms. DATA EXTRACTION AND SYNTHESIS: Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies by using the tools developed by Joanna Briggs Institute. Multivariate random-effects meta-analysis served to pool data by considering the variability between diagnostic tools used to identify patients with depressive disorders or symptoms. RESULTS: We included 11 studies with 5299 adults with hypertension. Data were collected between 2002 and 2017, from South Africa, Nigeria, Ghana, Ethiopia and Burkina Faso. The mean age varied between 50.3 years and 59.6 years. The proportion of men ranged from 28% to 54%. The adjusted prevalence of depressive disorders taking into account the variance between diagnostic tools was 17.9% (95% CI 13.0% to 23.4%). The prevalence of depressive symptoms and major depressive symptoms was 33.3% (95% CI 9.9% to 61.6%) and 7.8% (95% CI 3.0% to 14.5%), respectively. There was heterogeneity attributable to the diagnostic tools for depressive disorders and symptoms. There was no publication bias. CONCLUSION: Notwithstanding the representativeness lack of some (sub) regions of Africa, weakening the generalisability of findings to the entire region; depressive disorders and symptoms are prevalent in people living with hypertension in Africa, indicating that strategies from clinicians, researchers and public health makers are needed to reduce its burden in the region.