Epidemiology of depression and anxiety in gout: A systematic review and metaanalysis.
To conduct a systematic review of depression and anxiety among patients with gout that specifically evaluates the prevalence, incidence, determinants, and impacts of these mental health comorbidities.We conducted a literature search in Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO using indexed terms and key words to identify studies reporting on depression/anxiety in patients with gout. This review included full-text articles published in English that reported on patients with gout, evaluated depression/anxiety using a routinely reported measure, and provided estimates or sufficient data on the prevalence, incidence, determinants, or impacts of depression/anxiety. Meta-analyses were conducted using random effects models.20 of 901 articles identified through the search strategy met our inclusion criteria. All 20 studies evaluated depression, while only ten assessed anxiety (50.0%). Meta-analyses suggest a positive association between mental health disorders and gout, as resultant pooled odds ratios were 1.29 (95% confidence interval [CI] 1.07 to 1.56) for depression and 1.29 (95% CI 0.96 to 1.73) for anxiety. Findings from four studies reporting on the incidence of depression in patients with gout resulted in a pooled hazard ratio of 1.17 (95% CI 1.01 to 1.36). Significant determinants of depression included number of tophi, frequency of flares, and oligo/polyarticular gout.Our systematic review suggests depression and anxiety are significantly associated with gout and highlights the need for future research to focus on the onset of mental disorders after gout diagnosis as well as identify potential targets for intervention.