Point prevalence of depression in persons with active epilepsy and impact of methodological moderators: A systematic review and meta-analysis

•Depression is a well-established comorbid condition among persons with epilepsy (PWE).•In this study, the prevalence estimate of depression in PWE was determined as 32%.•Assessment method, study year, and location significantly affected prevalence estimate.•Screening tools can be a less resource intensive means for assessing depression in PWE.•Cutoff can be optimized to ensure that even minimal or mild depression is not missed out. The aim of this study was to determine the pooled prevalence of depression in persons with epilepsy and assess the methodological moderators affecting the prevalence estimates. Five electronic databases PubMed, The Cochrane Library, EMBASE, WHO Global Index Medicus, and Clinicaltrial.gov were searched for studies reporting prevalence of depression in PWE ≥ 18 years of age in any setting. Out of 13,873 studies, after deduplication and screening, 56 studies with 10,527 PWE met the eligibility criteria. The overall pooled prevalence of depression in PWE was 32% (95%confidence interval [CI] 28–35%) and significant heterogeneity (Chi-square = 1171.53, p = 0.00; τ2 = 0.02; I2 = 94.36%). Prevalence has doubled in the recent years (16% in 2000–2005 vs. 35% in 2016–2020), was higher in Asia than in Europe (coefficient 0.899, 95%CI: 0.809–0.999; p = 0.049). Among assessment methods, prevalence was highest in HAM-D scale (54%, 95%CI: 27–82%) and lowest in MINI (22%, 95%CI: 19–26%). Sensitivity analysis also corroborated findings when MINI was excluded (35%, 95%CI: 31–38%). A significant proportion of PWE have depression. Though there is substantial heterogeneity due to various methodological moderators, it is unlikely to affect the routine screening of PWE for depression. Use of a screening tool should be based on ease of administration, and cutoff selection should ensure identification of minimal depression as well.