Comorbid Major Depressive Disorder in Schizophrenia: A Systematic Review and Meta-Analysis

Abstract

Comorbid major depressive disorder (MDD) in schizophrenia (SZ; SZ-MDD) has been identified as a major prognostic factor. However, the prevalence and associated factors of SZ-MDD have never been explored in a meta-analysis. All studies assessing the prevalence of SZ-MDD in stabilized outpatients with a standardized scale or with structured interviews were included. The Medline, Web of Science, PsycINFO, and Google Scholar databases were searched. Using random effects models, we calculated the pooled estimate of the prevalence of SZ-MDD. We used meta-regression and subgroup analyses to evaluate the potential moderators of the prevalence estimates, and we used the leave-one-out method for sensitivity analyses. Of the 5633 potentially eligible studies identified, 18 studies (n = 6140 SZ stabilized outpatients) were retrieved in the systematic review and included in the meta-analysis. The pooled estimate of the prevalence of SZ-MDD was 32.6% (95% CI: 27.9–37.6); there was high heterogeneity (I2 = 92.6%), and Egger’s test did not reveal publication bias (P = .122). The following factors were found to be sources of heterogeneity: publication in or after 2015, the inclusion of patients from larger studies, the assessment tools, the inclusion of patients with substance use disorder or somatic chronic diseases, age, education level, the lifetime number of hospitalizations, and antidepressant use. Two-thirds of the extracted variables could not be explored due to an insufficient amount of published data. The prevalence of MDD is high among SZ individuals. Healthcare providers and public health officials should have an increased awareness of the burden of SZ-MDD.

The Community Assessment of Psychic Experiences: Optimal cut‐off scores for detecting individuals with a psychotic disorder

“…This may have methodological reasons, for example, the items in the hallucination dimensions appear to reflect stronger severity than in the other dimensions (e.g., hallucinations, “Do you ever hear voices when you are alone?”, compared to paranoia, “Do you ever feel as if you are being persecuted in some way?”). Although individuals with psychotic disorders have high level of depressive symptoms (Etchecopar‐Etchart et al., 2021 ), we found positive symptoms rather than depressive symptoms were the best indicator in discriminating individuals with a psychotic disorder from healthy individuals.…”

Effects of COVID-19-related stress and fear on depression in schizophrenia patients and the general population

“…Moreover, the results of our study showed larger differences in the latent means for loneliness and depression compared with the general population. Depression in patients with schizophrenia is related to poorer clinical outcome, low resilience, high suicidality, and reduced subjective quality of life 25 , 26 . The COVID-19 pandemic has reduced access to medical resources and weakened community mental health services.…”

Pain Sensitivity in Schizophrenia Spectrum Disorders: A Narrative Review of Recent Work

“…The study concluded that major depression and schizophrenia commonly co-existed but that schizophrenia eclipsed the depression, which was left untreated, thus negatively affecting the outcome of illness. A recent systematic review and meta-analysis [22] confirmed the frequency of this co-morbidity, recommending that antidepressants be more frequently used in schizophrenia [22], a currently uncommon practice [23].…”

“…When antidepressants are used, it is possible that they help schizophrenia patients to reduce pain response by impacting the emotional experience of pain [22]. This is speculation for which there is, as yet, no definitive evidence.…”