Depression in Patients with Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Eunhee Hwang; Sujin Shin

doi:10.15384/kjhp.2018.18.1.32

Korean J Health Promot > Volume 18(1); 2018 > Article

Hwang and Shin: Depression in Patients with Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Original Article

Korean Journal of Health Promotion 2018;18(1):32-41.

Published online: March 31, 2018

DOI: https://doi.org/10.15384/kjhp.2018.18.1.32

Depression in Patients with Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Eunhee Hwang¹, Sujin Shin²

¹Department of Nursing, Wonkwang University, Iksan, Korea.

²College of Nursing, Ewha Womans University, Seoul, Korea.

Corresponding author: Sujin Shin, PhD. College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea.
Tel: +82-2-3277-2726, Fax: +82-2-3277-2850, ssj1119@ewha.ac.kr

Received October 20, 2017 Accepted December 20, 2017

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

Symptoms of subclinical hypothyroidism include depression, memory loss, myocardial contractility disorder, lipid metabolic disorder, and atherosclerosis. However, the relationship between subclinical hypothyroidism and depression has not been consistent. Therefore, the purpose of this study was to provide the scientific evidence for the relationship between subclinical hypothyroidism and depression.

Methods

This study was a meta-analysis of depression in subjects with subclinical hypothyroidism. The search engine of PubMed, EBSCO, ScienceDirect, and RISS was used to search the studies published since the 1990s. A total of 176 documents were retrieved from the literature search, and finally 10 studies were included in the analysis. Statistical analysis of effect sizes was performed using Comprehensive Meta-Analysis software version 2.2.064.

Results

Of the 10 studies, five studies reported that depression was associated with subclinical hypothyroidism. Two of these studies were on women and two were on the elderly. The effect size of depression in patients with subclinical hypothyroidism was 3.46 (95% confidence interval 0.20–0.74, P=0.001), and the subclinical hypothyroidism was significantly associated with depression.

Conclusions

This study showed that subclinical hypothyroidism is associated with depression. The results also suggest the need for regular screening of depressive symptoms of patients with subclinical hypothyroidism. Especially, elderly and women with subclinical hypothyroidism may be the main targets of depressive symptom.

Keywords: Hypothyroidism, Depression, Meta-analysis

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Figure 1

Flow chart of study selection.

Abbreviation: RCT, randomized contolled trial.

Figure 2

Effect size of depression among subclinical hypothyroidism.

Heterogeneity: I-squared=90.02%, tau-squared=0.180, P=0.000

Abbreviations: Std diff, standard difference; CI, confidence interval.

Figure 3

Effect size of depression according to the gender.

Heterogeneity: I-squared=92.16%, tau-squared=0.039, P=0.000

Abbreviations: Std diff, standard difference; CI, confidence interval.

Figure 4

Effect size of depression acdording to the sample size.

Heterogeneity: I-squared=92.16%, tau-squared=0.039, P=0.000

Abbreviations: Std diff, standard difference; CI, confidence interval.

Figure 5

Effect size of depression according to the data adjustment.

Heterogeneity: I-squared=92.16%, tau-squared=0.039, P=0.000

Abbreviations: Std diff, standard difference; CI, confidence interval.

Figure 6

Publication bias.

Abbreviations: Std, standardized; diff, difference.

Table 1

characteristics of the studies included in the meta-analysis

Abbreviations: TSH, thyroid-stimulating hormone; HAM-D, Hamilton Depression Scale; BDI, BeckD, Hamilton DeInventory; NA, not applicable; PRL, prolactin; GDS, Geriatric Depression Scale; CES-D, Center for Epidemiologic Studies-Depression Scale; MADRS, Montgomery-Asberg Depression Rating Scale; HADS, Hospital Anxiety and Depression Scale; WHO, World Health Organization; MDI, Major Depression Inventory; GDS-K, Geriatric Depression Scale-Korean.