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


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

Article information

Korean J Health Promot. 2018;18(1):32-41
Publication date (electronic) : 2018 March 31
doi : https://doi.org/10.15384/kjhp.2018.18.1.32
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 2017 October 20; Accepted 2017 December 20.

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

References

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Article information Continued

Copyright © 2018 Korean Society for Health Promotion and Disease Prevention
Korean Society for Health Promotion and Disease Prevention

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.

Figure 1

Figure 1

Flow chart of study selection.

Abbreviation: RCT, randomized contolled trial.

Figure 2

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

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

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

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

Figure 6

Publication bias.

Abbreviations: Std, standardized; diff, difference.

Table 1

characteristics of the studies included in the meta-analysis

Table 1

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.