Prevalence of depressive symptoms in patients with advanced schistosomiasis in China: A systematic review and meta-analysis

Background: Advanced schistosomiasis is the most serious outcome of infection and has a negative impact on both physical fitness and mental health of patients, the latter of which has long been overlooked. Therefore, we performed this systematic review and meta-analysis to estimate the overall prevalence of depressive symptoms, one of the most common mental problems, in patients with advanced schistosomiasis in China. Methods: Six electronic databases were searched for studies reporting the prevalence of depressive symptoms in the targeted patients. Assessments were pooled using a fixed- or random-effects model based on heterogeneity test. Subgroup analyses were further performed and differences between/among groups were examined using the chi-squared test. The protocol had previously been registered in PROSPERO (CRD42023406708). Results: A total of 11 studies with 1,673 participants were included. The pooled prevalence of depressive symptoms in advanced schistosomiasis in China was 62.01% (95% CI: 51.30% - 72.72%), with a significant heterogeneity among studies. Depressive symptoms were more prevalent in patients with complications and more than half of the patients suffered a mild- or moderate-level of depression. No publication bias was found, and sensitivity analysis showed a stable result. Conclusions: The overall prevalence of depressive symptoms in advanced schistosomiasis in China was high enough to warrant psychotherapeutic interventions, especially for patients with complications. This would greatly prevent or/and reduce depression and improve their quality of life. Author summary: Schistosomiasis is a neglected tropical disease (NTD) which affects more than 250 million people across 78 countries worldwide. The three major schistosomes infecting humans are Schistosoma mansoni, S. japonicum, and S. haematobium. In China, after 70 years of control efforts, tremendous progress has been made, and now the number of schistosomiasis japonica infections is at its lowest historical level. However, advanced schistosomiasis, which is the most serious outcome of schistosome infection, poses a great threat as an increasing number of the patients have been diagnosed. Depression is a frequently occurring mental health issue caused by the disease that has long been overlooked. Therefore, we performed this meta-analysis to estimate the overall prevalence of depressive symptoms in patients with advanced schistosomiasis in China and its possible influential factors. We found that the pooled prevalence was 62.01% (95% CI: 51.30% - 72.72%) in the targeted patients and the estimate was associated with complications of the disease. Our study would call for psychological interventions to improve quality of life for patients with advanced schistosomiasis.