Prevalence and gender difference in depression in primary health care in India: A systematic review and meta-analysis

Background:Depression contributes to the major burden of mental illness in India. Assessment of burden is essential to develop interventions to address the problem at the primary care level.Materials and Methods:We carried out a systematic review and meta-analysis of studies documenting the prevalence of depression in primary care in India. A wide literature search strategy was developed using keywords and Medical Subject Headings. The literature search was done in MEDLINE (via PubMed), IndMed, and major Indian psychiatric journal websites. The protocol was registered at PROSPERO. Bias assessment was carried out using a Cochrane risk of bias tool.Results:A total of 186 studies were identified after an initial search, of which 17 were included in the final analysis using pre-specified inclusion and exclusion criteria. The aggregate point prevalence of depression at the primary care level of the 17 studies using the random-effect model was 23.0% (95% CI: 16.0-30.0%). Significant heterogeneity was reported among the studies attributed majorly to a variety of study tools for assessing depression. Sub-group analysis revealed the higher aggregated prevalence of depression among females as compared to males at the primary care level.Conclusion:The study provided updated evidence of higher and gender differential burden of depression at the primary care level in India.