| Background:Some studies show that depression is the most common psychiatric comorbidity in epilepsy patients,accounting for approximately one third of the epilepsy-related psychiatric disorders.Depressive symptoms not only have a detrimental negative impact on the quality of life of epilepsy patients,but also lead to much higher suicide rates among epilepsy patients.The depressive symptoms in epilepsy patients have not been adequately recognized and treated so far.Cognitive behavioral therapy（CBT）is currently recommended for the treatment of depressive symptoms in epilepsy patients.However,the effect of CBT on depressive symptoms in epilepsy patients remains controversial.Therefore,we conducted a meta-analysis to evaluate the effect of CBT on depressive symptoms in patients with epilepsy.Objective:This paper assessed the effect of CBT on depressive symptoms in patients with epilepsy by comparing the changes in the depression scale score in patients with epilepsy treated with CBT and those without CBT.Methods:China National Knowledge Infrastructure,Wanfang Database,China Biomedical Abstraction Database,VIP Chinese Journal Full-text Database,Pub Med,Embase,The Cochrane Library and Web of Science were systematically searched from inception to December 30,2021.Eligible studies that met the inclusion and exclusion criteria were screened out.Two researchers independently assessed the quality of the included studies,as well as extracted relevant information and data.Review Manager 5.3 and STATA 16.1 were used to perform a meta-analysis of the data.The continuous variable was described using the mean difference（MD）,standardized mean difference（SMD）,and 95%confidence interval（CI）.The difference between the CBT group and the control group was considered to be statistically significant when P<0.05.The I~2 was used to evaluate the heterogeneity.The publication bias was assessed using funnel plots and Egger’s test.Furthermore,a sensitivity analysis was performed to assess the stability of the results.Meanwhile,the cumulative meta-analysis was performed in order of year of publication and sample size to detect whether there is a trend of time and sample size in the effect of CBT on depressive symptoms in patients with epilepsy.Results:Fifteen studies involving 1582 participants were included in this meta-analysis.Among them,802 were in the CBT group and 780 were in the control group.The pooled results of the changes in depression scale scores in the CBT group and the control group before and after treatment showed that CBT could significantly reduce depressive symptoms in patients with epilepsy compared with the control group（SMD=-0.55,95%CI[-0.74,-0.36],P<0.00001）.In a pooled analysis of 2 or more studies using common depression scale scores:the Neurological Disorders Depression Inventory-Epilepsy Scale score showed that CBT could significantly reduce the depressive symptoms in epilepsy patients compared with the control group（MD=-1.33,95%CI[-1.75,-0.92],P<0.00001）;the Patient Health Questionnaire-9 scores showed that CBT could significantly reduce the depressive symptoms in epilepsy patients compared with the control group（MD=-1.59,95%CI[-2.48,-0.69],P=0.0005）;the Beck Depression Inventory scores showed that CBT could significantly reduce the depressive symptoms in epilepsy patients compared with the control group（MD=-4.96,95%CI[-9.35,-0.58],P=0.03）;the Hospital Anxiety and Depression Scale score showed that CBT could significantly reduce the depressive symptoms in epilepsy patients compared with the control group（MD=-2.02,95%CI[-3.38,-0.67],P=0.003）;the Depression Self-rating Scale for Children score showed that CBT could significantly reduce the depressive symptoms in epilepsy patients compared with the control group（MD=-1.32,95%CI[-1.83,-0.82],P<0.00001）.Among the results of the subgroup analysis:a subgroup analysis by classifying the treatment setting showed that both home-based CBT（SMD=-0.52,95%CI[-0.78,-0.26],P<0.0001）and clinic-based（SMD=-0.59,95%CI[-0.90,-0.29],P=0.0001）could significantly reduce depressive symptoms in epilepsy patients;a subgroup analysis by classifying delivery method showed that both individual CBT（SMD=-0.60,95%CI[-0.76,-0.44],P<0.00001）and group CBT（SMD=-0.58,95%CI[-1.02,-0.14],P=0.009）could significantly reduce depressive symptoms in epilepsy patients;a subgroup analysis by classifying age showed that CBT could reduce depressive symptoms in epilepsy patients among juvenile population（SMD=-0.81,95%CI[-1.20,-0.42],P<0.0001）,prime-age population（SMD=-0.58,95%CI[-0.80,-0.36],P<0.00001）and elderly population（SMD=-0.25,95%CI[-0.43,-0.07],P=0.007）;a subgroup analysis by classifying ethnicity showed that CBT could reduce depressive symptoms in epilepsy patients between Caucasian（SMD=-0.48,95%CI[-0.68,-0.28],P<0.00001）and Asian（SMD=-0.86,95%CI[-1.17,-0.55],P<0.00001）;a subgroup analysis by classifying assessment time after the end of treatment showed that CBT could reduce depressive symptoms in epilepsy patients between the population assessed immediately after treatment（SMD=-0.57,95%CI[-0.82,-0.32],P<0.00001）and delayed assessment population（SMD=-0.53,95%CI[-0.86,-0.19],P=0.002）;a subgroup analysis by classifying duration time of treatment showed that both short-term CBT of less than or equal to 2 months（SMD=-0.58,95%CI[-0.85,-0.31],P<0.0001）and medium to long-term CBT of more than 2 months（SMD=-0.48,95%CI[-0.67,-0.28],P<0.00001）could reduce depressive symptoms in epilepsy patients.The results of the cumulative meta-analysis showed that CBT could reduce depressive symptoms in epilepsy patients.However,there is a trend of time and sample size in the effect of CBT on depressive symptoms in epilepsy patients.Conclusions:Compared to the control group,depression scale scores were significantly lower in patients with epilepsy treated with CBT.Therefore,CBT could significantly reduce depressive symptoms in patients with epilepsy.In addition,CBT in different treatment settings and different delivery methods could significantly reduce depressive symptoms in patients with epilepsy.However,the intervention effect of CBT on depressive symptoms in patients with epilepsy could decrease with the increase of patients’age.On the other hand,the result of the cumulative meta-analysis showed that there is a trend of time and sample size in the effect of CBT on depressive symptoms in patients with epilepsy,which still needs to be verified by more clinical trials. |
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