A systematic review protocol for estimation of the prevalence of depression using diagnostic instruments in the elderly population in India, 2000-2019

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Abstract Introduction Depression is a common mental disorder in the elderly population, which significantly impacts their quality of life. However, correct estimates of its magnitude are not available in the elderly in India. The present systematic review and meta-analysis would attempt to estimate the prevalence of depression using diagnostic instruments among elderly persons aged 60 years and above. Methods and analysis Searches will be performed in PubMed, Scopus, Embase, Web of Science, CINAHL, and PsycINFO. Community-based cross-sectional and cohort studies (2001 – 9/2019) reporting the prevalence of depression in the elderly; using diagnostic instruments will be included. Studies conducted among chronic disease patients, in-hospital patients, and special groups such as with disaster-stricken populations, and studies reporting the only 1 or 2 subcategories of depression, will be excluded. Disagreements in study selection and data abstraction will be resolved by consensus and arbitration by a third reviewer. AXIS critical appraisal tool will be used for quality assessment of individual studies. Findings of eligible studies will be pooled using fixed-effects or random-effects meta-analysis whichever is appropriate. Heterogeneity between studies will be examined by Cochran’s Q test and quantified by I 2 statistic. A cumulative meta-analysis will be used to detect temporal trends in the prevalence of depression and the effect of poor-quality studies on the pooled estimate. Publication bias will be assessed by visual inspection of funnel plots and the Egger test. Ethics and dissemination No ethical approval will be needed because it will be a systematic review. Data from previously published studies will be retrieved and analyzed. Findings will be disseminated through a peer-reviewed publication in a scientific journal and conferences. PROSPERO registration number CRD42019138453. Strengths and limitations of this study It is a first-ever systematic review of depression prevalence in India based on diagnostic instruments only. Meta-analytic techniques such as cumulative meta-analysis, leave-one-out (jack-knife estimation) meta-analysis, and meta-regression will enrich the analysis and provide the estimate of prevalence nearer to the population estimate. A comprehensive synthesis of all available depression prevalence data in India using a standardized risk of bias tool. The protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Heterogeneity in methodologies, such as diagnostic criteria, study duration, sampling design, and study locations may limit comparison across studies.

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