Prevalence and associated factors of depression among adult patients with epilepsy in Ethiopia: a systematic review and meta-analysis, 2025

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BACKGROUND: Epilepsy is a major public health issue in Africa. Among individuals with epilepsy, the prevalence of depression is estimated to be two to three times higher than in the general population. The coexistence of epilepsy and depression has a detrimental impact on patients’ quality of life and increases the risk of anxiety disorders, substance use (including alcohol and drug dependence), suicide, poor medication adherence, and uncontrolled seizures. OBJECTIVES: To conduct a systematic review and meta-analysis on the prevalence and associated factors of depression among adult patients with epilepsy in Ethiopia, 2025. METHODS: A comprehensive literature search was performed across several databases, including PubMed, MEDLINE, the Cochrane Database of Systematic Reviews, UpToDate, EMBASE, and National Institute for Health and Care Excellence (NICE). The review focused on the prevalence of depression and its associated factors among patients with epilepsy. A random-effects model was applied to conduct pooled analysis, and the Joanna Briggs Institute quality appraisal checklist was used to evaluate the quality of included studies. RESULTS: A total of eleven studies (n = 4,027) were included in the final analysis. The pooled prevalence of depression among adult patients with epilepsy in Ethiopia was 43.26% (95% CI: 38.45%, 48.08%; I2 = 89.96%; p < 0.0001). Subgroup analysis indicated that the prevalence was 48.61% (95% CI: 44.92%–52.31%) in the Oromia region, and 38.28% (95% CI: 27.50%, 49.06%) in Addis Ababa. Poor adherence to anti-seizure medication 1.41 (95% CI: 1.17, 1.65), perceived stigma 1.74 (95% CI: 1.57, 1.91), and lower educational status 0.39 (95% CI: 0.26, 0.51) were significant predictors of depression among adult patients with epilepsy. CONCLUSION: The overall prevalence of depression among adult patients with epilepsy in Ethiopia remains high. Perceived stigma, low educational status, and poor adherence to anti-seizure medication were identified as key risk factors. Greater emphasis should be placed on reducing stigma and promoting adherence to ant-seizure medication to improve mental health outcomes in this population. CLINICAL TRIAL REGISTRATION: Not applicable. CLINICAL TRIAL NUMBER: Not applicable.

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