Supplementary Material for: Depression and anxiety trajectories in chronic disease: a systematic review and meta-analysis

Introduction: People living with chronic diseases are at increased risk of anxiety and depression, which are associated with poorer medical and psychosocial outcomes. Many studies have examined the trajectories of depression and anxiety in people with specific diseases, including the predictors of these trajectories. This is valuable for understanding the process of adjustment to disease and informing treatment planning. However, no review has yet synthesised this information across chronic diseases. Methods: Electronic databases were searched for studies reporting trajectories of depression or anxiety in chronic disease samples. Data extracted included sample characteristics, results from trajectory analyses, and predictors of trajectories. Meta-analysis of the overall pooled prevalence of depression and anxiety trajectories was conducted, and qualitative synthesis of disease severity predictors undertaken. Results: Following search and screening, 67 studies were included (N = 61,201 participants). Most participants followed a stable non-clinical trajectory for depression (69.0%, [95% CI 65.6, 72.2] and anxiety (73.4% [95% CI 66.3, 79.5]). Smaller but meaningful subsamples followed a trajectory of depression and anxiety symptoms consistently in the clinical range (11.8% [95% CI 9.2, 14.8], and 13.7% [95% CI 9.3, 19.7] respectively). Several clinical and methodological moderators emerged, and qualitative synthesis suggested that few aspects of disease severity were associated with participants’ trajectories. Discussion: Most people with chronic disease follow a trajectory of distress that is low and stable, suggesting that most people psychologically adjust to living with chronic disease. Evidence also suggests that the nature and severity of disease is not a meaningful predictor of psychological distress.

引言：慢性病（chronic diseases）患者罹患焦虑（anxiety）与抑郁（depression）的风险显著升高，而此类心理障碍与更差的医疗结局及社会心理预后密切相关。既往已有多项研究针对特定慢性病群体的抑郁与焦虑症状轨迹（trajectories）展开探讨，包括此类轨迹的预测因素。这类研究对于理解患者适应疾病的过程、指导临床治疗方案制定具有重要价值。然而，目前尚无综述对覆盖各类慢性病的相关研究成果进行系统性综合梳理。

方法：本研究通过检索电子数据库，筛选报道慢性病样本中抑郁或焦虑症状轨迹的相关研究。提取的数据涵盖样本特征、轨迹分析结果以及轨迹预测因素。本研究开展了抑郁与焦虑症状轨迹总体合并患病率的元分析（meta-analysis），并针对疾病严重程度相关预测因素进行了定性综合（qualitative synthesis）。

结果：经检索与筛选流程，最终纳入67项研究，共涉及61201名参与者。多数参与者的抑郁症状轨迹呈现稳定的非临床水平（69.0%，95%CI [65.6, 72.2]），焦虑症状轨迹亦呈现稳定的非临床水平（73.4%，95%CI [66.3, 79.5]）。另有规模较小但具备临床意义的亚组群体，其抑郁与焦虑症状始终处于临床异常范围（占比分别为11.8%，95%CI [9.2, 14.8]；以及13.7%，95%CI [9.3, 19.7]）。研究识别出若干临床与方法学层面的调节变量，定性综合结果显示，极少有疾病严重程度相关指标与参与者的症状轨迹存在显著关联。

讨论：多数慢性病患者的心理痛苦轨迹呈现低水平且稳定的特征，提示大多数患者能够在心理上适应慢性病的长期生活。研究证据同时表明，疾病的性质与严重程度并非心理痛苦症状轨迹的有效预测因素。