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Br J Psychiatry. 2019 Mar 13:1-10. doi: 10.1192/bjp.2019.5. [Epub ahead of print]

Prevalence and correlates of major depressive disorder, bipolar disorder and schizophrenia among nursing home residents without dementia: systematic review and meta-analysis.

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Neuroscience, Reproductive Science and Odontostolmatology,Section of Psychiatry,University School of Medicine 'Federico II',Italy.
Neuroscience Department,Psychiatry Unit,University of Padua;Psychiatry Unit,Azienda Ospedaliera di Padova,Padua Hospital,Italy;and Psychiatry and Psychology Department of the Hospital Clínic,Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM,Spain.
Physiotherapy Department,South London and Maudsley NHS Foundation Trust;and Health Service and Population Research Department and the Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience, King's College London,UK.
National Research Council,Ageing Branch,Italy.
Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neuroscience,University of Salerno,Italy.
Camaldoli Hospital,Naples,Italy.
Department of Mental Health, Psychiatric Service of Diagnosis and Treatment,Hospital 'G. Mazzini',Italy.
Department of Psychiatry,University of Toronto; and Centre for Addiction & Mental Health (CAMH),Canada.
Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience,University of Barcelona, IDIBAPS, CIBERSAM,Spain.



The elderly population and numbers of nursing homes residents are growing at a rapid pace globally. Uncertainty exists regarding the actual rates of major depressive disorder (MDD), bipolar disorder and schizophrenia as previous evidence documenting high rates relies on suboptimal methodology.AimsTo carry out a systematic review and meta-analysis on the prevalence and correlates of MDD, bipolar disorder and schizophrenia spectrum disorder among nursing homes residents without dementia.


Major electronic databases were systematically searched from 1980 to July 2017 for original studies reporting on the prevalence and correlates of MDD among nursing homes residents without dementia. The prevalence of MDD in this population was meta-analysed through random-effects modelling and potential sources of heterogeneity were examined through subgroup/meta-regression analyses.


Across 32 observational studies encompassing 13 394 nursing homes residents, 2110 people were diagnosed with MDD, resulting in a pooled prevalence rate of 18.9% (95% CI 14.8-23.8). Heterogeneity was high (I2 = 97%, P≤0.001); no evidence of publication bias was observed. Sensitivity analysis indicated the highest rates of MDD among North American residents (25.4%, 95% CI 18-34.5, P≤0.001). Prevalence of either bipolar disorder or schizophrenia spectrum disorder could not be reliably pooled because of the paucity of data.


MDD is highly prevalent among nursing homes residents without dementia. Efforts towards prevention, early recognition and management of MDD in this population are warranted.Declaration of interestE.V. has received grants and served as consultant, advisor or continuing medical education speaker for the following organisations: AB-Biotics, Allergan, Angelini, AstraZeneca, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Farmindustria, Ferrer, Gedeon Richter, Glaxo-Smith-Kline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, Shire, Sunovion, Takeda, the Brain and Behaviour Foundation, the Spanish Ministry of Science and Innovation (CIBERSAM), the Seventh European Framework Programme (ENBREC) and the Stanley Medical Research Institute.


Major depressive disorder; long-term care; meta-analysis; nursing homes; review


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