Prevalence of Depression in Childhood-Onset Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Prevalence of Depression in Childhood-Onset Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Depression in Childhood-Onset Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis Xia Xiao-Jing, Pan Min This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5708513/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Childhood-onset systemic lupus erythematosus (cSLE) is frequently associated with psychological symptoms, particularly depression. However, there remains a lack of quantitative evidence regarding the prevalence and disease course of depression based on the currently available evidence. In this context, we conducted the first systematic review and meta-analysis addressing this important issue. Methods: Three medical databases, including PubMed, Embase, Cochrane Library were utilized in this study. We included studies that reported on cSLE patients experiencing depression for a meta-analysis. STATA software were employed to synthesize the results as well as to assess heterogeneity and publication bias. Results: Totally 12 eligible studies encompassing 652 cSLE patients were incorporated into this meta-analysis. Each of the publications included exhibited commendable methodological rigor, with Newcastle-Ottawa scores no less than 6. The pooled results with 12 articles indicated that the prevalence of depression among cSLE patients was 32.6% (95% CI: 0.25-0.40, Z=8.656, P<0.001). Subsequent subgroup analysis indicated that the prevalence of depression varied according to the different screening tools used: it was found to be 26% with CDI (95% CI: 0.18-0.34, P=0.023, I²=61.8%), 41% with PHQ-9 (95% CI: 0.20-0.63, P<0.001, I²=90.7%), and 37% with other tools such as BSI, BDI, and CES-D (95% CI: 0.21-0.53, P=0.031, I²=71.3%). Furthermore, the Egger’s test indicates that publication bias is insignificant among the studies included. Conclusions: The prevalence of depression in patients with cSLE is slightly higher compared with adult SLE patients. It is noteworthy that screening rates for depression vary significantly among different assessment tools. There exists an urgent need to establish a consensus aimed at standardizing diagnostic criteria for depression through screening, thereby providing valuable guidance for clinical and nursing practice. Pediatrics Prevalence Disease Course Depression Childhood-Onset Systemic Lupus Erythematosus Meta-Analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Systemic lupus erythematosus (SLE) is a chronic, inflammatory, multi-system autoimmune disease characterized by its involvement of multiple organs, including the kidneys, lungs, and nervous system. It is also associated with psychological complications such as depression and anxiety [ 1 – 3 ] . In the pediatric population, childhood-onset systemic lupus erythematosus (cSLE) frequently presents with severe psychological symptoms, particularly depressive moods that can lead to significant psychiatric sequelae, disability, and increased mortality rates [ 4 – 6 ] . Consequently, cSLE complicated by depression represents a critical issue in clinical practice that necessitates greater attention to identify more effective treatment strategies. For children diagnosed with SLE who exhibit depressive symptoms, there exists a limited number of reported literature. Furthermore, the findings regarding prevalence and disease course are inconsistent. It is very imperative to conduct a thorough and quantitative analysis aimed at evaluating the prevalence and disease course of depression among SLE children. In light of the prevailing gaps in our understanding, we are compelled to undertake this systematic review and meta-analysis aimed at thoroughly evaluating the prevalence and the progression of disease linked to depression among cSLE patients. Our objective is to furnish high-caliber evidence that can inform more effective treatment and nursing modalities for pediatric patients grappling with cSLE complicated by depressive conditions. Methods This systematic review and meta-analysis was conducted in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines [7] (see Supplementary Table 1 ) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist [8] (see Supplementary Table 2 ). Searching Strategy A total of three prominent medical databases, from their inceptions to 1 Nov, 2024 were employed for the literature search: PubMed, Embase, and the Cochrane Library. Medical Subject Headings (MeSH) in conjunction with pertinent free-text keywords (synonyms) were utilized in various combinations to enhance the effectiveness of the search process. The key-words included “systemic lupus erythematosus,” “children,” and “depression.” The literature search imposed no restrictions regarding language, region, ethnicity, or country. Literature Selection This systematic review and meta-analysis have rigorously established comprehensive inclusion and exclusion criteria for the selection of literature, delineated as follows: Inclusion Criteria: 1) Studies focused exclusively on children and adolescents; 2) Studies employing validated screening tools for the assessment of depression symptoms; 3) Studies designed as cross-sectional, retrospective, or prospective cohorts; 4) Inclusion of patients who meet the revised American College of Rheumatology or Systemic Lupus Collaborating Clinics Classification Criteria for SLE; 5) Patients diagnosed with neuropsychiatric systemic lupus erythematosus ( NPSLE ) were also included. Exclusion Criteria: 1) Studies lacking a validated screening tool for the diagnosis of depression; 2) Studies that do not specify diagnostic criteria for SLE; 3) Non-human studies, including animal research, laboratory investigations, and in vitro experiments; 4) Studies with insufficient data, particularly those presenting information solely in an abstract form. Literature Screening Process Stringent principles and methodologies of quality control were meticulously applied throughout the literature screening process. The comprehensive literature screening procedure was thoroughly documented. Two independent reviewers (XJX and MP) conducted this search process. In cases where discrepancies arose, they engaged in collaborative discussions to reach a resolution. Data Extraction The study employed a pre-established Excel spreadsheets for data extraction. The extracted information encompassed the first author's name, year of publication, study period, age, gender, sample size, withdrawals, dropouts, follow-up duration, and outcome measures. The primary outcome measure was defined as the prevalence of depression in patients with cSLE, while the secondary outcome measures included mean depression scores, the course of depression and associated risk factors. Methodological Quality evaluation The methodological quality of the publications included in this review was assessed using the Newcastle-Ottawa Scale [9] , which allocates a maximum quality score of 9 points. Two authors independently evaluated the methodological quality and calculated the average as the final score. Statistical Methods Odds ratios (OR) accompanied by 95% confidence intervals (CI) were employed as the effect sizes for the meta-analysis. Risk estimates derived from the included studies were analyzed utilizing DerSimonian-Laird random-effects models. The assessment of heterogeneity was conducted through both the Chi-square test and I² statistic. Specifically, an I² value ranging from 0 to 25% signifies negligible heterogeneity, while values between 26% and 50% indicate low heterogeneity; those spanning from 51% to 75% denote moderate heterogeneity, and values exceeding 75% are indicative of high heterogeneity. A sensitivity analysis was executed to uncover potential sources of variability in study outcomes. Furthermore, funnel plots alongside Egger’s test were employed to scrutinize publication bias across the studies examined. Statistical analyses were performed using STATA software, with a two-tailed P-value of less than 0.05 denoting statistical significance. Results Study Selection Process The initial search resulted in a total of 661 records obtained from three medical databases: PubMed (306 records), Embase (299 records), and the Cochrane Library (56 records). Following the removal of duplicates and the exclusion of publications reporting irrelevant topics, 72 articles were selected for full-text screening. Ultimately, 12 eligible articles [10-21] were incorporated into the final pooled analysis. A detailed flow diagram is provided in Figure 1 . Characteristics of Included Studies As presented in detail in Table 1 , the pooled analysis included a total of 12 articles encompassing 652 cSLE patients. All articles are published in English, with publication years spanning from 2010 to 2024. The sample sizes of the studies included in this analysis vary, ranging from 24 to 106. All diagnostic criteria for SLE as delineated in included literatures conform to the guidelines established by the American College of Rheumatology (ACR) 1997. The criteria for diagnosing depression are not uniform, including the Childhood Depression Inventory (CDI) : 6 articles; Patient Health Questionnaire-9 (PHQ9): 3 articles; and others (Brief Symptom Inventory/Beck Depression Inventory/Birleson Scale/Center for Epidemiologic Studies Depression Scale for Children): 3 articles. Prevelance of Depression Symptoms in cSLE Patients A total of 12 articles reported the prevalence of depression in patients with cSLE. The pooled results indicated that the prevalence of depression among cSLE patients was 32.6% (95% CI: 0.25-0.40, Z=8.656, P<0.001), exhibiting relatively high heterogeneity (Cochran's Q=49.24, I²=77.7%), as illustrated in Figure 2 . Furthermore, a meta-analysis pooling aggregate data was conducted using the random-effects inverse-variance model with the DerSimonian-Laird estimate of Tau² (Tau²=0.0128). Subgroup Analysis of Depression Prevalence Based on Different Screening Tools Subgroup analysis of depression prevalence was performed based on various screening tools. A total of 6 studies reported depression prevalence using the Children's Depression Inventory (CDI), while 3 studies utilized the Patient Health Questionnaire-9 (PHQ-9). Additionally, 3 studies employed other assessment instruments, including the Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI), and Center for Epidemiologic Studies Depression Scale (CES-D). As demonstrated in Figure 3 , the subgroup analysis indicated that the prevalence of depression varied according to the different screening tools used: it was found to be 26% with CDI (95% CI: 0.18-0.34, P=0.023, I²=61.8%), 41% with PHQ-9 (95% CI: 0.20-0.63, P<0.001, I²=90.7%), and 37% with other tools such as BSI, BDI, and CES-D (95% CI: 0.21-0.53, P=0.031, I²=71.3%). Exploration of potential sources of heterogeneity with sensitivity analysis As illustrated in Figure 4 , the subsequent sensitivity analysis did not identify any potential sources of heterogeneity across the studies. The variations among the included studies remained stable, situated between the lower and upper confidence interval limits. Methodological Quality and Publication Bias Assessment As illustrated in Table 2 , which presents the assessment of methodological quality, each publication included demonstrated commendable methodological rigor. The Newcastle-Ottawa scores were all no less than 6, indicating a relatively high standard of methodological quality across the studies. As demonstrated in Figure 5A and 5B , the Egger’s test indicates that publication bias is insignificant among the studies included, with P-value >0.05. Discussions This systematic review and meta-analysis represents the first comprehensive evaluation of the prevalence and disease course of depression in cSLE patients. Through a rigorous systematic review process, our study determined that the crude prevalence of depression among cSLE patients is 27%. Notably, significant discrepancies were observed in the assessment of depression incidence based on different depression screening tools. Specifically, the prevalence assessed using CDI was 26%, while that evaluated by PHQ-9 was 41%. Other scales, including BSI, BDI and CES-D, yielded an incidence rate of 37%, highlighting substantial variation across these instruments. Our investigation also delved into potential sources of heterogeneity; however, no distinct heterogeneous literature emerged from our analysis. Additionally, all Newcastle-Ottawa Scale (NOS) scores pertaining to our methodological evaluation exceeded a score of 6, indicating high-quality literatures. The Egger’s test further confirmed that there was no significant publication bias present in our findings. A previous meta-analysis conducted by Lijuan Zhang et al [22] . indicated that the crude prevalence of SLE among adults was 24%. Consequently, our pooled results demonstrate that the prevalence among patients with cSLE is slightly higher than that observed in adult patients. Nevertheless, owing to the disparities in measurement scales, the outcomes of our comparative analysis with adults must be approached and interpreted with a degree of caution. However, it is unequivocal that as children endure prolonged episodes of illness in the future, the repercussions of depression on their quality of life will become increasingly enduring and profound. Therefore, the execution of this systematic review and meta-analysis proves to be exceptionally valuable and indispensable in steering clinical and nursing practices for patients suffering from depression associated with cSLE. Besides, our findings also indicated that significant discrepancies were observed in the assessment of depression incidence based on different depression screening tools, which is strongly recommended to establish standardized and comprehensive criteria for the assessment and screening of depression in children with cSLE [23] . This initiative aims to enhance the clinical management and nursing care provided to these young patients, thereby facilitating more effective support throughout their treatment journey [24] . Therefore, comprehensive prospective studies with larger sample sizes are imperative to thoroughly assess the incidence of depression in cSLE paitents as evaluated by an unified scale. Furthermore, it is essential to juxtapose and scrutinize these findings against those derived from our meta-analysis. Last but by no means least, the present systematic review and meta-analysis exhibits both strengths and limitations. In terms of strengths, this investigation represents the inaugural pooled analysis concerning the prevalence of depression in cSLE patients and its disease course, to the best of our knowledge. Furthermore, the studies included in this review demonstrated relatively high methodological rigor, as evidenced by Newcastle-Ottawa Scale (NOS) scores that were no less than 6. Additionally, we conducted a subgroup analysis which revealed significant discrepancies in the assessment of depression incidence contingent upon varying screening tools for depression. This finding holds substantial implications for clinical practice and nursing, offering valuable insights into tailored approaches for patient care. However, this meta-analysis has several limitations. Firstly, the studies included were predominantly retrospective in design, which reflects real-world conditions; however, it is essential to recognize the potential for confounding biases. Secondly, all included studies had relatively small sample sizes, ranging from 24 to 106 participants. Thirdly, there is a lack of data available to analyze gender differences in the prevalence of depression among patients with cSLE. Therefore, we continue to advocate for further prospective studies with larger sample sizes that are crucial for a comprehensive assessment of the incidence of depression in cSLE patients. Conclusions The prevalence of depression in patients with cSLE is slightly higher compared with adult SLE patients. It is noteworthy that screening rates for depression vary significantly among different assessment tools. There exists an urgent need to establish a consensus aimed at standardizing diagnostic criteria for depression through screening, thereby providing valuable guidance for clinical and nursing practice. Declarations Funding: None Declarations of interest: None Conflict of Interest declaration The authors declare there is no conflict of interest. Funding declaration None. References Fangtham M, Kasturi S, Bannuru RR, Nash JL, Wang C. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus. 2019; 28(6):703-712. doi: 10.1177/0961203319841435. Koletsos N, Dipla K, Triantafyllou A, Dolgyras P, Aslanidis S, Zafeiridis A, et al. Depression in systemic lupus erythematosus: A manifestation of microcirculation dysfunction? Lupus. 2023; 32(6):727-736. doi: 10.1177/09612033231167792. Palagini L, Mosca M, Tani C, Gemignani A, Mauri M, Bombardieri S. Depression and systemic lupus erythematosus: a systematic review. Lupus. 2013; 22(5):409-16. doi: 10.1177/0961203313477227. Davis AM, Graham TB, Zhu Y, McPheeters ML. Depression and medication nonadherence in childhood-onset systemic lupus erythematosus. Lupus. 2018; 27(9):1532-1541. doi: 10.1177/0961203318779710. Baba O, Kisaoglu H, Bilginer C, Ozkaya E, Kalyoncu M. Depression, anxiety, and sleep quality in childhood onset systemic lupus erythematosus and relationship with brain-derived neurotrophic factor. Lupus. 2022; 31(13):1630-1638. doi: 10.1177/09612033221127901. Blamires J, Foster M, Napier S, Dickinson A. Experiences and Perspectives of Children and Young People Living with Childhood-Onset Systemic Lupus Erythematosus-An Integrative Review. Children (Basel). 2023; 10(6):1006. doi: 10.3390/children10061006. Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605. Higgins JP, Thompson SG, Deeks JJ et al. Measuring inconsistency in metaanalyses. BMJ 2003; 327: 557-560. Higgins JPT, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. www.handbook.cochrane.org. S Ahola,Kohut,T S,Williams,J,Jayanthikumar, et al.Depressive symptoms are prevalent in childhood-onset systemic lupus erythematosus (cSLE).[J].Lupus,2013,22(7):712-20. Donnelly C, Cunningham N, Jones JT, Ji L, Brunner HI, Kashikar-Zuck S. Fatigue and depression predict reduced health-related quality of life in childhood-onset lupus. Lupus. 2018;27(1):124-133. Jordan T,Jones,Natoshia,Cunningham,SusmitA,Kashikar-Zuck,Hermine I,Brunner.Pain, Fatigue, and Psychological Impact on Health-Related Quality of Life in Childhood-Onset Lupus.[J].Arthritis care & research,2016,68(1):73-80.DOI:10.1002/acr.22650. Yasemin,Düzçeker,Nuray Ö,Kanbur,Erkan,Demirkaya,Orhan,Derman,Lakshmi N,Moorthy,Seza,Ozen.Quality of life measures and psychiatric symptoms in adolescents with systemic lupus erythematosus and familial Mediterranean fever.[J].International journal of adolescent medicine and health,2014,26(4):541-9.DOI:10.1515/ijamh-2013-0332. Selcuk,Uzuner,Sezgin,Sahin,Gizem,Durcan,Amra,Adrovic,Kenan,Barut,Ali Guven,Kilicoglu,Ayhan,Bilgic,Kayhan,Bahali,Ozgur,Kasapcopur.The impact of peer victimization and psychological symptoms on quality of life in children and adolescents with systemic lupus erythematosus.[J].Clinical rheumatology,2017,36(6):1297-1304.DOI:10.1007/s10067-017-3650-5. Tricia S,Williams,Cynthia,Aranow,Gail S,Ross,Alexandra,Barsdorf,Lisa F,Imundo,Andrew H,Eichenfield,Philip J,Kahn,Betty,Diamond,Deborah M,Levy.Neurocognitive impairment in childhood-onset systemic lupus erythematosus: measurement issues in diagnosis.[J].Arthritis care & research,2011,63(8):1178-87.DOI:10.1002/acr.20489. Appearance concern and depression in adolescent girls with systemic lupus erythematous[J].Clinical rheumatology,2012,31(12):1671-1675. A M,Davis,T B,Graham,Y,Zhu,M L,McPheeters.Depression and medication nonadherence in childhood-onset systemic lupus erythematosus.[J].Lupus,2018,27(9):1532-1541.DOI:10.1177/0961203318779710. H,Aldar,A T,Lapa,B,Bellini,N A,Sinicato,M,Postal,P T,Fernandes,L T L,Costallat,R,Marini,S,Appenzeller.Prevalence and clinical significance of anti-ribosomal P antibody in childhood-onset systemic lupus erythematosus. Kate M,Neufeld,Paris,Moaf,Michelle,Quilter,Ashley N,Danguecan,Julie,Couture,Daniela,Dominguez,Olivia,Hendrikx,Lawrence,Ng,Reva,Schachter,Daphne D,Korczak,Deborah M,Levy,Linda,Hiraki,Andrea M,Knight.Evaluation of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus: Frequency, course, and associated risk factors.[J].Lupus,2024,33(8):874-885.DOI:10.1177/09612033241254170. Tamar B Rubinstein, Marija Dionizovik-Dimanovski, Alaina M Davis, Chelsey Smith, Lauren Faust, Beth Rutstein, et al. Multicenter Study of Utility and Acceptability of Depression and Anxiety Screening in Adolescents and Young Adults With Childhood-Onset Systemic Lupus. Arthritis Care Res (Hoboken). 2023;75(4):724-733. Mulvihill E, Furru R, Goldstein-Leever A, Driest K, Lemle S, MacDonald D, et al. Targeted provider education and pre-visit planning increase rates of formal depression screening in childhood-onset SLE. Pediatr Rheumatol Online J. 2021;19(1):116. Ahmed T,Moustafa,Mitra,Moazzami,Lisa,Engel,Elvira,Bangert,Mohamed,Hassanein,Sherief,Marzouk,Maryana,Kravtsenyuk,William,Fung,Lihi,Eder,Jiandong,Su,Joan E,Wither,Zahi,Touma.Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis.[J].Seminars in arthritis and rheumatism,2020,50(1):84-94.DOI:10.1016/j.semarthrit.2019.06.017. E Muscal, D R Bloom, J V Hunter, B L Myones. Neurocognitive deficits and neuroimaging abnormalities are prevalent in children with lupus: clinical and research experiences at a US pediatric institution. Lupus. 2010 Mar;19(3):268-79. doi: 10.1177/0961203309352092. Hilda Lilian,Carbajal-Alonso,Norberta Prisilia,García-Moreno,Brenda,Rodríguez-Arreola,Juan Carlos,Barrera de León.[Depressive disorder in Mexican pediatric patients with systemic lupus erythematosus (SLE)].[J].Gaceta medica de Mexico,152(1):36-42. Tables Table 1. Comprehensive Characteristics of the Included Articles (N=12) First Author Country Language Publication Year Study Period Study Design Sample size Age (years) Gender (Male %) Depression validated tool Criteria for SLE S Ahola Kohut Canada English 2013 2010-2012 Cross-sectional 38 14.3±2.4 6（16%） CDI ACR Catherine Donnelly US English 2018 NR Cross-sectional 50 16.2±2.5 8（16%） CDI ACR Eyal Muscal US English 2010 2001-2008 Retrospective+Prospective Cohort 39 RC: 15.1 (12.2-16.9) PC: 15.8 (14.8-16.5) RC: 3(12.5%) PC: 2(13.3%) CDI ACR Jordan Jones US English 2016 NR Cross-sectional 60 16.1±2.5 11（20%） CDI ACR Yasemin Düzçeker Turkey English 2013 2011-2012 Cross-sectional 25 NR NR BSI ACR Tricia S. Williams Canada English 2011 2006-2009 Case-control study 41 16.4±2.5(10.3- 21.8) 11(27%) BDI ACR Li Ji China English 2012 2010-2011 Case-control study 84 15.3±1.4 0(0%) CDI ACR Alaina M. Davis US English 2018 2016 Cross-sectional 51 16.2±3.3(7-22) 4(7.8%) PHQ-9 ACR H Aldar Brazil English 2012 2010 Retrospective Cohort 50 16.82±3.46 3（5.7%） CDI ACR Kate M. Neufeld Canada English 2024 2017-2019 Retrospective Cohort 51 15.0±1.9 6（12%） CES-DC ACR Tamar B. Rubinstein US&Canada English 2023 2017-2020 Multicenter, retrospective cohort 106 Median:17 IQR:15-19 12（11%） PHQ-9 ACR Evan Mulvihill US English 2021 2017 Retrospective Cohort 62 13.32+3.04 9(14.5%) PHQ-9 ACR US: United States; NR: Not Report; RC: retrospective cohort; PC: Prospective cohort; CDI: Childhood Depression Inventory; BSI: Brief Symptom Inventory; BDI: Beck Depression Inventory; CES-DC: Center for Epidemiologic Studies Depression Scale for Children; PHQ-9: Patient Health Questionnaire-9; ACR: 1997 American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus Table 2 Assessment of Methodological Qualities Utilizing the Newcastle–Ottawa Scale First Author Selection(0-4) Comparability(0-2) Outcome(0-3) Total REC SNEC AE DO SC AF AO FU AFU S Ahola Kohut 1 1 1 0 1 0 1 1 1 7 Catherine Donnelly 1 1 1 1 1 0 1 1 1 8 Eyal Muscal 1 1 1 0 1 1 1 1 1 8 Jordan Jones 1 1 1 1 0 0 1 1 1 7 Yasemin Düzçeker 1 0 1 1 0 1 1 1 1 7 Tricia S. Williams 1 1 1 1 0 0 1 1 1 7 Li Ji 1 1 1 1 0 0 1 1 1 7 Alaina M. Davis 1 1 1 1 0 1 1 1 1 8 H Aldar 1 1 1 1 0 0 1 1 1 7 Kate M. Neufeld 1 1 1 1 0 1 1 1 1 8 Tamar B. Rubinstein 1 1 1 1 0 0 1 1 1 7 Evan Mulvihill 1 1 0 1 1 1 1 1 1 8 “1” indicates that the cohort study has met the specified criterion, while “0” denotes a failure to do so. REC: Representativeness of the exposed cohort; SNEC: Selection of the non-exposed cohort; AE: Ascertainment of exposure; DO: Demonstration that the outcome of interest was not present at the start of the study; SC: Study controls for age and sex; AF: Study controls for any additional factors (such as donor source, immunotherapy, etc.); AO: Assessment of outcome; FU: Follow-up duration sufficient (36 months) for outcomes to manifest; AFU: Adequacy of follow-up among cohorts (≥90%). Supplementary tables Supplementary tables 1 and 2 are not available with this version Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5708513","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":394227028,"identity":"c14aabc6-3002-48c7-90c8-7a2802325238","order_by":0,"name":"Xia Xiao-Jing","email":"","orcid":"","institution":"Department of Pediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Xiao-Jing","suffix":""},{"id":394227075,"identity":"ab88e82b-4440-44f3-b8a3-4a3dba03650e","order_by":1,"name":"Pan Min","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYFADZgbGBwwFEqRpYTZgMCBJCwMDmwSDARHKzCVyH3/4uMMuT7ed91jFDwOLxA23Gxg/fMzBrcVyRrqZ5MwzycVmh/nSbvYYSCRuuHOAWXLmNtxaDG6ksTHztjEnbjvMY3aDB6TlRgJQBL8W5s9/2+rBWgr/EKmFQZqx7TBYCzNxtpx5xibZe+Y4SIuxtIyBhPHMG4nN+P1yPI35w88d1Ynbzp8x/Pimok6270bywQ8f8WgBA8YGBNuxAYVLjBZ7wspHwSgYBaNgpAEAF1FS14UFYAsAAAAASUVORK5CYII=","orcid":"","institution":"Department of Pediatric Respiratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":true,"prefix":"","firstName":"Pan","middleName":"","lastName":"Min","suffix":""}],"badges":[],"createdAt":"2024-12-25 01:57:53","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5708513/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5708513/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72591058,"identity":"f63cbc13-1c3c-434f-8777-0dc1e7b45193","added_by":"auto","created_at":"2024-12-30 07:12:00","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":119636,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Chart of Study Selection in Accordance with the PRISMA Guidelines\u003c/p\u003e","description":"","filename":"Fig1.Flowdiagramofstudyselection.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5708513/v1/138ef5fe43b62ed38a2d938d.jpg"},{"id":72593128,"identity":"dde497c7-59de-4790-b9cb-c2f04078ed95","added_by":"auto","created_at":"2024-12-30 07:28:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":225917,"visible":true,"origin":"","legend":"\u003cp\u003ePooled Results for Prevelance of Depression in cSLE\u003c/p\u003e","description":"","filename":"Fig2.PooledresultsforprevalencefordepressionincSLE.png","url":"https://assets-eu.researchsquare.com/files/rs-5708513/v1/d8b9e8426c02cb8fad34e042.png"},{"id":72591880,"identity":"5bb6bb47-49ad-4382-b506-11d3ef4588bd","added_by":"auto","created_at":"2024-12-30 07:20:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":883393,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup Analysis Based on Different Screening Tool for Depression\u003c/p\u003e","description":"","filename":"Fig3.subgroupanalysis.png","url":"https://assets-eu.researchsquare.com/files/rs-5708513/v1/a01c368123c487e1e45c5ce2.png"},{"id":72591064,"identity":"938fe6da-c4cc-41b1-8c35-5909d924b68d","added_by":"auto","created_at":"2024-12-30 07:12:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":84080,"visible":true,"origin":"","legend":"\u003cp\u003eSensitivity Analysis to Investigate the Potential Sources of Heterogeneity\u003c/p\u003e","description":"","filename":"Fig4.sensitivityanalysis.png","url":"https://assets-eu.researchsquare.com/files/rs-5708513/v1/6fd50f03ff1a8b53fad6f6ea.png"},{"id":72591068,"identity":"8c55fda9-26a1-43dd-a4bc-727627dd7058","added_by":"auto","created_at":"2024-12-30 07:12:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":330576,"visible":true,"origin":"","legend":"\u003cp\u003eAssessments of Publication Bias with Egger’s Test\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-5708513/v1/7a085ca9846ab44b12350e6f.png"},{"id":72594640,"identity":"471c48d4-b385-400e-8256-91a55436c7df","added_by":"auto","created_at":"2024-12-30 07:44:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2189198,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5708513/v1/65326425-7b1d-4c6d-a086-ec2d99d8811d.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePrevalence of Depression in Childhood-Onset Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSystemic lupus erythematosus (SLE) is a chronic, inflammatory, multi-system autoimmune disease characterized by its involvement of multiple organs, including the kidneys, lungs, and nervous system. It is also associated with psychological complications such as depression and anxiety \u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. In the pediatric population, childhood-onset systemic lupus erythematosus (cSLE) frequently presents with severe psychological symptoms, particularly depressive moods that can lead to significant psychiatric sequelae, disability, and increased mortality rates \u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Consequently, cSLE complicated by depression represents a critical issue in clinical practice that necessitates greater attention to identify more effective treatment strategies.\u003c/p\u003e \u003cp\u003eFor children diagnosed with SLE who exhibit depressive symptoms, there exists a limited number of reported literature. Furthermore, the findings regarding prevalence and disease course are inconsistent. It is very imperative to conduct a thorough and quantitative analysis aimed at evaluating the prevalence and disease course of depression among SLE children. In light of the prevailing gaps in our understanding, we are compelled to undertake this systematic review and meta-analysis aimed at thoroughly evaluating the prevalence and the progression of disease linked to depression among cSLE patients. Our objective is to furnish high-caliber evidence that can inform more effective treatment and nursing modalities for pediatric patients grappling with cSLE complicated by depressive conditions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis systematic review and meta-analysis was conducted in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines \u003csup\u003e[7]\u003c/sup\u003e (see \u003cstrong\u003eSupplementary Table 1\u003c/strong\u003e) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist \u003csup\u003e[8]\u003c/sup\u003e (see \u003cstrong\u003eSupplementary Table 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearching Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of three prominent medical databases, from their inceptions to 1 Nov, 2024 were employed for the literature search: PubMed, Embase, and the Cochrane Library. Medical Subject Headings (MeSH) in conjunction with pertinent free-text keywords (synonyms) were utilized in various combinations to enhance the effectiveness of the search process. The key-words included “systemic lupus erythematosus,” “children,” and “depression.” The literature search imposed no restrictions regarding language, region, ethnicity, or country.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiterature Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic review and meta-analysis have rigorously established comprehensive \u003cstrong\u003einclusion and exclusion criteria\u0026nbsp;\u003c/strong\u003efor the selection of literature, delineated as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1) Studies focused exclusively on children and adolescents;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2) Studies employing validated screening tools for the assessment of depression symptoms;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3) Studies designed as cross-sectional, retrospective, or prospective cohorts;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4) Inclusion of patients who meet the revised American College of Rheumatology or Systemic Lupus Collaborating Clinics Classification Criteria for SLE;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5) Patients diagnosed with neuropsychiatric systemic lupus erythematosus (\u003cstrong\u003eNPSLE\u003c/strong\u003e) were also included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1) Studies lacking a validated screening tool for the diagnosis of depression;\u003c/p\u003e\n\u003cp\u003e2) Studies that do not specify diagnostic criteria for SLE;\u003c/p\u003e\n\u003cp\u003e3) Non-human studies, including animal research, laboratory investigations, and in vitro experiments;\u003c/p\u003e\n\u003cp\u003e4) Studies with insufficient data, particularly those presenting information solely in an abstract form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiterature Screening Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStringent principles and methodologies of quality control were meticulously applied throughout the literature screening process. The comprehensive literature screening procedure was thoroughly documented. Two independent reviewers (XJX and MP) conducted this search process. In cases where discrepancies arose, they engaged in collaborative discussions to reach a resolution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study employed a pre-established Excel spreadsheets for data extraction. The extracted information encompassed the first author's name, year of publication, study period, age, gender, sample size, withdrawals, dropouts, follow-up duration, and outcome measures. The primary outcome measure was defined as the prevalence of depression in patients with cSLE, while the secondary outcome measures included mean depression scores, the course of depression and associated risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodological Quality evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe methodological quality of the publications included in this review was assessed using the Newcastle-Ottawa Scale \u003csup\u003e[9]\u003c/sup\u003e, which allocates a maximum quality score of 9 points. Two authors independently evaluated the methodological quality and calculated the average as the final score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOdds ratios (OR) accompanied by 95% confidence intervals (CI) were employed as the effect sizes for the meta-analysis. Risk estimates derived from the included studies were analyzed utilizing DerSimonian-Laird random-effects models. The assessment of heterogeneity was conducted through both the Chi-square test and I² statistic. Specifically, an I² value ranging from 0 to 25% signifies negligible heterogeneity, while values between 26% and 50% indicate low heterogeneity; those spanning from 51% to 75% denote moderate heterogeneity, and values exceeding 75% are indicative of high heterogeneity. A sensitivity analysis was executed to uncover potential sources of variability in study outcomes. Furthermore, funnel plots alongside Egger’s test were employed to scrutinize publication bias across the studies examined. Statistical analyses were performed using STATA software, with a two-tailed P-value of less than 0.05 denoting statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy Selection Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe initial search resulted in a total of 661 records obtained from three medical databases: PubMed (306 records), Embase (299 records), and the Cochrane Library (56 records). Following the removal of duplicates and the exclusion of publications reporting irrelevant topics, 72 articles were selected for full-text screening. Ultimately, 12 eligible articles \u003csup\u003e[10-21]\u0026nbsp;\u003c/sup\u003ewere incorporated into the final pooled analysis. A detailed flow diagram is provided in \u003cstrong\u003eFigure 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of Included Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs presented in detail in \u003cstrong\u003eTable 1\u003c/strong\u003e, the pooled analysis included a total of 12 articles encompassing 652 cSLE patients. All articles are published in English, with publication years spanning from 2010 to 2024. The sample sizes of the studies included in this analysis vary, ranging from 24 to 106. All diagnostic criteria for SLE as delineated in included literatures conform to the guidelines established by the American College of Rheumatology (ACR) 1997. The criteria for diagnosing depression are not uniform, including the Childhood Depression Inventory (CDI) : 6 articles; Patient Health Questionnaire-9 (PHQ9): 3 articles; and others (Brief Symptom Inventory/Beck Depression Inventory/Birleson Scale/Center for Epidemiologic Studies Depression Scale for Children): 3 articles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevelance of Depression Symptoms in cSLE Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 12 articles reported the prevalence of depression in patients with cSLE. The pooled results indicated that the prevalence of depression among cSLE patients was 32.6% (95% CI: 0.25-0.40, Z=8.656, P\u0026lt;0.001), exhibiting relatively high heterogeneity (Cochran's Q=49.24, I²=77.7%), as illustrated in \u003cstrong\u003eFigure 2\u003c/strong\u003e. Furthermore, a meta-analysis pooling aggregate data was conducted using the random-effects inverse-variance model with the DerSimonian-Laird estimate of Tau²\u0026nbsp;(Tau²=0.0128).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup Analysis of Depression Prevalence Based on Different Screening Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubgroup analysis of depression prevalence was performed based on various screening tools. A total of 6 studies reported depression prevalence using the Children's Depression Inventory (CDI), while 3 studies utilized the Patient Health Questionnaire-9 (PHQ-9). Additionally, 3 studies employed other assessment instruments, including the Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI), and Center for Epidemiologic Studies Depression Scale (CES-D).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs demonstrated in \u003cstrong\u003eFigure 3\u003c/strong\u003e, the subgroup analysis indicated that the prevalence of depression varied according to the different screening tools used: it was found to be 26% with CDI (95% CI: 0.18-0.34, P=0.023, I²=61.8%), 41% with PHQ-9 (95% CI: 0.20-0.63, P\u0026lt;0.001, I²=90.7%), and 37% with other tools such as BSI, BDI, and CES-D (95% CI: 0.21-0.53, P=0.031, I²=71.3%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploration of potential sources of heterogeneity with sensitivity analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs illustrated in \u003cstrong\u003eFigure 4\u003c/strong\u003e, the subsequent sensitivity analysis did not identify any potential sources of heterogeneity across the studies. The variations among the included studies remained stable, situated between the lower and upper confidence interval limits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodological Quality and Publication Bias Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs illustrated in \u003cstrong\u003eTable 2\u003c/strong\u003e, which presents the assessment of methodological quality, each publication included demonstrated commendable methodological rigor. The Newcastle-Ottawa scores were all no less than 6, indicating a relatively high standard of methodological quality across the studies.\u003c/p\u003e\n\u003cp\u003eAs demonstrated in \u003cstrong\u003eFigure 5A and 5B\u003c/strong\u003e, the Egger’s test indicates that publication bias is insignificant among the studies included, with P-value \u0026gt;0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis systematic review and meta-analysis represents the first comprehensive evaluation of the prevalence and disease course of depression in cSLE patients. Through a rigorous systematic review process, our study determined that the crude prevalence of depression among cSLE patients is 27%. Notably, significant discrepancies were observed in the assessment of depression incidence based on different depression screening tools. Specifically, the prevalence assessed using CDI was 26%, while that evaluated by PHQ-9 was 41%. Other scales, including BSI, BDI and CES-D, yielded an incidence rate of 37%, highlighting substantial variation across these instruments. Our investigation also delved into potential sources of heterogeneity; however, no distinct heterogeneous literature emerged from our analysis. Additionally, all Newcastle-Ottawa Scale (NOS) scores pertaining to our methodological evaluation exceeded a score of 6, indicating high-quality literatures. The Egger’s test further confirmed that there was no significant publication bias present in our findings.\u003c/p\u003e\n\u003cp\u003eA previous meta-analysis conducted by Lijuan Zhang et al \u003csup\u003e[22]\u003c/sup\u003e. indicated that the crude prevalence of SLE among adults was 24%. Consequently, our pooled results demonstrate that the prevalence among patients with cSLE is slightly higher than that observed in adult patients. Nevertheless, owing to the disparities in measurement scales, the outcomes of our comparative analysis with adults must be approached and interpreted with a degree of caution. However, it is unequivocal that as children endure prolonged episodes of illness in the future, the repercussions of depression on their quality of life will become increasingly enduring and profound. Therefore, the execution of this systematic review and meta-analysis proves to be exceptionally valuable and indispensable in steering clinical and nursing practices for patients suffering from depression associated with cSLE.\u003c/p\u003e\n\u003cp\u003eBesides, our findings also indicated that significant discrepancies were observed in the assessment of depression incidence based on different depression screening tools, which is strongly recommended to establish standardized and comprehensive criteria for the assessment and screening of depression in children with cSLE \u003csup\u003e[23]\u003c/sup\u003e. This initiative aims to enhance the clinical management and nursing care provided to these young patients, thereby facilitating more effective support throughout their treatment journey \u003csup\u003e[24]\u003c/sup\u003e. Therefore, comprehensive prospective studies with larger sample sizes are imperative to thoroughly assess the incidence of depression in cSLE paitents as evaluated by an unified scale. Furthermore, it is essential to juxtapose and scrutinize these findings against those derived from our meta-analysis.\u003c/p\u003e\n\u003cp\u003eLast but by no means least, the present systematic review and meta-analysis exhibits both \u0026nbsp;strengths and limitations. In terms of strengths, this investigation represents the inaugural pooled analysis concerning the prevalence of depression in cSLE patients and its disease course, to the best of our knowledge. Furthermore, the studies included in this review demonstrated relatively high methodological rigor, as evidenced by Newcastle-Ottawa Scale (NOS) scores that were no less than 6. Additionally, we conducted a subgroup analysis which revealed significant discrepancies in the assessment of depression incidence contingent upon varying screening tools for depression. This finding holds substantial implications for clinical practice and nursing, offering valuable insights into tailored approaches for patient care.\u003c/p\u003e\n\u003cp\u003eHowever, this meta-analysis has several limitations. Firstly, the studies included were predominantly retrospective in design, which reflects real-world conditions; however, it is essential to recognize the potential for confounding biases. Secondly, all included studies had relatively small sample sizes, ranging from 24 to 106 participants. Thirdly, there is a lack of data available to analyze gender differences in the prevalence of depression among patients with cSLE. Therefore, we continue to advocate for further prospective studies with larger sample sizes that are crucial for a comprehensive assessment of the incidence of depression in cSLE patients.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe prevalence of depression in patients with cSLE is slightly higher compared with adult SLE patients. It is noteworthy that screening rates for depression vary significantly among different assessment tools. There exists an urgent need to establish a consensus aimed at standardizing diagnostic criteria for depression through screening, thereby providing valuable guidance for clinical and nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations of interest:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFangtham M, Kasturi S, Bannuru RR, Nash JL, Wang C. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus. 2019; 28(6):703-712. doi: 10.1177/0961203319841435.\u003c/li\u003e\n \u003cli\u003eKoletsos N, Dipla K, Triantafyllou A, Dolgyras P, Aslanidis S, Zafeiridis A, et al. Depression in systemic lupus erythematosus: A manifestation of microcirculation dysfunction? Lupus. 2023; 32(6):727-736. doi: 10.1177/09612033231167792.\u003c/li\u003e\n \u003cli\u003ePalagini L, Mosca M, Tani C, Gemignani A, Mauri M, Bombardieri S. Depression and systemic lupus erythematosus: a systematic review. Lupus. 2013; 22(5):409-16. doi: 10.1177/0961203313477227.\u003c/li\u003e\n \u003cli\u003eDavis AM, Graham TB, Zhu Y, McPheeters ML. Depression and medication nonadherence in childhood-onset systemic lupus erythematosus. Lupus. 2018; 27(9):1532-1541. doi: 10.1177/0961203318779710.\u003c/li\u003e\n \u003cli\u003eBaba O, Kisaoglu H, Bilginer C, Ozkaya E, Kalyoncu M. Depression, anxiety, and sleep quality in childhood onset systemic lupus erythematosus and relationship with brain-derived neurotrophic factor. Lupus. 2022; 31(13):1630-1638. doi: 10.1177/09612033221127901.\u003c/li\u003e\n \u003cli\u003eBlamires J, Foster M, Napier S, Dickinson A. Experiences and Perspectives of Children and Young People Living with Childhood-Onset Systemic Lupus Erythematosus-An Integrative Review. Children (Basel). 2023; 10(6):1006. doi: 10.3390/children10061006.\u003c/li\u003e\n \u003cli\u003eStang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605.\u003c/li\u003e\n \u003cli\u003eHiggins JP, Thompson SG, Deeks JJ et al. Measuring inconsistency in metaanalyses. BMJ 2003; 327: 557-560.\u003c/li\u003e\n \u003cli\u003eHiggins JPT, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. www.handbook.cochrane.org.\u003c/li\u003e\n \u003cli\u003eS Ahola,Kohut,T S,Williams,J,Jayanthikumar, et al.Depressive symptoms are prevalent in childhood-onset systemic lupus erythematosus (cSLE).[J].Lupus,2013,22(7):712-20.\u003c/li\u003e\n \u003cli\u003eDonnelly C, Cunningham N, Jones JT, Ji L, Brunner HI, Kashikar-Zuck S. Fatigue and depression predict reduced health-related quality of life in childhood-onset lupus. Lupus. 2018;27(1):124-133.\u003c/li\u003e\n \u003cli\u003eJordan T,Jones,Natoshia,Cunningham,SusmitA,Kashikar-Zuck,Hermine I,Brunner.Pain, Fatigue, and Psychological Impact on Health-Related Quality of Life in Childhood-Onset Lupus.[J].Arthritis care \u0026amp; research,2016,68(1):73-80.DOI:10.1002/acr.22650.\u003c/li\u003e\n \u003cli\u003eYasemin,D\u0026uuml;z\u0026ccedil;eker,Nuray \u0026Ouml;,Kanbur,Erkan,Demirkaya,Orhan,Derman,Lakshmi N,Moorthy,Seza,Ozen.Quality of life measures and psychiatric symptoms in adolescents with systemic lupus erythematosus and familial Mediterranean fever.[J].International journal of adolescent medicine and health,2014,26(4):541-9.DOI:10.1515/ijamh-2013-0332.\u003c/li\u003e\n \u003cli\u003eSelcuk,Uzuner,Sezgin,Sahin,Gizem,Durcan,Amra,Adrovic,Kenan,Barut,Ali Guven,Kilicoglu,Ayhan,Bilgic,Kayhan,Bahali,Ozgur,Kasapcopur.The impact of peer victimization and psychological symptoms on quality of life in children and adolescents with systemic lupus erythematosus.[J].Clinical rheumatology,2017,36(6):1297-1304.DOI:10.1007/s10067-017-3650-5.\u003c/li\u003e\n \u003cli\u003eTricia S,Williams,Cynthia,Aranow,Gail S,Ross,Alexandra,Barsdorf,Lisa F,Imundo,Andrew H,Eichenfield,Philip J,Kahn,Betty,Diamond,Deborah M,Levy.Neurocognitive impairment in childhood-onset systemic lupus erythematosus: measurement issues in diagnosis.[J].Arthritis care \u0026amp; research,2011,63(8):1178-87.DOI:10.1002/acr.20489.\u003c/li\u003e\n \u003cli\u003eAppearance concern and depression in adolescent girls with systemic lupus erythematous[J].Clinical rheumatology,2012,31(12):1671-1675.\u003c/li\u003e\n \u003cli\u003eA M,Davis,T B,Graham,Y,Zhu,M L,McPheeters.Depression and medication nonadherence in childhood-onset systemic lupus erythematosus.[J].Lupus,2018,27(9):1532-1541.DOI:10.1177/0961203318779710.\u003c/li\u003e\n \u003cli\u003eH,Aldar,A T,Lapa,B,Bellini,N A,Sinicato,M,Postal,P T,Fernandes,L T L,Costallat,R,Marini,S,Appenzeller.Prevalence and clinical significance of anti-ribosomal P antibody in childhood-onset systemic lupus erythematosus.\u003c/li\u003e\n \u003cli\u003eKate M,Neufeld,Paris,Moaf,Michelle,Quilter,Ashley N,Danguecan,Julie,Couture,Daniela,Dominguez,Olivia,Hendrikx,Lawrence,Ng,Reva,Schachter,Daphne D,Korczak,Deborah M,Levy,Linda,Hiraki,Andrea M,Knight.Evaluation of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus: Frequency, course, and associated risk factors.[J].Lupus,2024,33(8):874-885.DOI:10.1177/09612033241254170.\u003c/li\u003e\n \u003cli\u003eTamar B Rubinstein, Marija Dionizovik-Dimanovski, Alaina M Davis, Chelsey Smith, Lauren Faust, Beth Rutstein, et al. Multicenter Study of Utility and Acceptability of Depression and Anxiety Screening in Adolescents and Young Adults With Childhood-Onset Systemic Lupus. Arthritis Care Res (Hoboken). 2023;75(4):724-733.\u003c/li\u003e\n \u003cli\u003eMulvihill E, Furru R, Goldstein-Leever A, Driest K, Lemle S, MacDonald D, et al. Targeted provider education and pre-visit planning increase rates of formal depression screening in childhood-onset SLE. Pediatr Rheumatol Online J. 2021;19(1):116.\u003c/li\u003e\n \u003cli\u003eAhmed T,Moustafa,Mitra,Moazzami,Lisa,Engel,Elvira,Bangert,Mohamed,Hassanein,Sherief,Marzouk,Maryana,Kravtsenyuk,William,Fung,Lihi,Eder,Jiandong,Su,Joan E,Wither,Zahi,Touma.Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis.[J].Seminars in arthritis and rheumatism,2020,50(1):84-94.DOI:10.1016/j.semarthrit.2019.06.017.\u003c/li\u003e\n \u003cli\u003eE Muscal, D R Bloom, J V Hunter, B L Myones. Neurocognitive deficits and neuroimaging abnormalities are prevalent in children with lupus: clinical and research experiences at a US pediatric institution. Lupus. 2010 Mar;19(3):268-79. doi: 10.1177/0961203309352092.\u003c/li\u003e\n \u003cli\u003eHilda Lilian,Carbajal-Alonso,Norberta Prisilia,Garc\u0026iacute;a-Moreno,Brenda,Rodr\u0026iacute;guez-Arreola,Juan Carlos,Barrera de Le\u0026oacute;n.[Depressive disorder in Mexican pediatric patients with systemic lupus erythematosus (SLE)].[J].Gaceta medica de Mexico,152(1):36-42.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Comprehensive Characteristics of the Included Articles (N=12)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"1150\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst Author\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLanguage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePublication Year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Period\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (Male %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression validated tool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCriteria for SLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS Ahola Kohut\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2010-2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e14.3\u0026plusmn;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e6（16%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eCDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCatherine Donnelly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e16.2\u0026plusmn;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e8（16%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eCDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEyal Muscal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2001-2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eRetrospective+Prospective Cohort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003eRC: 15.1 (12.2-16.9)\u003cbr\u003e\u0026nbsp;PC: 15.8 (14.8-16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003eRC: 3(12.5%)\u003cbr\u003e\u0026nbsp;PC: 2(13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eCDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJordan Jones\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e16.1\u0026plusmn;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e11（20%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eCDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYasemin D\u0026uuml;z\u0026ccedil;eker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eTurkey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2011-2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eBSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTricia S. Williams\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2006-2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eCase-control study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e16.4\u0026plusmn;2.5(10.3- 21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e11(27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLi Ji\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2010-2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eCase-control study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e15.3\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eCDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlaina M. Davis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e16.2\u0026plusmn;3.3(7-22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e4(7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH Aldar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eBrazil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eRetrospective Cohort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e16.82\u0026plusmn;3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e3（5.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eCDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKate M. Neufeld\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2017-2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eRetrospective Cohort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e15.0\u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e6（12%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003eCES-DC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTamar B. Rubinstein\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eUS\u0026amp;Canada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2017-2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eMulticenter, retrospective cohort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003eMedian:17\u003cbr\u003e\u0026nbsp;IQR:15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e12（11%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.6272%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvan Mulvihill\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003eUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5.83624%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.27178%;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.01045%;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.7596%;\"\u003e\n \u003cp\u003eRetrospective Cohort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4.87805%;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21.1672%;\"\u003e\n \u003cp\u003e13.32+3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.62369%;\"\u003e\n \u003cp\u003e9(14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.58188%;\"\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.97213%;\"\u003e\n \u003cp\u003eACR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eUS:\u0026nbsp;\u003c/strong\u003eUnited States;\u003cstrong\u003e\u0026nbsp;NR:\u0026nbsp;\u003c/strong\u003eNot Report; \u003cstrong\u003eRC:\u0026nbsp;\u003c/strong\u003eretrospective cohort; \u003cstrong\u003ePC:\u0026nbsp;\u003c/strong\u003eProspective cohort; \u003cstrong\u003eCDI:\u003c/strong\u003e Childhood Depression Inventory; \u003cstrong\u003eBSI:\u0026nbsp;\u003c/strong\u003eBrief Symptom Inventory; \u003cstrong\u003eBDI:\u003c/strong\u003eBeck Depression Inventory; \u003cstrong\u003eCES-DC:\u003c/strong\u003eCenter for\u003c/p\u003e\n\u003cp\u003eEpidemiologic Studies Depression Scale for Children; \u003cstrong\u003ePHQ-9:\u003c/strong\u003e Patient Health Questionnaire-9; \u003cstrong\u003eACR:\u0026nbsp;\u003c/strong\u003e1997 American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eAssessment of Methodological Qualities Utilizing the Newcastle\u0026ndash;Ottawa Scale\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"685\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eFirst Author\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 15.0365%;\"\u003e\n \u003cp\u003eSelection(0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 18.1022%;\"\u003e\n \u003cp\u003eComparability(0-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 18.1022%;\"\u003e\n \u003cp\u003eOutcome(0-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003eREC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003eSNEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003eAE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003eDO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003eSC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003eAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003eAO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003eFU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003eAFU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eS Ahola Kohut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eCatherine Donnelly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eEyal Muscal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eJordan Jones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eYasemin D\u0026uuml;z\u0026ccedil;eker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eTricia S. Williams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eLi Ji\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eAlaina M. Davis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eH Aldar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eKate M. Neufeld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eTamar B. Rubinstein\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.8321%;\"\u003e\n \u003cp\u003eEvan Mulvihill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0292%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.15328%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.88321%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.46715%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.63504%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.94161%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.54745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.69343%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.86131%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0949%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026ldquo;1\u0026rdquo; indicates that the cohort study has met the specified criterion, while \u0026ldquo;0\u0026rdquo; denotes a failure to do so.\u003c/p\u003e\n\u003cp\u003eREC: Representativeness of the exposed cohort; SNEC: Selection of the non-exposed cohort; AE: Ascertainment of exposure; DO: Demonstration that the outcome of interest was not present at the start of the study; SC: Study controls for age and sex; AF: Study controls for any additional factors (such as donor source, immunotherapy, etc.); AO: Assessment of outcome; FU: Follow-up duration sufficient (36 months) for outcomes to manifest; AFU: Adequacy of follow-up among cohorts (\u0026ge;90%).\u003c/p\u003e"},{"header":"Supplementary tables","content":"\u003cp\u003eSupplementary tables 1 and 2 are not available with this version\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Shandong Provincial Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, Disease Course, Depression, Childhood-Onset Systemic Lupus Erythematosus, Meta-Analysis","lastPublishedDoi":"10.21203/rs.3.rs-5708513/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5708513/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eChildhood-onset systemic lupus erythematosus (cSLE) is frequently associated with psychological symptoms, particularly depression. However, there remains a lack of quantitative evidence regarding the prevalence and disease course of depression based on the currently available evidence. In this context, we conducted the first systematic review and meta-analysis addressing this important issue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThree medical databases, including PubMed, Embase, Cochrane Library were utilized in this study. We included studies that reported on cSLE patients experiencing depression for a meta-analysis. STATA software were employed to synthesize the results as well as to assess heterogeneity and publication bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eTotally 12 eligible studies encompassing 652 cSLE patients were incorporated into this meta-analysis. Each of the publications included exhibited commendable methodological rigor, with Newcastle-Ottawa scores no less than 6. The pooled results with 12 articles indicated that the prevalence of depression among cSLE patients was 32.6% (95% CI: 0.25-0.40, Z=8.656, P\u0026lt;0.001). Subsequent subgroup analysis indicated that the prevalence of depression varied according to the different screening tools used: it was found to be 26% with CDI (95% CI: 0.18-0.34, P=0.023, I²=61.8%), 41% with PHQ-9 (95% CI: 0.20-0.63, P\u0026lt;0.001, I²=90.7%), and 37% with other tools such as BSI, BDI, and CES-D (95% CI: 0.21-0.53, P=0.031, I²=71.3%). Furthermore, the Egger’s test indicates that publication bias is insignificant among the studies included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe prevalence of depression in patients with cSLE is slightly higher compared with adult SLE patients. It is noteworthy that screening rates for depression vary significantly among different assessment tools. There exists an urgent need to establish a consensus aimed at standardizing diagnostic criteria for depression through screening, thereby providing valuable guidance for clinical and nursing practice.\u003c/p\u003e","manuscriptTitle":"Prevalence of Depression in Childhood-Onset Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-30 07:11:55","doi":"10.21203/rs.3.rs-5708513/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e183dc6-c013-4e7e-ab08-aa551d39652e","owner":[],"postedDate":"December 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42017443,"name":"Pediatrics"}],"tags":[],"updatedAt":"2024-12-30T07:11:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-30 07:11:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5708513","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5708513","identity":"rs-5708513","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}