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Depression and anxiety in ovarian cancer: a systematic review and meta-analysis of prevalence rates
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    Response to "Depression and anxiety in ovarian cancer: a systematic review and meta-analysis of prevalence rates"

    We read with interest the systematic review and meta-analysis by Watts et al. published in BMJ Open [1] which reported on the prevalence of depression and anxiety in women with ovarian cancer at three time-points: pre-treatment, on-treatment and post-treatment. We agree this is an important topic but, after reviewing the article, would like to raise some concerns. We have reproduced the key components of Table 1 from that paper with additional comments to note some potential inaccuracies. Our main concerns are as follows:
    First, it appears that the same women have been counted twice in some analyses. The most concerning instance of this relates to the Australian Ovarian Cancer Study, which is by far the largest study with 794 cases with data on depression and anxiety. Women in this study have been double counted (Price 2009 [2] and Price 2010 [3]) in the pre-treatment analysis, then also counted (Price 2009) in the on-treatment analysis, when in practice 79% of women in this study were post-treatment so these data (one or other of the reports) should have been included in the post-treatment analyses only (but they are not). Watts et al. also include two papers (Liavaag 2007 [4] and Liavaag 2009 [5]) from a single study at the Norwegian Radium Hospital and count these women in two separate analyses. Furthermore, they include four papers from a group with study sites in Iowa, Miami and Texas (Lutgendorf 2008 [6], Lutgendorf 2008 [7], Lutgendorf 2009 [8] and Clevenger 2...

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    Conflict of Interest:
    None declared.