Prevalence of depression among diabetic patients in Pakistan: A systematic review and meta-analysis

Abstract Background: Depression commonly co-occurs with diabetes, exacerbating health outcomes, particularly in high-prevalence settings like Pakistan. Aim:To estimate the pooled prevalence of depression among diabetic patients in Pakistan through a systematic review and meta-analysis. Methods: Following PRISMA guidelines, we searched databases (PubMed, Web of Science, Google Scholar) up to June 2025. Eligible cross-sectional and prospective studies reported depression prevalence in Pakistani diabetic adults. Data were extracted on prevalence, study characteristics, and risk of bias (JBI Checklist). A random-effects model pooled estimates, with subgroup analyses by province, gender, and diabetes duration. Results: From 26 studies (n=8,805 participants), the pooled prevalence was 46.38% (95% CI: 38.47%-54.29%; I²=98%). Higher rates were in Khyber Pakhtunkhwa (60.05%) and females (60.02%). Meta-regression showed associations with publication year (R²=47.18%) and diabetes duration. No significant publication bias was detected. Conclusions: Depression affects nearly half of diabetic patients in Pakistan, warranting integrated screening and national policies. Future research should address heterogeneity and expand geographic coverage.