Anxiety prevalence among women with polycystic ovary syndrome in mainland China: a systematic review and meta-analysis

Objective This systematic review and meta-analysis aimed to determine the pooled prevalence of anxiety among women with polycystic ovary syndrome (PCOS) in mainland China and explore the potential contributors related to anxiety prevalence among PCOS. Methods We searched PubMed, EMBASE, Web of Science, CNKI, WanFang, and VIP databases from inception to January 2025. Pooled prevalence estimates were calculated using random-effects models, with subgroup analyses stratified by region, age, BMI, assessment tools, and diagnostic criteria. Heterogeneity was assessed by I 2 statistics and meta-regression. Results Thirty-five studies (8,655 participants) met inclusion criteria. The pooled anxiety prevalence was 32% (95% CI: 26–38%), with substantial heterogeneity ( I 2 = 97.8%, p < 0.001). Subgroup analyses revealed higher prevalence in younger women (<26 years: 39% vs. ≥26 years: 25%), West China (36% vs. East/Central China: 28%), and studies using GAD-7 (41% vs. SAS: 31%). Diagnostic criteria influenced estimates (Rotterdam: 31% vs. PRCHIS: 27%). Meta-regression identified no significant moderators. Sensitivity analyses confirmed robustness, and publication bias was nonsignificant. Conclusion Anxiety affects nearly one-third of Chinese women with PCOS, with prevalence shaped by age, region, and assessment methodologies. Despite alignment with global trends, regional disparities underscore the need for culturally adapted mental health interventions. Clinicians should prioritize anxiety screening in PCOS management, particularly for younger women and underserved populations.