Pooled prevalence of anxiety and depressive symptoms among adults with type 2 diabetes: a systematic review and meta-analysis

Abstract

Anxiety and depressive symptoms are highly prevalent among individuals with type 2 diabetes mellitus (T2DM), yet they remain underdiagnosed despite their substantial impact on health outcomes. In addition to impairing treatment adherence, these conditions may contribute to the development of chronic complications, reduce quality of life, and, in severe cases, increase mortality. Therefore, this review aims to estimate the pooled prevalence of anxiety symptoms and depressive symptoms among adults with T2DM and to explore potential sources of between-study heterogeneity, including assessment instruments and cut-off points. PubMed, Embase, PsycINFO, Scopus, and Web of Science were searched from inception to July 6, 2026. After screening 6,948 records according to PRISMA 2020, 34 cross-sectional studies involving 21,024 participants were included. We considered observational studies involving adults with T2DM that reported the prevalence of anxiety symptoms or depressive symptoms assessed using validated screening instruments or diagnostic criteria. Two reviewers independently screened the records, extracted the data, and assessed the risk of bias. Separate random-effects meta-analyses were conducted for anxiety symptoms and depressive symptoms. Thirty-four cross-sectional studies involving 21,024 participants were included. The pooled prevalence was 43.82% for anxiety symptoms (95% CI 36.86–50.90; \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:{I}^{2}=99.06\%$$\end{document}) and 41.83% for depressive symptoms (95% CI 33.83–50.06; \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:{I}^{2}=99.31\%$$\end{document}). Estimates varied substantially across assessment instruments and cut-off points. Several studies reported associations with sex, glycemic control, and social support; however, differences in the definitions, measurements, and analytical methods prevented quantitative pooling of these factors. Anxiety and depressive symptoms were frequently reported among adults with T2DM. However, the extreme between-study heterogeneity limits the interpretation of the pooled estimates, which should be understood as summary measures across diverse study populations rather than universal prevalence estimates. These findings should not be interpreted as estimates of clinically diagnosed anxiety or depressive disorders.