Systematic review and meta-analysis on depression burden among Type 2 diabetes patients in India

Depression and Type 2 Diabetes Mellitus (T2DM) are closely linked health challenges in India, which currently has more than 101 million people living with diabetes. This systematic review and meta-analysis aimed to determine the pooled prevalence of depression among Indian T2DM patients, highlight regional differences, and identify associated risk factors. Following PRISMA guidelines, a thorough search was conducted across PubMed, Embase, Scopus, and Web of Science for studies published until February 3, 2025. Random-effects models were applied to calculate pooled prevalence, while subgroup analyses assessed variations by geographic region, diagnostic tool, and study setting. Heterogeneity was quantified using I² statistics. Publication bias was evaluated using funnel plots and Egger’s regression, with trim-and-fill analysis performed when bias was detected. Meta-regression examined the impact of covariates such as sample size, mean age, diabetes duration, hypertension, and urban residence. A total of 59 studies with 24,073 participants were included. The pooled prevalence of depression among T2DM patients was 38% (95% CI: 33–42%), derived using a random-effects model to account for the substantial heterogeneity observed across studies (I² = 98.28%). This estimate reflects a statistical synthesis across studies with widely varying diagnostic tools, cutoff thresholds, and clinical settings, and should be interpreted as an approximation of the burden rather than a precise national prevalence figure. Mild, moderate, and severe depression accounted for 24%, 14%, and 14% of cases respectively. Regional variation was observed, with Western India showing the highest prevalence (48%) and multicenter studies the lowest (27%). Prevalence differed by diagnostic tool: CIDI-SF (20%), PHQ-9 (34%), and BDI (72% with lenient cutoffs). Hospital-based studies reported higher prevalence (42%) compared to community-based ones (28%). Females had a greater burden (39%) than males (31%). No significant differences were found between pre- and post-COVID-19 studies. Sensitivity analyses confirmed robustness of estimates. Meta-regression identified diabetes duration as a significant predictor (p = 0.026). Nearly two in five Indian T2DM patients experience depression, emphasizing the urgent need for standardized screening and integration of mental health care into India’s National Program for Non-Communicable Diseases.