Prevalence of anxiety and depressive symptoms and associated factors among nursing interns during clinical practice in China: a systematic review and meta-analysis

Nursing interns enter clinical practice under substantial psychological strain. Anxiety and depression are reported repeatedly among Chinese nursing students, but the positive-screening prevalence during the internship, and its associated factors, have not been synthesised quantitatively. Nine databases (four Chinese, five English) were searched from inception to 28 June 2026 for cross-sectional studies reporting positive-screening rates of anxiety and/or depressive symptoms at validated cut-offs among nursing interns in mainland China. Quality was assessed with the AHRQ checklist. Prevalence was pooled with the Freeman–Tukey double-arcsine transformation in random-effects (REML) models and summarised with 95% prediction intervals ( PIs ); robustness was checked with logit and GLMM models, leave-one-out, quality-restricted and exploratory subgroup analyses, and Begg’s and Egger’s tests. Forty-seven studies were included. Thirty-three reported anxiety screening during the placement at a standard cut-off, covering 10 157 interns: 28.4%, 95% CI 22.8% to 34.4%, I-squared 97.6%, 95% prediction interval roughly 4% to 64%. Only six reported depressive-symptom screening at a standard cut-off, covering 2674 interns: 37.7%, 95% CI 27.3% to 48.8%, I-squared 96.8%, prediction interval roughly 13% to 66%. Most SDS studies scored positive from 50 rather than the standard 53, and pooling all 22 reported depression rates gave 34.4%, 95% CI 29.1% to 40.0%. At this level of variation the prediction intervals are more informative than the summaries, which are not national prevalences. The anxiety summary was robust to transformation, leave-one-out and quality-restricted analyses, with no detectable funnel-plot asymmetry. No exploratory subgroup differed significantly, including internship stage, p = 0.468. Associated factors were too inconsistently defined to pool. Screening rates among nursing interns in mainland China describe a wide, setting-dependent distribution rather than one prevalence, centred near 28% for anxiety and between one third and two fifths for depressive symptoms, but plausibly running from a few per cent to about two thirds in a cohort. The depression estimate rests on few studies that used a standard threshold. The summaries are a benchmark for a specific cohort, not a national figure, and are screening, not diagnostic, rates; prospective measurement with standard instruments and stated thresholds is the priority. PROSPERO CRD420261430366 (registered 22 June 2026).