SynthesisBMJ open2026
Prevalence of depressive symptoms among medical students in Pakistan: a systematic review and meta-analysis.
Synthesis in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesDepressive symptoms are highly prevalent among medical students globally, yet estimates from Pakistan remain fragmented and inconsistent across studies. Medical students in Pakistan face multiple academic, social and environmental stressors that may increase their risk of depression. We conducted a systematic review and meta-analysis to estimate the prevalence of depressive symptoms among medical students in Pakistan and to explore sources of heterogeneity across studies.
designSystematic review and meta-analysis reported in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. DATA SOURCES: MEDLINE (via PubMed), Web of Science, Embase, Scopus, APA PsycInfo and Pakistani journals were searched without date restriction up to September 2025. ELIGIBILITY CRITERIA: Observational studies conducted among medical students in Pakistan reporting prevalence of depressive symptoms using validated assessment tools (eg, PHQ-9, BDI, DASS-21) were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened studies, extracted data and assessed methodological quality using the Joanna Briggs Institute tool. Random-effects meta-analysis was conducted. Subgroup analyses (province and assessment instrument) and meta-regression (publication year) were performed. Heterogeneity and publication bias were assessed using I² statistics, funnel plots and Egger's and Begg's tests.
resultsSeventy-one studies contributed 72 prevalence estimates, including approximately 23 000 medical students. The reported prevalence of depressive symptoms ranged from 9% to 94%, with considerable heterogeneity across studies (I²=99.15%, p<0.001). Subgroup analysis showed slightly higher prevalence estimates in Sindh compared with Punjab and other regions; however, subgroup differences were not statistically significant (Q=1.00, df=2, p=0.61). Prevalence estimates also varied according to the assessment instrument, with generally higher estimates reported using PHQ-9 and DASS-21. Meta-regression demonstrated a significant positive association between publication year and reported prevalence (β=0.016, SE=0.007, 95% CI 0.002 to 0.031, p=0.03). Evidence of publication bias was identified by Egger's test (p=0.024) and Begg's test (p<0.001), although adjusted analyses yielded broadly consistent findings.
conclusionsThe prevalence of depressive symptoms among medical students in Pakistan varies widely across studies, with evidence suggesting an increasing trend over time. However, the findings should be interpreted with caution due to substantial heterogeneity across studies, variability in assessment instruments and cut-off thresholds, and methodological limitations in some included studies. Despite these limitations, the findings highlight the need for scalable mental health interventions, including screening, counselling and educational reforms. PROSPERO REGISTRATION NUMBER: CRD420251160506.
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