Impact of comorbid depression on clinical outcomes in patients with peripheral artery disease: a systematic review and meta-analysis.

Background: Depression is a common comorbidity in cardiovascular disease; however, its prognostic impact in peripheral artery disease (PAD) remains uncertain. This study evaluated the association between depression and clinical outcomes in patients with PAD. Methods: PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to December 2025. Observational studies comparing PAD patients with and without depression were included. Primary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), major amputation, and major adverse limb events (MALE). Random-effects meta-analyses were performed. Results: Thirteen studies involving 681,959 patients were included. Compared with those without depression, PAD patients with depression were generally younger and had a higher burden of cardiovascular and metabolic comorbidities. Depression was not significantly associated with all-cause mortality in pooled analyses of either odds ratios (OR = 2.01; 95% CI: 0.77-5.27; Conclusions: In PAD, comorbid depression was associated with higher MALE and MACE risks, but not all-cause mortality. These findings suggest that mental health assessment may be considered as part of comprehensive PAD care.