Depression among nursing students in Pakistan: a systematic review and meta-analysis

Depression is a common psychological disorder that adversely affects emotional functioning, motivation, and academic performance. Nursing students are at increased risk due to academic load, clinical responsibilities, and frequent exposure to patient suffering. In Pakistan, cultural expectations, financial pressure, and stigma surrounding mental health may further exacerbate vulnerability. This study aimed to synthesize existing evidence on the prevalence of depression among nursing students in Pakistan. This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines and registered in the PROSPERO database (CRD420251178412). A comprehensive literature search was conducted across MEDLINE (PubMed), Embase, Scopus, Web of Science, APA PsycINFO, and Pakistani academic databases without year restrictions. Studies reporting the prevalence of depression among nursing students using validated tools (e.g., DASS-21, BDI-I, BDI-II, SSDS) were included. Data extraction and quality appraisal were performed independently by two reviewers using the Joanna Briggs Institute (JBI) tool. A random-effects model was applied using STATA version 17. Heterogeneity was assessed using the Cochran Q test and I² statistic. Subgroup analyses and meta-regression explored potential sources of variability. Eleven studies comprising 2,253 nursing students met the eligibility criteria. The pooled prevalence of depression was 37% (95% CI: 25%–50%), with high heterogeneity across studies (I² > 95%). Subgroup analyses showed no significant differences by measurement tool or province. Meta-regression indicated no significant association between year of publication and reported prevalence. Depression is a notable mental health concern among nursing students in Pakistan. Strengthening psychological support services and implementing stress management interventions within nursing education are essential. Further high-quality, multi-center, and longitudinal research is needed.