Prevalence of depressive symptoms in the nursing workforce in Pakistan: Systematic review and meta-analytic evidence

Introduction
Nursing involves demanding clinical responsibilities and emotional challenges that may increase the risk of depressive symptoms and affect nurses' well-being and patient care. This study estimated the pooled prevalence of depressive symptoms among registered nurses in Pakistan and examined variations across regions and assessment instruments.
Methods
This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, PsycINFO, and Pakistan-based databases were searched. Eligible studies reported the prevalence or severity of depressive symptoms among registered nurses in clinical settings using validated or clearly described assessment tools. Two reviewers conducted data extraction and quality assessment using the Joanna Briggs Institute checklist. A random-effects model was used to estimate pooled prevalence. Subgroup analyses were performed by region and assessment instrument, and meta-regression assessed temporal trends.
Results
Twenty-two studies involving 3190 nurses were included. The pooled prevalence of depressive symptoms was 49%, with substantial heterogeneity (I2 = 97%). Prevalence varied by assessment instrument, ranging from 38% with the PHQ-9 to 61% with the DASS-21. Regional analyses indicated higher prevalence estimates in Khyber Pakhtunkhwa than in other provinces. Meta-regression showed no significant association between publication year and prevalence estimates. Although Egger's test suggested possible funnel plot asymmetry, Trim-and-Fill analysis did not indicate substantial publication bias.
Conclusion
Depressive symptoms are highly prevalent among nurses in Pakistan and represent a major occupational mental health concern. Interventions to improve working conditions and organizational support, along with standardized assessment methods, may help reduce this burden and improve the consistency of future research findings.