Burden of Depression Among HIV Caregivers in India: A Systematic Review and Meta-Analysis

Caregivers of individuals living with HIV face significant mental health challenges, with depression being the most common. Despite global research highlighting this burden, studies specific to the Indian context are scarce. Addressing India's unique sociocultural and economic factors, this review aims to estimate the prevalence and identify the correlates of depression among HIV caregivers, providing a basis for targeted interventions. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across PubMed, EMBASE, Scopus, and Web of Science. Observational studies reporting the prevalence of depression among HIV caregivers using validated screening tools were included. A random-effects model was used to estimate pooled prevalence, with heterogeneity assessed using Cochran's Q and I² statistics. Sensitivity and meta-regression analyses were conducted to explore potential sources of variability. A total of four studies, comprising 417 caregivers from different regions of India (Bangalore, Pune, and Mangalore), were included in the meta-analysis. The prevalence of depression among caregivers varied widely across studies, ranging from 5.5% to 68.3%. Using a random-effects model, the pooled prevalence of depression was estimated at 31% (95% CI: 1-61%), indicating a substantial mental health burden among this population. Significant heterogeneity was observed (I² = 98.81%). Publication bias was assessed through Egger's test, which indicated small-study effects, while trim-and-fill analysis did not identify any missing studies. Depression is a significant but under-researched issue among HIV caregivers in India. There is an urgent need for standardized assessment tools, routine mental health screenings, and structured psychosocial interventions to support caregivers. Future research should focus on interdisciplinary approaches and policy-driven frameworks to mitigate the caregiving burden effectively.