The prevalence of depression among patients with primary hyperhidrosis: a systematic review and meta-analysis

A well-established clinical association is recognized between primary hyperhidrosis (PH) and depression. However, the evidence about the prevalence of depression among people with PH is inconsistent, and there is currently no systematic review on the subject.

This study systematically searched PubMed, Cochrane Library, Embase, Ovid MEDLINE, Web of Science, and PsycINFO for studies reporting on the prevalence of depression in people with PH from database inception to December 19, 2025. We included cross-sectional and cohort studies reporting depression prevalence, as well as case-control studies reporting depression proportions, in patients with primary hyperhidrosis (PH). Two reviewers independently performed literature screening and data extraction, and assessed methodological quality using the Joanna Briggs Institute (JBI) tool. Following the resolution of any discrepancies by discussion or a third reviewer, the pooled prevalence was derived using a random‑effects model with the Freeman-Tukey double arcsine transformation. Subsequently, subgroup and sensitivity analyses were performed, and publication bias was assessed.

A total of 18 studies published between 2001 and 2024 were included, encompassing 47,053 participants. The overall pooled prevalence of depression was 18.0% (95% CI: 14.3%-22.0%) under the random‑effects model, with substantial between‑study heterogeneity (I² = 90.24%). Subgroup analyses identified that the reported prevalence of depression varied significantly based on the assessment instrument employed (p < 0.001 for between‑subgroup heterogeneity).

This systematic review and meta-analysis demonstrate that depressive symptoms are highly prevalent among patients with primary hyperhidrosis (18.0% as assessed by validated scales), which is substantially higher than the estimated 4.4% global prevalence of clinically diagnosed major depressive disorder in the general population. Although this comparison should be interpreted cautiously, as these estimates are based on different definitions and are not directly comparable, the magnitude of the difference highlights the substantial burden of depressive symptoms in this population. The variation in reported prevalence rates attributable to different assessment tools highlights the necessity of adopting standardized and comparable measurement methods in clinical practice and future research. These findings provide updated evidence on the prevalence of depression in the PH population, identify assessment tools as a major contributor to heterogeneity, and offer valuable guidance for clinical assessment and research design.

The study protocol was prospectively registered with PROSPERO (CRD42025642265; 24 January 2025).