The association between depression and frozen shoulder: A systematic review and meta-analysis

BackgroundFrozen shoulder (FS), commonly known as adhesive capsulitis, is a disabling musculoskeletal condition frequently accompanied by psychological distress. This meta-analysis aimed to evaluate the association between FS and depression.MethodsFor this meta-analysis, a systematic literature search of EMBASE, PubMed, and the Cochrane Library was conducted through 2025 using the keywords "frozen shoulder", "adhesive capsulitis" and "depression." Data regarding study characteristics, participant information, and depression-related outcomes were extracted. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Pooled odds ratios (ORs), mean differences (MDs), and corresponding 95% confidence intervals (CIs) were calculated. Statistical heterogeneity and potential publication bias were also assessed.ResultsNine studies including 122,378 participants met the inclusion criteria. The pooled prevalence of depression among patients with FS was 25.5% (95% CI: 16.7-36.8%). Patients with FS showed significantly higher odds of depression compared with individuals without FS (OR = 2.15, 95% CI: 1.57-2.94). In addition, FS patients had significantly higher HADS-D scores (MD = 2.97, 95% CI: 0.66-5.28). Substantial heterogeneity was observed across studies, while no significant publication bias was detected.ConclusionFS is associated with an increased risk of depression. These findings emphasize the importance of incorporating psychological assessment and management into the clinical care of patients with FS to improve overall outcomes.