Prevalence of depression and anxiety among patients with Behçet's disease: a systematic review and meta-analysis

Behçet's disease (BD) is a chronic multisystemic vasculitis associated with significant physical and psychological morbidity, including depression and anxiety. This systematic review and meta-analysis aimed to estimate the pooled prevalence of depression and anxiety among BD patients and to examine variations by assessment tools and geographic regions.

Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, and Scopus was conducted up to April 2025. Data were extracted and quality-assessed using standardized tools, and pooled prevalence rates were calculated via random-effects meta-analysis.

A total of 17 studies were included in the systematic review, of which 16 contributed to the meta-analysis of depression and 11 to the meta-analysis of anxiety among patients with BD. The results revealed a high pooled prevalence of depression at 47.44% (95% CI: 34.09-60.97%) and anxiety at 48.48% (95% CI: 35.40-61.67%), both with substantial heterogeneity (I² > 90%). Depression prevalence varied significantly by diagnostic instrument, with PHQ-9 and HADS reporting higher rates compared to DSM-IV and MINI. Geographic differences were marked, with Egypt showing the highest prevalence for both depression (88.83%) and anxiety (92.00%), while France reported the lowest prevalence for depression (5.00%) and Brazil reported the lowest for anxiety (29.31%). No publication bias was detected.

The findings underscore a high burden of mental health comorbidities in BD, with pooled prevalence rates of 47.44% for depression and 48.48% for anxiety, reflecting significant psychological morbidity. Geographic disparities, suggest cultural, healthcare, or socioeconomic moderators requiring further investigation. These results advocate for integrating routine mental health screening into BD management to address unmet psychiatric needs in this population.