Association of Anaemia and Depression: A Systematic Review and Meta-analysis
Main Article Content
Keywords
Depression, Anaemia , Prevalence
Abstract
Background: This research aims to find out the prevalence of depression in all types of anaemia patients of all age groups and genders by conducting a comprehensive meta-analysis of observational epidemiological studies.
Methodology: The relevant peer-reviewed literature describing primary data analysis was thoroughly evaluated using the PRISMA checklist as a reference. We searched databases, including PubMed, Scopus, Embase, and Google Scholar, to identify research publications published between 2003 and 2024. R software version 4.3.0 was utilised to perform the meta-analysis, and the JBI score was employed for quality appraisal. Heterogeneity was assessed using the Q and I2 statistics. To pool estimates, a random-effects model was employed. Publication bias was assessed using a funnel plot and Egger's regression test.
Results: After combining the results of the papers, the prevalence of depression was estimated at 36 % (CI = 95: 28–45 %) based on a random effects model. Sub-group analysis showed that the prevalence of depression was higher in patients with sickle cell anaemia (42%) followed by Thalassemia (35%) and Iron deficiency anaemia (20%). Sub-group analysis also found a higher prevalence (almost double) of depression in anaemic patients of Asia (40%) and the African continent (37%,) which is almost double as compared to America (28%) and Europe (20%). The declining trend of meta-regression analysis demonstrates that depression prevalence is higher among young anaemia patients (Children and adolescents) as compared to older ones.
Conclusion: Routine screening for depression may be required during regular follow-ups of anaemic patients, especially in resource-limited settings.
References
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28. Ciulei MA, Ahluwalia N, McCormick BJJ, Teti DM, Murray-Kolb LE. Iron deficiency is related to depressive symptoms in United States nonpregnant women of reproductive age: a cross-sectional analysis of NHANES 2005-2010. J Nutr. 2023;153(12):3521-8. doi:10.1016/j.tjnut.2023.09.023
29. Nam HK, Park J, Cho SI. Association between depression, anemia and physical activity using isotemporal substitution analysis. BMC Public Health. 2023;23(1):2236. doi:10.1186/s12889-023-17126-y
30. Wang Y, Guo D, Sui C, Qu Z, He G, Meng H, et al. Association between anemia and depression: results from NHANES 2005-2018 and Mendelian randomization analyses. Ann Hematol. 2023;102(10):2651-8. doi:10.1007/s00277-023-05374-4
31. Kemppinen L, Mattila M, Ekholm E, Huolila L, Pelto J, Karlsson H, et al. Gestational anemia and maternal antenatal and postpartum psychological distress in a prospective FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth. 2022;22(1):704. doi:10.1186/s12884-022-05032-z
32. Kwak DW, Kim S, Lee SY, Kim MH, Park HJ, Han YJ, et al. Maternal anemia during the first trimester and its association with psychological health. Nutrients. 2022;14(17):3505. doi:10.3390/nu14173505
33. Park GN, Kim JO, Oh JW, Lee S. Association between anemia and depression: the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey. J Affect Disord. 2022;312:86-91. doi:10.1016/j.jad.2022.06.015
34. Tian Q, Chen S, Jiang D. Effects of anemia during the third trimester of pregnancy on postpartum depression and pregnancy outcomes in pregnant women older than 35 years: a retrospective cohort study. Ann Palliat Med. 2022;11(3):1048-57. doi:10.21037/apm-22-165
35. Maeda Y, Ogawa K, Morisaki N, Tachibana Y, Horikawa R, Sago H. Association between perinatal anemia and postpartum depression: a prospective cohort study of Japanese women. Int J Gynaecol Obstet. 2020;148(1):48-52. doi:10.1002/ijgo.12982
36. Peppard L, Oh KM, Gallo S, Milligan R. Risk of depression in pregnant women with low-normal serum vitamin B12. Res Nurs Health. 2019;42(4):264-72. doi:10.1002/nur.21951
37. Vindhya J, Nath A, Murthy GVS, Metgud C, Sheeba B, Shubhashree V, et al. Prevalence and risk factors of anemia among pregnant women attending a public-sector hospital in Bangalore, South India. J Family Med Prim Care. 2019;8(1):37-43. doi:10.4103/jfmpc.jfmpc_265_18
38. Babu GR, Murthy GVS, Singh N, Nath A, Rathnaiah M, Saldanha N, et al. Sociodemographic and medical risk factors associated with antepartum depression. Front Public Health. 2018;6:127. doi:10.3389/fpubh.2018.00127
39. Chandrasekaran N, De Souza LR, Urquia ML, Young B, Mcleod A, Windrim R, et al. Is anemia an independent risk factor for postpartum depression in women who have a cesarean section? - A prospective observational study. BMC Pregnancy Childbirth. 2018;18(1):400. doi:10.1186/s12884-018-2032-6
40. Hidese S, Saito K, Asano S, Kunugi H. Association between iron-deficiency anemia and depression: a web-based Japanese investigation. Psychiatry Clin Neurosci. 2018;72(7):513-21. doi:10.1111/pcn.12656
41. Shafi M, Taufiq F, Mehmood H, Afsar S, Badar A. Relation between depressive disorder and iron deficiency anemia among adults reporting to a secondary healthcare facility: a hospital-based case control study. J Coll Physicians Surg Pak. 2018;28(6):456-9. doi:10.29271/jcpsp.2018.06.456
42. Sutherland S, O'Sullivan D, Mullins J. An association between anemia and postpartum depression. Obstet Gynecol. 2018;131:39S. doi:10.1097/01.AOG.0000532975.79181.b6
43. Vulser H, Wiernik E, Hoertel N, Thomas F, Pannier B, Czernichow S, et al. Association between depression and anemia in otherwise healthy adults. Acta Psychiatr Scand. 2016;134(2):150-60. doi:10.1111/acps.12595
44. Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, et al. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community-based birth cohort study. BMC Pregnancy Childbirth. 2018;18(1):374. doi:10.1186/s12884-018-2009-5
45. Xu F, Roberts L, Binns C, Sullivan E, Homer CSE. Anaemia and depression before and after birth: a cohort study based on linked population data. BMC Psychiatry. 2018;18(1):224. doi:10.1186/s12888-018-1796-6
46. Surkan PJ, Sakyi KS, Christian P, Mehra S, Labrique A, Ali H, et al. Risk of depressive symptoms associated with morbidity in postpartum women in rural Bangladesh. Matern Child Health J. 2017;21(10):1890-900. doi:10.1007/s10995-017-2299-7
47. Eckerdal P, Kollia N, Löfblad J, Hellgren C, Karlsson L, Högberg U, et al. Delineating the association between heavy postpartum haemorrhage and postpartum depression. PLoS One. 2016;11(1):e0144274. doi:10.1371/journal.pone.0144274
2. Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, et al. Mental health service provision in low- and middle-income countries. Health Serv Insights. 2017; 10:1178632917694350. doi:10.1177/1178632917694350
3. Ciesla B, editor. Red blood cell production, function, and relevant red cell morphology. Washington, DC: Library of Congress Cataloguing-in-Publication Data; 2007.
4. Le CHH. The prevalence of anaemia and moderate-severe anaemia in the US population (NHANES 2003–2012). PLoS One. 2016;11(11): e0166635. doi: 10.1371/journal.pone.0166635
5. Payne CF, Davies JI, Gomez-Olive FX, Hands KJ, Kahn K, Kobayashi LC, et al. Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population. J Epidemiol Community Health. 2018;72(9):796-802. doi:10.1136/jech-2018-210449
6. Azami M, Badfar G, Khalighi Z, Qasemi P, Shohani M, Soleymani A, et al. The association between anaemia and postpartum depression: a systematic review and meta-analysis. Caspian J Intern Med. 2019;10(2):115-24. doi:10.22088/cjim.10.2.115
7. Kengne AP, Czernichow S, Hamer M, Batty GD, Stamatakis E. Anaemia, haemoglobin level and cause-specific mortality in people with and without diabetes. PLoS One. 2012;7(8): e41875. doi: 10.1371/journal.pone.0041875
8. Namaste SM, Aaron GJ, Varadhan R, Peerson JM, Suchdev PS, BRINDA Working Group. Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) project. Am J Clin Nutr. 2017;106(Suppl 1):333S-47S. doi:10.3945/ajcn.116.142273
9. Halawi R, Moukhadder H, Taher A. Anaemia in the elderly: a consequence of ageing? Expert Rev Hematol. 2017;10(4):327-35. doi:10.1080/17474086.2017.1285695
10. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27(23):2763-74. doi:10.1093/eurheartj/ehl338
11. van der Kooy K, van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A. Depression and the risk for cardiovascular diseases: systematic review and meta-analysis. Int J Geriatr Psychiatry. 2007;22(7):613-26. doi:10.1002/gps.1723
12. Rotella F, Mannucci E. Depression as a risk factor for diabetes: a meta-analysis of longitudinal studies. J Clin Psychiatry. 2013;74(1):31-7. doi:10.4088/JCP.12r07922
13. de Voogd JN, Wempe JB, Koëter GH, Postema K, van Sonderen E, Ranchor AV, et al. Depressive symptoms as predictors of mortality in patients with COPD. Chest. 2009;135(3):619-25. doi:10.1378/chest.08-1352
14. Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disord. 2002;72(3):227-36. doi:10.1016/S0165-0327(01)00453-X
15. Hoertel N, Limosin F, Leleu H. Poor longitudinal continuity of care is associated with an increased mortality rate among patients with mental disorders: results from the French National Health Insurance Reimbursement Database. Eur Psychiatry. 2014;29(6):358-64. doi: 10.1016/j.eurpsy.2014.02.006
16. Anand IS. Anemia and chronic heart failure: implications and treatment options. J Am Coll Cardiol. 2008;52(7):501-11. doi: 10.1016/j.jacc.2008.04.044
17. Kaiafa G, Kanellos I, Savopoulos C, Kakaletsis N, Giannakoulas G, Hatzitolios AI. Is anemia a new cardiovascular risk factor? Int J Cardiol. 2015;186:117-24. doi: 10.1016/j.ijcard.2015.03.159
18. Chen CK, Tsai YC, Hsu HJ, Wu IW, Sun CY, Chou CC, et al. Depression and suicide risk in hemodialysis patients with chronic renal failure. Psychosomatics. 2010;51(6):528-528.e6. doi:10.1016/S0033-3182(10)70747-7
19. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. doi:10.1136/bmj.n71
20. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 2015;13(3):147-53. doi:10.1097/XEB.0000000000000054
21. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-58. doi:10.1002/sim.1186
22. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-88. doi:10.1016/0197-2456(86)90046-2
23. Athman LP, Jonathan A, Musa F, Kipasika HJ, Mahawi I, Urio F, et al. Clinical depression prevalence and associated factors among adolescents with sickle cell anemia in Dar es Salaam, Tanzania: a cross-sectional study. BMC Pediatr. 2025;25(1):10. doi:10.1186/s12887-024-05359-w
24. Babah OA, Beňová L, Larsson EC, Hanson C, Afolabi BB. Is an improvement in anaemia and iron levels associated with the risk of early postpartum depression? A cohort study from Lagos, Nigeria. BMC Public Health. 2025;25(1):1-3. doi:10.1186/s12889-024-20844-7
25. Leung CY, Kyung M. Associations of iron deficiency and depressive symptoms among young adult males and females: NHANES 2017 to 2020. Prev Med Rep. 2023;37:102549. doi:10.1016/j.pmedr.2023.102549
26. Ahmed T, Lamoureux-Lamarche C, Berbiche D, Vasiliadis HM. The association between anemia and depression in older adults and the role of treating anemia. Brain Behav. 2023;13(5):e2973. doi:10.1002/brb3.2973
27. Cheng Z, Karra M, Guo M, Patel V, Canning D. Exploring the relationship between anemia and postpartum depression: evidence from Malawi. Int J Environ Res Public Health. 2023;20(4):3178. doi:10.3390/ijerph20043178
28. Ciulei MA, Ahluwalia N, McCormick BJJ, Teti DM, Murray-Kolb LE. Iron deficiency is related to depressive symptoms in United States nonpregnant women of reproductive age: a cross-sectional analysis of NHANES 2005-2010. J Nutr. 2023;153(12):3521-8. doi:10.1016/j.tjnut.2023.09.023
29. Nam HK, Park J, Cho SI. Association between depression, anemia and physical activity using isotemporal substitution analysis. BMC Public Health. 2023;23(1):2236. doi:10.1186/s12889-023-17126-y
30. Wang Y, Guo D, Sui C, Qu Z, He G, Meng H, et al. Association between anemia and depression: results from NHANES 2005-2018 and Mendelian randomization analyses. Ann Hematol. 2023;102(10):2651-8. doi:10.1007/s00277-023-05374-4
31. Kemppinen L, Mattila M, Ekholm E, Huolila L, Pelto J, Karlsson H, et al. Gestational anemia and maternal antenatal and postpartum psychological distress in a prospective FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth. 2022;22(1):704. doi:10.1186/s12884-022-05032-z
32. Kwak DW, Kim S, Lee SY, Kim MH, Park HJ, Han YJ, et al. Maternal anemia during the first trimester and its association with psychological health. Nutrients. 2022;14(17):3505. doi:10.3390/nu14173505
33. Park GN, Kim JO, Oh JW, Lee S. Association between anemia and depression: the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey. J Affect Disord. 2022;312:86-91. doi:10.1016/j.jad.2022.06.015
34. Tian Q, Chen S, Jiang D. Effects of anemia during the third trimester of pregnancy on postpartum depression and pregnancy outcomes in pregnant women older than 35 years: a retrospective cohort study. Ann Palliat Med. 2022;11(3):1048-57. doi:10.21037/apm-22-165
35. Maeda Y, Ogawa K, Morisaki N, Tachibana Y, Horikawa R, Sago H. Association between perinatal anemia and postpartum depression: a prospective cohort study of Japanese women. Int J Gynaecol Obstet. 2020;148(1):48-52. doi:10.1002/ijgo.12982
36. Peppard L, Oh KM, Gallo S, Milligan R. Risk of depression in pregnant women with low-normal serum vitamin B12. Res Nurs Health. 2019;42(4):264-72. doi:10.1002/nur.21951
37. Vindhya J, Nath A, Murthy GVS, Metgud C, Sheeba B, Shubhashree V, et al. Prevalence and risk factors of anemia among pregnant women attending a public-sector hospital in Bangalore, South India. J Family Med Prim Care. 2019;8(1):37-43. doi:10.4103/jfmpc.jfmpc_265_18
38. Babu GR, Murthy GVS, Singh N, Nath A, Rathnaiah M, Saldanha N, et al. Sociodemographic and medical risk factors associated with antepartum depression. Front Public Health. 2018;6:127. doi:10.3389/fpubh.2018.00127
39. Chandrasekaran N, De Souza LR, Urquia ML, Young B, Mcleod A, Windrim R, et al. Is anemia an independent risk factor for postpartum depression in women who have a cesarean section? - A prospective observational study. BMC Pregnancy Childbirth. 2018;18(1):400. doi:10.1186/s12884-018-2032-6
40. Hidese S, Saito K, Asano S, Kunugi H. Association between iron-deficiency anemia and depression: a web-based Japanese investigation. Psychiatry Clin Neurosci. 2018;72(7):513-21. doi:10.1111/pcn.12656
41. Shafi M, Taufiq F, Mehmood H, Afsar S, Badar A. Relation between depressive disorder and iron deficiency anemia among adults reporting to a secondary healthcare facility: a hospital-based case control study. J Coll Physicians Surg Pak. 2018;28(6):456-9. doi:10.29271/jcpsp.2018.06.456
42. Sutherland S, O'Sullivan D, Mullins J. An association between anemia and postpartum depression. Obstet Gynecol. 2018;131:39S. doi:10.1097/01.AOG.0000532975.79181.b6
43. Vulser H, Wiernik E, Hoertel N, Thomas F, Pannier B, Czernichow S, et al. Association between depression and anemia in otherwise healthy adults. Acta Psychiatr Scand. 2016;134(2):150-60. doi:10.1111/acps.12595
44. Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, et al. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community-based birth cohort study. BMC Pregnancy Childbirth. 2018;18(1):374. doi:10.1186/s12884-018-2009-5
45. Xu F, Roberts L, Binns C, Sullivan E, Homer CSE. Anaemia and depression before and after birth: a cohort study based on linked population data. BMC Psychiatry. 2018;18(1):224. doi:10.1186/s12888-018-1796-6
46. Surkan PJ, Sakyi KS, Christian P, Mehra S, Labrique A, Ali H, et al. Risk of depressive symptoms associated with morbidity in postpartum women in rural Bangladesh. Matern Child Health J. 2017;21(10):1890-900. doi:10.1007/s10995-017-2299-7
47. Eckerdal P, Kollia N, Löfblad J, Hellgren C, Karlsson L, Högberg U, et al. Delineating the association between heavy postpartum haemorrhage and postpartum depression. PLoS One. 2016;11(1):e0144274. doi:10.1371/journal.pone.0144274
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Nov 11, 2025
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Gupta, B., Goel, R., Satodiya, V., Gupta, K., & Mittal, A. (2025). Association of Anaemia and Depression: A Systematic Review and Meta-analysis. Nigerian Medical Journal, 66(4), 1486–1509. https://doi.org/10.71480/nmj.v66i4.959
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