Ethnic differences in the prevalence of mental health disorders among individuals with diabetes: a systematic review and meta-analysis

Aim: This systematic review and meta-analysis aimed to estimate the prevalence of mental health disorders among adults (≥ 18 years) with diabetes in different ethnic populations. Methods: A comprehensive search was conducted in five databases (EMBASE, Medline, PsycINFO, Scopus, and CINAHL) for peer-reviewed observational studies published in English between 2014 and 2024. Studies reporting the prevalence of mental health disorders determined using validated self-report screening tools or clinical diagnoses were included. Meta-analyses using random-effects models were conducted. Subgroup analyses and meta-regressions explored differences by ethnicity, diabetes type, diagnostic method, duration of diabetes, country income level, and indigenous status. Results: Of 17,723 identified records, 53 studies met the inclusion criteria. The pooled prevalence of mental health disorders among adults with diabetes was 25.78% (95% CI: 23.27–28.29), with high heterogeneity (I² = 99.9%). For those with known ethnic group, the prevalence of mental health disorder was highest in North Africa and the Middle East (32.44%, 95% CI: 27.71–37.45), followed by Hispanics or Latinos (28.36%, 95% CI: 25.20–31.57) and lowest prevalence was among Oceanians (10.42%). Post traumatic stress disorder (PTSD) (37.79%) and depression (27.55%) were the most common mental health disorders, while schizophrenia was the least prevalent (3.45%). Type 2 diabetes (31.91%), diabetes duration < 10 years (26.21%), low-income countries (40.63%), and use of non self-report tools (29.19%) were associated with higher prevalence of mental health disorder. Non-Indigenous populations also had a greater burden (26.45%) than Indigenous groups (17.65%). Conclusion: Approximately one in four adults with diabetes experiences mental health disorders, with significant variation by ethnicity, diabetes type, diagnostic method, and socioeconomic context. Culturally tailored, integrated care approaches are needed to address disparities in mental health among people with diabetes.