Post-infectious fatigue and depression following dengue: a systematic review and meta-analysis of associated factors

Post-dengue fatigue syndrome is a debilitating long-term condition that affects daily activities, quality of life, and productivity. Its underlying mechanisms remain unclear, but clinical similarities with post-dengue depression complicate differentiation. Therefore, we conducted a systematic review and meta-analysis to identify and compare factors associated with post-dengue fatigue and post-dengue depression. We searched PubMed, Science Direct, Web of Science and Google Scholar databases until 6 June 2025, with an update performed on 31 December 2025. This systematic review was conducted according to PRISMA guidelines. Meta-analyses were conducted to assess associations of demographic, biological, clinical, medical or psychosocial factors with post-dengue fatigue and post-dengue depression using pooled odds ratios (OR). The study protocol was registered in PROSPERO (CRD420250655004). Nine studies (2006–2023) covering 1470 patients were included. The systematic review identified 13 factors eligible for meta-analysis: twelve factors for post-dengue fatigue and one for post-dengue depression. Among these factors, female sex (OR 1.69, 95% CI: 1.33–2.14), myalgia (OR 3.45, 95% CI: 2.10–5.69), and severe dengue (OR 4.02, 95% CI: 1.45–11.13), particularly dengue haemorrhagic fever (OR 1.53, 95% CI: 1.04–2.24), were associated with post-dengue fatigue. No factor was associated with post-dengue depression in the meta-analysis. However, narrative synthesis revealed thrombocytopaenia as a shared factor of both outcomes. This study highlights risk profiles for post-dengue fatigue syndrome and depression, with female sex, myalgia, and dengue severity specifically associated with fatigue, while thrombocytopaenia might indicate a shared pathway. These findings support targeted surveillance and management strategies for at-risk patients and highlight the need for further research into post-dengue depression mechanisms.