Prevalence of depression among university students in low and middle income countries (LMICs): a systematic review and meta-analysis

•Adolescence is a critical period for on-set of many mental health disorders, and almost half of world's youth (15-24 years) lives in Low and Middle Income Countries (LMICs).•We did a systematic review and meta-analysis to estimate prevalence of depression among university students in LMICs.•Almost one fourth (24.4%) of university students in LMICs have symptoms of depression, however, many LMICs do not have large, quality studies.•Mental health interventions are needed to be integrated in university settings. Though university years are peak time for the onset of many mental health problems including depression, knowledge on the prevalence of depressive symptoms among university students in low and middle-income countries (LMICs) is limited. This study examined the prevalence of depressive symptoms among university students in LMICs. We systematically searched PubMed, Web of Science, and WHO Global Health Library for studies published between January 1, 2009 and December 31, 2018. Cross-sectional and longitudinal studies conducted in LMICs (as defined by World Bank), having a sample size≥500 and published in English were identified. Data on study characteristics and prevalence of depressive symptoms was extracted by two investigators. Estimate of prevalence was pooled in meta-analysis using random-effects meta-analysis. Sub-group differences were estimated using mixed-effects meta-analysis and meta-regression. Depressive symptoms prevalence data were extracted from 37 studies involving 76,608 individuals in 20 countries. Studies on depression among university students in LMICs were limited, and most were based on non-representative and small study samples. The overall prevalence of depressive symptoms was 24.4% (95% CI, 19.2% -30.5%). Subgroup analysis revealed that the prevalence did not vary by study design, sampling technique, sample size, study major, educational level, economic regions, and screening instrument. Only English language studies were included. Included studies were diverse in design, screening tool, and sample size that introduced substantial heterogeneity. Overall prevalence of depressive symptoms among university students in LMICs was 24.4%, however, finding should be interpreted with caution. Further research is needed to address the issue.