Aims: The primary aim of this study was to systematically review the prevalence of anxiety and depression in patients with COPD. The secondary aim was to identify risk factors contributing to the comorbidity.

Methods: The study was conducted following PRISMA guidelines and was registered on PROSPERO. MEDLINE, Embase, PsychInfo and Web of Science were used to select relevant studies before 1st January 2023. A total of 4,420 studies were gathered after the initial search. 39 papers were included after meeting inclusion and exclusion criteria. Quality assessment was conducted using Hawker?s tool. The pooled prevalence was calculated using the random effects model via Comprehensive Meta-Analysis.

Results: The total sample size was 84,411 including 17,489 for anxiety and 66,922 for depression. The pooled prevalence for anxiety and depression were 29.8%(95% CI: 24.7%-35.5%) and 28.5%(95% CI: 21.3%-36.9%), respectively. Reported risk factors included gender, BMI, smoking, and severity of COPD. I² test results derived from meta-analyses revealed substantial heterogeneity across studies due to the variability in study design.

Conclusions: This is the first meta-analysis that provides precise comorbidity and risk estimates of anxiety and depression in COPD. The study indicates higher prevalence of anxiety and depression in COPD suggesting the need for early assessment. The study also highlights females, higher BMI, smoking, and COPD with more exacerbation are contributing risk factors. Further research is warranted to examine underlying mechanisms and identify modifiable risk factors which may offer new intervention approaches to benefit COPD patients with anxiety and depression.