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ObjectiveTo systematically evaluate the prevalence of anxiety and depression among young stroke patients and their associated factors using a meta-analysis.MethodsIn this review, young stroke was defined as stroke occurring in individuals aged 15–60 years. A comprehensive literature search was conducted in the China National Knowledge Infrastructure (CNKI), Wanfang Data, China Biomedical Literature Database, PubMed, Embase, Web of Science, the Cochrane Library, and Wiley for studies reporting the prevalence of anxiety and depression as well as their associated factors in young stroke patients. The search period spanned from database inception to September 2025. Meta-analysis was performed using RevMan 5.4, and publication bias analyses were conducted in Stata 17.0.ResultsTwenty-six studies involving 5,634 patients were included, with 555 cases of anxiety and 1,334 cases of depression. Meta-analysis revealed that the prevalence rates of anxiety and depression among young stroke patients were 35% [95% CI (29–41%)] and 35% [95% CI (29–41%)], respectively. Subgroup analyses revealed the following: by publication year, 32% anxiety and 33% depression among young stroke patients from 2005 to 2018; 43% anxiety and 32% depression from January 2019 to September 2025. By country, the prevalence rates of anxiety and depression among young stroke patients in China were 35 and 34%, respectively, while those in other countries were 36 and 30%. By first-ever stroke, the prevalence rates among first-ever stroke patients were 32 and 31%, respectively, while those for non-first-ever patients were 37 and 34%. By gender, the prevalence rates of anxiety and depression among male patients were 32 and 36%, respectively, while those among female patients were 43 and 37%, respectively. Alcohol consumption and prior depressive symptoms showed relatively stable associations with anxiety in young stroke patients. Gender reached statistical significance in the primary analysis, but this finding was not robust in sensitivity analysis. National Institutes of Health Stroke Scale (NIHSS) score [OR = 3.22, 95% CI (2.04, 5.08)], alcohol consumption [OR = 3.15, 95% CI (1.85, 5.36)], lesion location [OR = 4.8, 95% CI (2.55, 9.06)], Herth Hope Index (HHI) score [OR = 1.96, 95% CI (1.42, 2.71)], Stroke-related shame (SSS) score [OR = 2.04, 95% CI (1.47, 2.81)], hypertension [OR = 1.64, 95% CI (1.31, 2.04)], diabetes [OR = 2.15, 95% CI (1.6, 2.88)], hyperlipidemia [OR = 1.53, 95% CI (1.2, 1.96)], monthly household income [OR = 1.93, 95% CI (1.18, 3.15)], lesion area [OR = 3.25, 95% CI (1.8, 5.87)], multiple lesions [OR = 2.31, 95% CI (1.51, 3.55)], and length of hospitalization [OR = 1.62, 95% CI (1.16, 2.27)] were identified as factors influencing depression in young stroke patients (p < 0.05).ConclusionIn conclusion, this review indicates that anxiety and depression are both common among young stroke patients and deserve greater attention in routine stroke care. Alcohol consumption appears to be a common factor associated with both anxiety and depression, while prior depressive symptoms may also be associated with anxiety. For depression, neurological severity, lesion-related characteristics, vascular comorbidities, and psychosocial factors were identified as potential associated factors. However, some findings, particularly those related to gender and several other exploratory variables, were not stable in sensitivity analyses and should therefore be interpreted with caution. More standardized, prospective, and longitudinal studies are needed to further clarify the mental health burden and associated factors in young stroke patients and to support earlier and more targeted psychological assessment and intervention in this population.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier, CRD420251181939.
