Background: A well-established clinical association is recognized between primary hyperhidrosis (PH) and depression. Nonetheless, comprehensive evidence regarding the incidence of depression among individuals with PH remains inconsistent, and a systematic review on this topic is currently absent.

Objective: This study systematically searched observational studies reporting the incidence of depression in patients with PH across multiple databases, including PubMed, Cochrane, Embase, Ovid, Web of Science, and PsycINFO, from their inception through December 2025. Two reviewers independently conducted literature screening, data extraction, and methodological quality evaluation using the Joanna Briggs Institute (JBI) tool. The pooled incidence rate was derived using a random‑effects model with Freeman–Tukey double arcsine transformation. Subgroup analyses, sensitivity analyses, and assessment of publication bias were also performed.

Results: A total of 18 studies published between 2001 and 2024 were included, encompassing 48,053 participants. The overall pooled incidence of depression was 18.0% (95% CI: 14.3%–22.0%) under the random‑effects model, with substantial between‑study heterogeneity (I² = 90.24%). Subgroup analyses demonstrated that the reported incidence of depression varied significantly based on the assessment instrument employed (p < 0.001 for between‑subgroup heterogeneity).

Conclusion: Depression is highly prevalent among patients with PH. The variation in reported incidence rates attributable to different assessment tools highlights the necessity of adopting standardized and comparable measurement methods in clinical practice and future research. This study presents the first systematic estimate of depression incidence in the PH population based on updated evidence, identifies assessment tools as a major contributor to heterogeneity, and offers valuable guidance for clinical assessment and research design.

Xiaoyu Wang has completed his PhD from Tianjing Medical University. He is the attending physician of Department of Thoracic Surgery, Haidian Section of Peking University Third Hospital. He has conducted in-depth research on the psychological state of patients with hyperhidrosis and published relevant articles in well-known journals