Prevalence of Depression Among Urban and Rural Residents of Saudi Arabia Compared With Other Gulf Cooperation Council Countries: A Systematic Review.

Depression is a leading cause of disability worldwide, with significant variations in prevalence across urban and rural populations. In the Gulf Cooperation Council (GCC) countries, rapid urbanization and socioeconomic changes have introduced new mental health challenges. However, comprehensive data on depression disparities between urban and rural residents remain limited. This systematic review aims to explore depression prevalence in Saudi Arabia and other GCC nations, examining associated factors and regional variations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search of PubMed, MEDLINE, PsycINFO, Scopus, and Web of Science for studies published between 2010 and 2024. Studies published between 2010 and 2024 were included if they assessed depression prevalence among adults in urban or rural settings within GCC countries using validated diagnostic tools. Studies were excluded if they focused on narrow subpopulations or lacked clear geographic classification. Data were extracted independently by two reviewers, and study quality was assessed using the Newcastle-Ottawa Scale for observational studies and Assessment of Multiple Systematic Reviews 2 for reviews. Twenty-four studies were included, with 18 from Saudi Arabia, four from the UAE, two from Oman, and one from Qatar. No studies from Bahrain or Kuwait met the inclusion criteria. Prevalence ranged widely: 2.1-77.8% in Saudi Arabia, 2.1-21.1% in the UAE, and 8.1-21.7% in Oman. Rural-specific data were scarce, though indirect evidence suggested higher rates in rural Saudi Arabia (e.g., 62.3% in northern regions). Women, younger adults in Qatar, older adults in Saudi Arabia, and individuals with lower socioeconomic status consistently showed higher depression rates. Stigma and underdiagnosis (74% undetected cases in Saudi Arabia) were key barriers. Depression prevalence in the GCC varies significantly by country, urbanization level, and demographic factors. The lack of rural-specific data and studies from Bahrain and Kuwait highlights critical research gaps. Culturally tailored interventions, improved mental health infrastructure, and anti-stigma campaigns are urgently needed, particularly for women and rural populations. Future research should standardize measurement tools and prioritize disaggregated urban-rural analyses to guide equitable policy-making.