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OBJECTIVE: To derive precise estimates of anxiety and depressive disorder prevalence in patients with common vestibular disorders. DATA SOURCES: CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS. REVIEW METHODS: This systematic review and meta-analysis was reported per PRISMA guidelines. Outcomes included continuous measures (mean), proportions (%), and relative risks (RR) with 95% confidence intervals. RESULTS: Eighty-five studies (n = 764,403) examining anxiety, depression, and vestibular disorders in adults were included. Mean ages were 50.3 (vestibular) and 46.7 (control); females comprised 63.8% and 64.3%, respectively. Patients with vestibular disorders had significantly higher rates and risks of anxiety (31.4% vs. 8.3%, p < 0.0001; RR = 1.50, 95% CI: 1.1-2.0) and depression (28.3% vs. 4.7%, p < 0.0001; RR = 2.9, 95% CI: 1.8-4.4) than controls. Elevated rates were observed in benign paroxysmal positional vertigo (30.6%, 23.6%), Meniere's disease (47.0%, 43.1%), vestibular migraine (46.5%, 35.7%), and vestibular neuritis (19.4%, 20.7%) (all p < 0.0001). Episodic disorders showed higher prevalence than vestibular neuritis. Patients with unspecified peripheral vestibular disorders also had significantly higher anxiety (12.1%) and depression (13.2%) rates than controls. Meta-regression revealed significant associations between Dizziness Handicap Inventory (DHI) scores and Hospital Anxiety and Depression Scale (HADS) anxiety and depression subscales. CONCLUSIONS: This meta-analysis offers the most precise prevalence and relative risk estimates of anxiety and depressive disorders in vestibular illness. The greater risk in episodic versus single-event vestibular disorders may inform the understanding of vestibular-psychiatric comorbidity mechanisms.