Study design <p>Systematic review and meta-analysis.</p> Objectives <p>Despite a growing prevalence of cognitive impairment and depression after spinal cord injury (SCI), evidence of associations between specific cognitive domains and processes with depressive symptoms remains uncertain. This systematic review with meta-analysis aimed to evaluate the relationship between cognitive functions and depressive symptoms in adults with SCI.</p> Methods <p>This review was pre-registered with PROSPERO (CRD42024523479). Seven databases were searched from inception to March 2025. Eligible studies assessed depression and cognitive function in adults with SCI and were published in English. Cognitive functions included self-reported subjective cognitive failures and objective cognitive functions assessed by neuropsychological tests. Study quality was assessed via the Newcastle-Ottawa Scale.</p> Results <p>Ten studies (three cohort, seven cross-sectional; <i>N</i> = 1683 participants) were included, with seven studies eligible for meta-analysis. The pooled results revealed that elevated depressive symptoms are significantly associated with global cognitive impairment, whereas there were no associations with subjective cognitive decline or deficits in specific domains (i.e., executive function, attention, and learning and memory).</p> Conclusions <p>Adults with SCI who have impaired global cognitive function exhibit higher levels of depressive symptoms. Interventions targeting either depression or cognitive function may yield concomitant benefits on both outcomes, thereby enhancing health-related quality of life of the SCI population. More prospective studies are needed to investigate the relationship between depression severity and specific cognitive domains and to elucidate their potential causal mechanisms.</p>