The effect of mind- and body-based interventions on poststroke depression and its neural mechanisms: A systematic review and meta-analysis

Post-stroke depression (PSD) is recognized as the most common psychiatric disorder following a stroke, impacting the subsequent recovery and quality of life of stroke survivors. In recent years, physical activities and mindfulness have been proven to improve depression, however, it remained unknown whether those interventions were also effective in the treatment of PSD. This systematic review aims to assess the effects of mind- and body-based interventions on PSD and their underlying neural mechanisms. The systematic review (PROSPERO registration number: CRD42024514565) searched CINAHL, Cochrane, PsycINFO, PubMed, and Scopus up to March 11, 2024, focusing on English-language studies. Inclusion criteria encompassed randomized controlled trials of stroke patients with depression using validated assessment tools, targeting body-based, mind-based, or mind-body interventions, while excluding psychological or counseling interventions and passive movements. Two authors conducted data extraction with checks for accuracy, and risk of bias was assessed using the PEDro scale, which evaluates study design and methodology, yielding a maximum score of 10 points. Data extraction and risk of bias assessment were conducted by independent reviewers. A total of 68 studies were included, involving 6,825 participants, and 54 of these studies were included in the meta-analysis. The average PEDro score of 6.51 indicates good methodological quality, with combined interventions scoring highest at 7.44, highlighting variability among the studies. Meta-analysis results demonstrate that all mind- and body-based interventions have a significant impact on PSD (p < 0.05), with effect sizes as follows: all mind- and body-based interventions (n = 66, Hedges’ g = -0.572), mind-based interventions (n = 4, Hedges’ g = -0.549), body-based interventions (n = 52, Hedges’ g = -0.532), and combined interventions (n = 10, Hedges’ g = -0.805). The systematic review and meta-analysis revealed that all mind- and body-based interventions significantly improved post-stroke depression, and combined interventions are more effective than mind-based or body-based interventions alone. It is suggested to integrate additional mindfulness elements into the daily exercises of stroke survivors in clinical practice can further alleviate depressive symptoms.