Effectiveness of Mindful Breathing Exercises on Symptom Reduction, quality of life, and Psychological Well-being in Individuals with Major Depressive Disorder: A Systematic Review and Meta-analysis Protocol

IntroductionMajor depressive disorder (MDD) is a prevalent mental health condition marked by persistent sadness, loss of interest, and impaired cognition, significantly affecting quality of life. While pharmacotherapy and psychotherapy are standard treatments, non-pharmacological interventions like mindful breathing exercises have gained attention for their potential to reduce depressive symptoms and enhance well-being. Despite some evidence of effectiveness, a comprehensive, up-to-date synthesis focusing solely on mindful breathing in MDD is lacking. This systematic review protocol will evaluate the impact of mindful breathing exercises on depressive symptom severity, quality of life, and psychological well-being in adults with MDD.Methods and analysisThis review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 checklists. A comprehensive search of Cochrane, Medline, PEDro, CINAHL, Scopus, Web of Science, and BioMed Central will be carried out from inception to April 2025. Using the PICOs framework, we will include quantitative studies (randomised controlled trials and controlled observational designs) involving adults aged 18 and above who have been diagnosed with MDD using standardised criteria (e.g., DSM-5, ICD-10). Three reviewers will independently screen titles, abstracts, and full texts and extract data using the COVIDENCE software. The risk of Bias Assessment will be conducted using Cochrane RoB 2 (RCTs) and ROBINS-I (non-randomised studies), and the evidence quality will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A meta-analysis using RevMan 5.4 will pool mean differences, standardised mean differences, or odds ratios if data permit; otherwise, a narrative synthesis will be conducted. The search began in September 2025, with completion anticipated by December 2025.Ethics and disseminationNo ethical approval is required as this review uses existing published data. Findings will be disseminated through a peer-reviewed journal and presented at academic conferences. PROSPERO registration : CRD420251032845