Third-wave therapies significantly reduce post-stroke depression symptoms with sustained mid- to long-term effectsThird-wave therapies show promise for post-stroke depression symptoms

BACKGROUND: Post-stroke depression (PSD) is the most common neuropsychological complication in stroke survivors. While psychological interventions are promising non-pharmacological treatments, the most effective intervention type, as well as their mid- to long-term efficacy and effectiveness across PSD severity levels, remains unclear. This study aims to compare the efficacy of psychological interventions for PSD, focusing on overall effectiveness, mid- to long-term efficacy, and effectiveness across PSD severity levels. METHODS: We systematically searched seven databases for randomized controlled trials (RCTs) of psychological interventions targeting depression in stroke survivors. The primary outcome was depression symptom reduction. Post-intervention, mid- to long-term data were analyzed. A frequentist network meta-analysis (NMA) with random effects was conducted in Stata 17.0. Subgroup analyses by PSD severity were performed. RESULTS: Thirty-eight RCTs involving 3106 participants were included. Post-intervention, third-wave therapies (Hedges'  = -1.08, 95% CI: -1.62 to -0.55) significantly improved PSD compared to treatment as usual. At mid- to long-term follow-up, third-wave therapies (Hedges'  = -0.82, 95% CI: -1.25 to -0.39) maintained significant effects. Relaxation therapy significantly ameliorated mild PSD (Hedges'  = -0.77, 95% CI: -1.27 to -0.27); for moderate-to-severe PSD, no significant effects were observed. CONCLUSIONS: Third-wave therapies are potentially effective for PSD, showing sustained mid- to long-term benefits. Relaxation therapy seems to be most effective for mild PSD, while no significant effects were observed for moderate-to-severe PSD. However, the NMA showed high heterogeneity and generally low to very low evidence certainty for most comparisons, the findings should be interpreted with caution.