Efficacy of non-pharmacological interventions on psychological well-being in stable COPD: A systematic review and network meta-analysis

OBJECTIVE: This study aimed to compare the efficacy of multiple non-pharmacological interventions to improve anxiety and depression in chronic obstructive pulmonary disease (COPD) patients by network meta-analysis and to determine the optimal intervention. METHODS: PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science databases were searched for randomized controlled trials (RCTs) related to the study objectives. The search spanned from database inception to January 2025. Two reviewers independently selected the literature, extracted data, and assessed the risk of bias in the included studies. A random-effects model based on a frequency framework was applied using Stata 18.0 software to perform network meta-analysis. Publication bias was evaluated using funnel plots. RESULTS: This study included 41 RCTs involving 5055 participants, and seven different intervention categories were involved. Network meta-analysis revealed that mind-body therapy (MBT) [SMD = -0.59, 95 %CI (-0.88, -0.30)], exercise (EX) [SMD = -0.44, 95 %CI (-0.84, -0.05)], and biopsychosocial approach (BA) [SMD = -0.42, 95 %CI (-0.69, -0.15)] significantly outperformed the control group in improving anxiety. For depression relief, MBT [SMD = -0.72, 95 %CI (-1.03, -0.40)] and EX [SMD = -0.68, 95 %CI (-1.08, -0.27)] significantly surpassed the control group. The ranked probabilities indicated that mind-body therapy was the most effective, followed by exercise, in reducing depression and anxiety in patients with COPD. The funnel plot suggested a potential risk of publication bias. CONCLUSION: Our network meta-analysis highlights the superior efficacy of mind-body therapy and exercise interventions in improving anxiety and depression among COPD patients. However, given the low certainty of the evidence, additional high-quality trials are needed to confirm these findings.