Emotional management interventions for nursing students: A systematic review and network meta-analysis of randomized controlled trials.

PURPOSE: Nursing students exhibit a high prevalence of anxiety and depression, which negatively affect their well-being. This study aimed to compare the effects of various emotional management interventions to identify the optimal strategies for this population. METHODS: A systematic search of the Cochrane Library, ProQuest, Embase, PubMed, and Web of Science was conducted from the inception of each database to January 19, 2025, using keywords such as "nursing students," "stress," and "anxiety." The ROB2 tool was used to assess the quality of the included studies (22 trials, 1946 participants). Primary outcomes (stress scores) and secondary outcomes (anxiety and depression scores) were analyzed using random- or fixed-effects models in R software. Standardized mean differences (SMDs) with 95 % credible intervals (CrIs) were calculated. The surface under the cumulative ranking curve (SUCRA) was employed to rank the effect of different interventions. All statistical analyses were performed using the R software (version 4.4.1). RESULTS: A total of 22 studies involving 1946 nursing students were included. The network meta-analysis demonstrated that, compared with standard care, laughter yoga was the most effective intervention for reducing stress (SMD = -1.2; 95 % CrI: -1.5 to -0.88; SUCRA = 97.40 %). Laughter therapy showed the greatest effect in lowering anxiety scores (SMD = -0.95; 95 % CrI: -1.2 to -0.72; SUCRA = 87.24 %). Cognitive behavioral therapy was identified as the most effective intervention for mitigating depression (SMD = -1.1; 95 % CrI: -1.7 to -0.57; SUCRA = 94.54 %). CONCLUSION: Laughter yoga, laughter therapy, and CBT are the optimal strategies for reducing stress, anxiety, and depression, respectively, in nursing students.