Effectiveness of mindfulness-based stress reduction for depression in post-stroke patients: a systematic review and meta-analysis

BACKGROUND: Depression is a common complication after stroke. Although prior studies suggest that mindfulness-based stress reduction (MBSR) may alleviate depressive symptoms in post-stroke patients, the evidence remains inconclusive. This meta-analysis aimed to synthesize randomized controlled trials (RCTs) to evaluate the effects of MBSR on depressive symptoms after stroke. METHODS: PubMed, Web of Science, Embase, the Cochrane Library, PsycINFO, CNKI, and Wanfang Data were searched from inception to October 2025. Eligible studies were RCTs assessing the effects of MBSR on depressive symptoms in post-stroke patients. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. RESULTS: Eight RCTs involving 469 participants were included. Meta-analysis using the standardized mean difference (SMD) showed that MBSR significantly reduced depressive symptoms compared with control conditions (SMD = -0.96, 95% CI: -1.35 to -0.58, P < 0.001), with substantial heterogeneity (I² = 71%). The 95% prediction interval ranged from -1.95 to 0.03, indicating that the true effect may be negligible in some future settings. In subgroup analyses, trials conducted in Asia demonstrated significant benefits (SMD = -1.27, 95% CI: -1.60 to -0.93, P < 0.001), whereas trials conducted in other regions did not reach statistical significance (SMD = -0.31, 95% CI: -0.74 to 0.13, P = 0.17); the difference between subgroups was significant (Q-between = 11.77, P = 0.0006). Participants receiving MBSR during the stable post-stroke phase showed significant improvement (SMD = -1.02, 95% CI: -1.57 to -0.47, P < 0.001), whereas those treated during the acute phase did not (SMD = -0.80, 95% CI: -1.88 to 0.27, P = 0.14); the subgroup difference was not significant (Q-between = 0.13, P = 0.7204). CONCLUSIONS: MBSR may reduce depressive symptoms after stroke, particularly during the stable phase. However, the overall certainty of evidence was rated as low due to high risk of bias, substantial heterogeneity, and imprecision. Well-designed RCTs with longer follow-up are warranted to confirm these results. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251271797.