Effects of Nonpharmacological Interventions on Depressive Symptoms in Post-acute Coronary Syndrome: A Systematic Review and Meta-analysis

Background: Depressive symptoms following acute myocardial infarction (MI) are associated with adverse cardiovascular outcomes. Although numerous studies have examined nonpharmacological interventions to alleviate post-MI depression, their results remain inconclusive. This systematic review and meta-analysis evaluated the effects of nonpharmacological interventions on depressive symptoms in patients after acute MI. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and six electronic databases were systematically searched to identify randomized controlled trials (RCTs) comparing nonpharmacological interventions with usual care in patients with post-MI depression. Data were extracted on intervention content, format, delivery setting, frequency, and duration. Meta-analyses were conducted using both random-effects and fixed-effects models, and subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity. Results: Thirteen RCTs involving 3267 patients were included. Compared with usual care, nonpharmacological interventions exerted significant immediate and intermediate effects on post-MI depression, with standardized mean differences of −0.29 (95% CI: −0.45 to −0.13, P < 0.001) and −0.28 (95% CI: −0.42 to −0.14, P < 0.001), respectively. Subgroup analyses indicated that psychological interventions, relaxation training (RT), weekly intervention frequency, session durations of ≤30 min, total durations of ≤3 months, and delivery by nurses or psychologists were associated with greater effectiveness. Conclusion: Nonpharmacological interventions, particularly RT and psychological therapies, significantly reduced depressive symptoms in patients with MI at the end of the intervention period. Additional RCTs are determined to clarify how differences in intervention type, intensity, and delivery format contribute to variability in treatment outcomes.