Effects of Music, Massage, Exercise, or Acupuncture in the Treatment of Depression Among College Students: A Network Meta-Analysis

Figures & data

Figure 1 Study selection process.

Table 1 Research Characteristics Table

No	Author, Years	Country	Study Design	Population Characters	Number Analysed at End of Treatment (N)	Classification	Duration	Main Outcomes	Reference
1	Zhang et al, 2014	China	Controlled trial	College students with depression; Gender: 36m/56w	82 (50/32)	Five Elements Music of Traditional Chinese Medicine	6 weeks, 2 times a week	SDS; SCL-90	[17]
2	Ming Zhang et al, 2022	China	RCT	College students with DERS ≥ 101, BDI score ≥ 10, and depressive symptoms; Gender: 34m/37w	71 (36/35)	Group improvisational music therapy (GIMT)	4 weeks, 1 times a week	DERS;BDI	[3]
3	Hye-Kyung Lee et al, 2014	Korean	Non equivalent control group design	College students with PHQ-9 score >5; Gender: 12m/29w	41 (21/20)	Self-Aromatherapy Massage	2 weeks, 3 times a week	PHQ-9;	[7]
4	Cheng Xiang et al, 2016	China	RCT	Mildly depressed college students; Gender: 15m/15w	30 (15/15)	Health Qigong Wuqinxi	12 weeks, 3 times a week	BDI	[18]
5	Nasrin Falsafi et al, 2016	USA	RCT	Students who had a diagnosis of depression or anxiety	90 (30/30/30)	Yoga	8 weeks, 75 minutes a week	BDI	[19]
6	Jiayuan Zhang et al, 2018	China	RCT	Freshman and sophomore had subthreshold symptoms of depression; Gender: 21m/41w	62 (32/30)	Mindfulness-based Tai Chi Chuan (MTCC)	8 weeks, 2 times a week	PHQ-9;	[20]
7	Chen et al, 2019	China	RCT	Moderate depression [CES-D score 24–29] female college students	36 (18/18)	Taijiquan exercise	16 weeks, 3 times a week	CES-D	[21]
8	Duan et al, 2014	China	Controlled trial	College students with SDS score≥53; Gender: 61m/48w	109 (30/41/38)	Basketball; sports dance; badminton	12 weeks, 3 times a week	SDS	[22]
9	Ma et al, 2017	China	RCT	College students with depression and anxiety scores exceeding the critical value; Gender: 59m/65w	124 (31/31/31/31)	Basketball; dance; badminton (moderate-intensity)	12 weeks, 3 times a week	SDS	[23]
10	Wang et al, 2016	China	Controlled trial	College Students with positive anxiety and depression scores; Gender: 58m/40w	98 (39/22/37)	Badminton (Singles; doubles); volleyball	16 weeks, 3 times a week	SDS	[24]
11	Li et al, 2017	China	RCT	College students with depression factor score>3; Gender: 33m/31w	64 (32/32)	Volleyball and group psychological guidance	8 weeks, 4times a week	SDS	[25]
12	Mao et al, 2014	China	RCT	Male college students with mild depression	29 (15/14)	Tennis with different intensity	12 weeks, 3 times a week	SDS	[26]
13	Zhang et al, 2012	China	Controlled trial	College students with mild and moderate depression; Gender: 43m/77w	120 (40/40/40)	Sports dance training group, basketball training group and table tennis training group	16 weeks, 3 times a week	SDS	[27]
14	Guan et al, 2008	China	RCT	Female students with low to moderate levels of depression (CES-D score is 16–29)	30 (15/15)	Progressive Strength Training	8 weeks, 3 times a week	CES-D	[28]
15	Li et al, 2014	China	RCT	Female college students with depression symptoms	45 (15/15/15)	Strength training; aerobic exercise	8 weeks, 3 times a week	CES-D	[29]
16	Tang et al, 2009	China	RCT	College students with moderate and mild depression	104 (39/34/31)	Basketball, badminton, etc; Yoga, aerobics, etc	12 weeks, 3 times a week	SDS	[30]
17	Jiao et al, 2010	China	RCT	College students with depression; Gender: 18m/26w	44 (21/23)	Aerobic Exercise	8 weeks, 3 times a week	SDS	[31]
18	Duk, Oh Sang et al, 2012	Korean	RCT	College students with depressive symptoms; Gender: 0m/16w	16 (8/8)	Moderate aerobic exercise	12 weeks, 3 times a week	BDI	[32]
19	Geetanjli Chawla et al, 2022	India	RCT	College students with Depression, Anxiety Stress Scale (DASS) (depression > 10); Gender: 9m/21w	30 (15/15)	Whole-body vibration (WBV) training	4 weeks, 2 times a week	DASS scores (Depression; Anxiety; Stress)	[33]
20	Zhao et al, 2017	China	RCT	College students with SDS score≥53;Gender:0m/43w	43 (14/14/15)	High intensity intermittent exercise group (HIT); Continuous exercise group	4 weeks, 3 times a week	SDS	[34]
21	Li et al, 2017	China	Controlled trial	College students with SDS score≥50;Gender:15m/23w	38 (20/18)	Taijiquan exercise	12 weeks, 3 times a week	SDS	[35]
22	Song et al, 2017	China	Controlled trial	College students with depression; Gender: 0m/51w	51 (27/24)	Taijiquan exercise, Aerobic Exercise	16 weeks, 3 times a week	BDI	[36]
23	Khirollah Sadeghi et al, 2016	Iran	RCT	Undergraduate students with BDI score>13; Gender: 24m/6w	30 (16/14)	Aerobic Exercise	8 weeks, 2 times a week	BDI	[37]
24	Chen-Jung Chen et al, 2014	China Taiwan	RCT	Nursing students with DMSRIA scores of 8points or higher; Gender: 2m/69w	71 (31/40)	Five Elements Music of Traditional Chinese Medicine	10weeks, 2 times a week	Depression Mood Self Report Inventory for Adolescence (DMSRIA)	[38]

Notes: The scores of several scales used in the included study are positively correlated with the degree of depression, that is, the higher the score, the more severe the degree of depression.

Figure 2 Results of Cochrane system evaluation.

Table 2 The Physiotherapy Evidence Database (PEDro) Scores for the Articles Included

Publication	Item on the PEDro Scale											Score
	a	b	c	d	e	f	g	h	i	j	k
Zhang et al, 2014^Citation17	1	0	0	1	0	0	0	1	1	1	1	6
Ming Zhang et al, 2022^Citation3	1	1	0	1	0	0	0	1	1	1	1	7
Hye-Kyung Lee et al, 2014^Citation7	1	0	0	1	0	0	0	1	1	1	1	6
CHENG Xiang et al, 2016^Citation18	1	1	0	0	0	0	0	1	1	1	1	6
Nasrin Falsafi et al, 2016^Citation19	1	1	0	1	0	0	0	1	1	1	1	7
Jiayuan Zhang et al, 2018^Citation20	1	1	1	1	0	0	1	1	1	1	1	9
Chen et al, 2019^Citation21	1	1	0	1	0	0	0	1	1	1	1	7
Duan et al, 2014^Citation22	1	0	0	1	0	0	0	1	1	1	1	6
Ma et al, 2017^Citation23	1	1	0	1	0	0	0	1	1	1	1	7
Wang et al, 2016^Citation24	1	0	0	1	0	0	0	1	1	1	1	6
Li et al, 2017^Citation25	1	1	0	1	0	0	0	1	1	1	1	7
Mao et al, 2014^Citation26	1	1	0	1	0	0	0	1	1	1	1	7
Zhang et al, 2012^Citation27	1	0	0	1	0	0	0	1	1	1	1	6
Guan et al, 2008^Citation28	1	1	0	1	0	0	0	1	1	1	1	7
Li et al, 2014^Citation29	1	1	0	1	0	0	0	1	1	1	1	7
Tang et al, 2009^Citation30	1	1	0	1	0	0	0	1	1	1	1	7
Jiao et al, 2010^Citation31	1	1	0	1	0	0	0	1	1	1	1	7
Duk, Oh Sang et al, 2012^Citation32	1	1	0	1	0	0	0	1	1	1	1	7
Geetanjli Chawla et al, 2022^Citation33	1	1	0	1	0	0	0	1	1	1	1	7
Zhao et al, 2017^Citation34	1	1	0	1	0	0	0	1	1	1	1	7
Li et al, 2017^Citation35	1	0	0	1	0	0	0	1	1	1	1	6
Song et al, 2017^Citation36	1	0	0	1	0	0	0	1	1	1	1	6
Khirollah Sadeghi et al, 2016^Citation37	1	1	0	1	0	0	0	1	1	1	1	7
Chen-Jung Chen et al, 2014^Citation38	1	1	0	1	0	0	0	1	1	1	1	7

Notes: Item on the PEDro scale (a: Eligibility criteria and source; b: Random allocation; c: Concealed allocation; d: Baseline comparability; e: Blinding of participants; f: Blinding of therapists; g: Blinding of assessors; h: Adequate follow-up (. 85%); i: Intention-to-treat analysis; j: Between-group statistical comparisons; k: Reporting of point measures and measures of variability).

Figure 3 Network analysis of depression efficacy. The numbers represent the quantity after intervention measures.

Figure 4 Meta-analysis results of depression score rates.

Table 3 Probability: Ranking of Different Mind-Body Exercise Therapies to Improve Depression Grade in College Students

Treatment	SUCRA	MeanRank	No
Interval training	96%	1.4	1
Yoga	94.90%	1.6	2
Dance	78.30%	3.4	3
Music	73.30%	3.9	4
Ball	62.50%	5.1	5
Strength exercise	51.70%	6.3	6
Aerobic exercise	45.30%	7	7
Taichi	35.40%	8.1	8
Vibration training	27.30%	9	9
Massage	20.10%	9.8	10
Qigong	14.30%	10.4	11
Placebo	1.00%	11.9	12

Figure 5 Subgroup analysis. Number: 1, aerobic sports;^31,32,34,37 2, traditional Chinese sports;^{18–21,30,35} 3, ball games;^23,25,30 4, high-intensity interval sports.³⁴

Figure 6 Calibration comparison funnel diagram. Capital: A, Placebo; B, Music; C, Massage; D, aerobic sports; E, Qigong; F, Yoga; G, Tai chi; H, Ball games; I, strength exercise; J, Dance; K, whole body vibration training; L, high-intensity interval sports.

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