Comparative effectiveness of non-pharmacological interventions on depression and anxiety in aging populations: a systematic review and network meta-analysis of randomized controlled trials

Background Depression and anxiety are highly prevalent among older adults and significantly impair quality of life. Non-pharmacological interventions have increasingly gained attention as alternative or complementary therapeutic approaches. This study aimed to evaluate the comparative efficacy of these interventions for depression and anxiety in adults aged ≥55 years using a systematic review and network meta-analysis (NMA). Methods Following PRISMA guidelines, five databases were systematically searched from inception to March 2025. Eighty-three randomized controlled trials (RCTs; n = 6,646) were included, covering 11 non-pharmacological interventions such as dance, qigong, cognitive behavioral therapy (CBT), internet-based CBT (ICBT), resistance training, and others. A random-effects NMA was conducted using Stata 15.1, with efficacy ranked using Surface Under the Cumulative Ranking Curve (SUCRA) values. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was evaluated using the GRADE approach. Publication bias was examined using comparison-adjusted funnel plots and Egger’s regression tests (depression: intercept = 2.40, p = 0.029; anxiety: intercept = 1.00, p = 0.538). Results Eighty-three RCTs (n = 6,646) encompassing 11 interventions were included. For depression, dance ranked highest (SUCRA = 98.5%) and demonstrated statistically significant superiority over CBT, ICBT, waitlist, and usual care. Resistance training (SUCRA = 67.5%) and CBT (SUCRA = 65.6%) ranked next. For anxiety, music (SUCRA = 78.9%) and Tai Chi (SUCRA = 77.1%) ranked highest; however, only Tai Chi and CBT showed statistically significant advantages over waitlist. MBSR demonstrated limited efficacy across both outcomes, while outdoor walking ranked among the least effective interventions for depression. Conclusions Dance and music/Tai Chi demonstrated the highest probabilities of efficacy for depression and anxiety, respectively, followed by resistance training and CBT/ICBT. MBSR and outdoor walking showed limited effectiveness. Given the heterogeneity across studies, SUCRA rankings should be interpreted cautiously, and a personalized, stepped-care approach is recommended. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/ , identifier CRD420251007063.