Comparative efficacy of non-pharmacological interventions for patients with irritable bowel syndrome and depressive disorder: A network meta-analysis and systematic review

Objective This review aimed to evaluate the effectiveness of different NPIs in improving depressive symptoms among IBS patients with depressive disorder. Methods We searched PubMed, Cochrane Library, Embase, and Web of Science up to May 14, 2025, for all studies investigating Non-Pharmacological Interventions (NPIs) treatment in IBS patients with depressive disorder. The network meta-analysis (NMA) was performed using Stata 18.0. The Risk of Bias (ROB) 2.0 tool was utilized to assess bias. PROSPERO registered (CRD420251051915). Results 16 RCTs were included, involving 1,275 participants. The main NPIs comprised acupuncture (ACU), various types of cognitive behavioral therapy (CBT), psychological interventions (PT), Bioenergy Economy (BEE), and Traditional Chinese Medicine-based nursing therapy (TCM-NT). NMA results indicate that ACU outperforms conventional drug therapy, TCM-NT, and PT in reducing Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) scores, with SMDs of-8.29 [-14.24, -2.34] and -6.75 [-8.77, -4.74], respectively. For reducing Beck Depression Inventory-II (BDI-II) scores, CBT-based BEE demonstrated superior efficacy compared to CBT and placebo, with an SMD of -1.15 [-2.16, -0.14]. Regarding improving IBS Quality of Life (IBS-QOL) scores, TCM NT outperformed CBT. Conclusion ACU and various types of CBT demonstrated a certain advantage in reducing depression scores among patients with IBS. Future large multicenter long-term RCTs are needed to test ACU, CBT, and NPIs for emotional and gastrointestinal symptoms in IBS-depressed patients.