Table 1_A systematic review and meta-analysis of the effects of non-pharmacological interventions in improving psychological status and sleep quality among hemodialysis patients.docx

Meta-analyses were performed using RevMan 5.4 and R version 4.5.2.</p>Result<p>Fourteen randomized controlled trials were included. Meta-analyses comprised 9 studies (570 participants) for depression, 11 studies (647 participants) for anxiety, and 14 studies (871 participants) for sleep quality. Compared with usual care, non-pharmacological interventions significantly improved depression (SMD = −0.62, 95% CI: −0.87 to −0.37, I² = 52%), anxiety (SMD = −0.86, 95% CI: −1.23 to −0.49, I² = 79%), and sleep quality (SMD = −0.94, 95% CI: −1.33 to −0.55, I² = 87%).

Leave-one-out sensitivity analyses did not materially reduce heterogeneity for anxiety or sleep quality. Exploratory subgroup analyses revealed no statistically significant differences in effect estimates according to intervention type or duration (P > 0.05). Potential publication bias was suggested for depression, whereas no statistically significant evidence of publication bias was identified for anxiety or sleep quality.

Based on the GRADE framework, the certainty of evidence was moderate for depression and low for anxiety and sleep quality.</p>Conclusion<p>The available evidence suggests that non-pharmacological interventions may improve depressive symptoms, anxiety symptoms, and sleep quality in patients receiving MHD. However, the certainty of evidence was low for anxiety and sleep quality outcomes and moderate for depressive symptoms, and these findings should be interpreted cautiously.</p>Systematic Review Registration<p>Identifier CRD420261370746.</p>