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Traditional Chinese mind-body practices and depressive symptoms in university students: a multilevel dose-response
Yuming Zhang1, Shaoyang Hu2, Yonghua Liu3
1Department of Physical Education, Beijing University of Chemical Technology, Beijing, China.
Objective:
Numerous meta-analyses have evaluated Tai Chi, Qigong and related traditional Chinese mind-body practices (TCMBPs) for depressive symptoms across broader populations; however, to our knowledge, no previous meta-analysis has focused specifically on university students. We therefore aimed to estimate the average effect of TCMBPs on depressive symptoms in this population using a three-level model that explicitly accounts for dependent effect sizes, and to explore nonlinear dose-response patterns and Bayesian cumulative exposure.
Methods:
PubMed, Web of Science, PsycINFO, the Cochrane Library and CNKI were searched from inception to 29 December 2025 for randomized controlled trials. Effect sizes were synthesized with a three-level random-effects model. Heterogeneity, small-study effects and influential estimates were examined using prespecified diagnostics, sensitivity analyses and cluster-robust variance estimation. Subgroup, meta-regression and Bayesian dose-response analyses were treated as exploratory.
Results:
Fifteen randomized controlled trials met the eligibility criteria. After influence diagnostics, the pooled estimate indicated lower depressive-symptom scores after traditional Chinese mind-body practice (SMD = -0.56, 95% CI - 0.84 to -0.27; p < 0.001), although heterogeneity was substantial and the certainty of evidence was moderate. The estimate was similar with cluster-robust variance estimation. Subgroup patterns differed by practice, comparator and participant characteristics, but most contrasts were supported by few studies. Bayesian models placed the lowest fitted effect near a cumulative dose of 33.7 h; this estimate arose from sparse and uneven exposure data and should not be interpreted as a prescriptive optimum.
Conclusion:
Traditional Chinese mind-body practices were associated with a moderate average reduction in depressive symptoms and may be feasible complements to university mental-health programs. Because the evidence was heterogeneous, concentrated in China and of moderate certainty, the findings do not establish equivalent benefits across practices or a recommended dose. Larger, better-reported randomized trials are needed.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251275476, identifier PROSPERO (CRD420251275476).
