Mobile App Use and Pregnancy Health Literacy: Cross-Sectional Study Using Bayesian Network Analysis.

Post-stroke depression (PSD) is the most common psychiatric complication after stroke, characterized by persistent low mood, diminished interest, and emotional distress (Zhou, Wei, & Xie, ). The prevalence of PSD ranges from 11% to 41% within two years after stroke (Guo, Wang, Sun, & Liu, ). It is associated with poorer treatment adherence, delayed functional recovery, reduced social participation, lower quality of life, and even higher risks of suicide and mortality (Cai et al., ; J. Li et al., ; Paolucci et al., ). Early and effective management of PSD is therefore critical for improving recovery trajectories and overall well-being (van Nimwegen et al., ). Clinical guidelines in the UK and Ireland recommend offering psychological support to stroke survivors at risk of depression (Intercollegiate Stroke Working Party, ). Over the past decades, numerous trials have examined various psychological interventions for PSD in stroke survivors (Allida et al., ), creating a valuable but heterogeneous body of evidence. Conventional systematic reviews and meta-analyses have reported that interventions such as mindfulness-based therapies (Tao et al., ), cognitive behavioral therapy (CBT) (M. Wan, Zhang, Wu, & Ma, ), and motivational interviewing may be effective for PSD in stroke survivors (Qiqi et al., ). However, traditional pairwise meta-analyses are limited because they cannot determine the comparative effectiveness of different psychological interventions – a critical question for clinical decision-making. Network meta-analysis (NMA) provides a methodological advantage by integrating both direct and indirect evidence to compare and rank multiple interventions simultaneously (Bucher, Guyatt, Griffith, & Walter, ). Despite its potential, few NMAs have comprehensively evaluated psychological therapies for PSD, and existing findings remain inconsistent. For instance, Yi et al. () conducted a NMA of 43 studies involving 3138 stroke survivors to compare the efficacy of various non-pharmacological therapies for PSD. The study reported no significant difference between psychotherapy and control groups, but their analysis included only 13 psychological intervention studies – insufficient to capture the current diversity of approaches and the overall evidence grade is very low. Conversely, another NMA explored the effects of 17 non-pharmacological interventions on PSD in stroke patients. The study reported superior effects of psychological interventions over usual care, but it also had limitations, namely the limited types of psychological interventions and a lack of evidence quality assessment (Y. Li et al., ). Thus, a more comprehensive and methodologically rigorous NMA is needed to clarify the relative efficacy of psychological interventions for PSD across diverse contexts.