Impacts of acupressure treatment on depression: A systematic review and meta-analysis

Table 1 Characteristics of included studies

Ref.	Type of study	Participants (sample size, mean age ± SD)	Drop-out rate, n (%)	Treatment (frequency and duration)	Manupilation techniques (acupoints composition, and techniques used)	Control	Depressive symptoms at baseline M (SD)	Outcome measures
Bergmann et al[27], 2014	RCT	Acute myocardial infarction with PPS acore ≥ 60 (213, 61.0 ± 8.1)	32 (15.0)	Acupressure (45 min twice a day for 12 wk)	Figure pressure on two points at the sternum	Treat as usual (TAU)	MDI: 8.9 (7.4), PPS: 81 (13)	MDI, QOL, WHO-5’s well-being index, PPS
Dehghanmehr et al[31], 2020	RCT	Hemodialysis with no severe depression and anxiety (60, 39.2 ± 11.32)	0	Acupressure (8 min, 3 d weekly for 4 wk)	Figure pressure on acupoint Saiyinjiao	Sham, TAU	BDI: 31.44 (20.95), STAI: 47.60 (7.04)	STAI, BDI
Hmwe et al[32],2015	RCT	Hemodialysis with depressive symptom (108, 58.06 ± 11.4)	0	Acupressure (12 min per session, 3 sessions weekly for 4 wk)	Figure pressure on acupoints Yintang, Shenmen, and Taixi	TAU	DASS depression: 10.93 (8.38), GHQ total: 25.33 (12.56)	DASS, GHQ-28
Honda et al[35], 2012	RCT	College students with depressive symptoms (25, 33.2 ± 10.0)	Not mentioned	Acupressure (30 seconds per session, 3 sessions daily for 4 wk)	Figure pressure on six points on the neck (three points on the left and right side each)	TAU	BDI: 55 (10)	BDI
Kalani et al[33], 2019	RCT	Hemodialysis with BDI score ≥ 10 (96, 53.4 ± 13.9)	0	Acupressure (18 min per session, 3 sessions weekly for 4 wk)	Figure pressure on acupoints Sanyinjiao, Zusanli, Yanglingquan, Yongquan, Shenshu, and Shenmen	Sham, TAU	BDI: 27.5 (9.1)	BDI
Lanza et al[23], 2018	RCT	Alzheimer with CDR score ≤ 2 (12, 80.0 ± 9.0)	0	Acupressure (40 min weekly for 40 wk)	Figure pressure on relevant trigger points of the meridians	TAU	GDS: 13 (2)	GDS, MMSE, ADL, IADL
Molassiotis et al[24], 2020	RCT	Depression with GDS score ≥ 8 (118, 79.5 ± 14.5)	34 (28.8)	Acupressure (5 min per session, twice weekly for 12 wk)	Figure pressure on acupoints Zusanli, Zhongfu, Shenmen, Taichong, Baihui	Sham, TAU	GDS: 10.6 (2.1), GHQ: 18.8 (5.9)	GDS, PSQI
Rahimi et al[30], 2020	RCT	Multiple sclerosis with EDSS score = 0-5.5 (106, 20-45 years old)	20 (18.9)	Acupressure (15 min every day for 4 wk)	Figure pressure on acupoints Shenmen and Yintang	Sham	DASS depression: 11.48 (3.1)	DASS, FSS
Rani et al[34], 2020	RCT	Knee osteoarthritis with Kellgrene Lawrance scale grade 2 or 3 (212, 58.07 ± 11.22)	11 (5.2)	Acupressure (15 min per session, 2 sessions per day, 5 d weekly for 32 wk)	Figure pressure on acupoints Liangqiu, Dubi, Zusanli, Yinglingquan, Xuehai, Yanglingquan	TAU	DASS depression: 14.56 (8.63)	DASS, VAS, GHQ-12, BMSWBI, WHOQOL-BREF
Tang et al[26], 2014	RCT	Lung cancer undergoing chemotherapy (40, 64.4 ± 9.2)	10 (25)	Acupressure (3 min once every morning for 20 wk)	Figure pressure on acupoints Hegu, Zusanli, and Sanyinjiao	Sham	HADS: 7.29 (4.39), ECOG-PSR: 11 (45.8)	HADS, TFRS, ECOG-PSR, PSQI
Tseng et al[25], 2020	RCT	Depression with GDS score > 5 (47, 82.78 ± 6.88)	8 (17.0)	Acupressure with a magnetic bead (7 d weekly for 2 wk)	Magnetic bead on ear Shenmen point	Sham	GDS: 8.71 (2.31) BAI: 13.63 (7.36)	GDS, BAI
Wu et al[22], 2007	RCT	Chronic obstructive pulmonary disease with depressive symptom (44, 73.0 ± 9.7)	0	Acupressure (16 min per session, 5 sessions weekly for 4 wk)	Figure pressure on acupoints Dazhui, Tiantu, Shousaili, Feishu, Shenshu	Sham	GDS score at basline not available	GDS, DVAS
Yu et al[29], 2020	RCT	Postpartum wome with low back pain score ≥ 1 (70, 34.4 ± 4.8)	0	Acupressure (10 min per session, 5 sessions weekly for 4 wk)	Figure pressure on acupoints Shenhu, Dachangshu, Guanyuanshu, Weiyang, and Sanyinjiao	Sham	EPDS: 9.4 (4.5)	EPDS, RMDQ, ODI, VAS
Zick et al[28], 2018	RCT	Breast cancer with depressive symptom (288, 60.5 ± 10.0)	Not mentioned	Acupressure (30 min every day for 10 wk)	Figure pressure on acupoints Hegu, Zusanli, Sanyinjiao, Taixi, Baihui, and Qihai	Sham, TAU	HADS: 6.2 (3.2)	VAS, BPI

ADL: Activity of daily living; BAI: Beck anxiety inventory; BDI: Beck depression inventory; BMSWBI: Body-mind-spirit well-being inventory; BPI: Brief pain inventory; CDR: Clinical dementia rating; COPD: Chronic obstructive pulmonary disease; DASS: Depression anxiety stress scales; DVAS: Dyspnea visual analogue scale; ECOG-PSR: Eastern cooperative oncology group performance status rating; EDSS: Expanded disability status scale; EPDS: Edinburgh postnatal depression scale; FSS: Fatigue severity scale; GDS: Geriatric depression scale; GHQ: General health questionnaire; HADS: Hospital anxiety and depression scale; IADL: Instrumental ADL; MDI: Major depression inventory; MMSE: Mini mental state examination; ODI: Oswestry disability index; PFS: Piper fatigue scale; PPS: Pressure pain sensitivity; PSQI: Pittsburgh sleep quality index; QOL: SF-36 quality of life; RMDQ: Roland-morris disability questionnaire; STAI: Spielberger state-trait anxiety inventory; TAU: treat as usual; TFRS: Tang fatigue rating scale; VAS: Visual analog scale.

Table 2 Quality assessment using standards for reporting interventions in clinical trials of acupuncture for the included studies

	Acupressure details						Other components of treatment
Ref.	Acupressure rationale	Acupoints used	Materials used for acupressure	Frequency of acupressure	Acupressure retention	Description of method/materials used for acupressure	Other components	Setting and context	Practitioner background	Control intervention
Bergmann (2014)	NR	NR	Y	Y	Y	Y	NR	Y	Y	Y
Dehghanmehr (2020)	Y	Y	Y	Y	Y	Y	NR	Y	NR	Y
Hmwe (2015)	Y	Y	NR	Y	Y	Y	NR	Y	NR	Y
Honda (2012)	Y	NR	NR	Y	Y	Y	NR	Y	Y	Y
Kalani (2019)	Y	Y	Y	Y	Y	Y	NR	Y	NR	Y
Lanza (2018)	Y	NR	NR	Y	NR	Y	Y	Y	NR	Y
Molassiotis (2020)	Y	Y	Y	Y	Y	Y	NR	Y	NR	Y
Rahimi (2020)	Y	Y	Y	Y	Y	Y	NR	Y	Y	Y
Rani (2020)	Y	Y	NR	Y	Y	Y	NR	Y	Y	Y
Tang (2014)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Tseng (2020)	Y	Y	NR	Y	NR	Y	NR	Y	NR	Y
Wu (2007)	Y	Y	Y	Y	Y	Y	NR	Y	Y	Y
Yu (2020)	Y	Y	NR	Y	Y	Y	NR	Y	NR	Y
Zick (2018)	Y	Y	Y	Y	Y	Y	NR	Y	Y	Y

NR: Not reported; Y: Reported.