People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear.

To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs.

We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the Cochrane Collaboration’s ‘risk-of-bias 2 tool’. We calculated a random-effects, inverse-variance weighting meta-analysis.

Of the 21 386 initial studies, 12 RCTs (with 2144 patients) comparing behavioural activation with any comparator on treatment outcomes for depression with comorbid NCD met the inclusion criteria. Six studies rated as low risk of bias. For short-term follow-ups (up to 6 months), meta-analysis showed behavioural activation had little effect on depression symptom improvement in people with NCDs (Hedges’ g = −0.24; 95% CI, −0.62 to 0.15), compared to comparators, with high heterogeneity (I2 = 91.91%). Of the 12 included studies, three RCTs provided data on adverse events occurring during the trial.

Evidence from this systematic review is not sufficient to draw clear conclusions about the efficacy and safety of behavioural activation for reducing depression symptoms in people with NCDs. Future reviews need to include more high-quality, well-designed RCTs to better understand the potential benefits of behavioural activation for comorbid depression.

Previous research showed that behavioural activation is as effective as cognitive–behavioural therapy for general depression. However, it remains unclear if it leads to greater improvement in depressive symptoms when compared with standard treatment for post-stroke depression.

To compare the effectiveness of behavioural activation against control conditions in reducing depression symptoms in individuals with post-stroke depression.

This review searched five databases from inception until 13 July 2021 (updated 15 September 2023) for randomised controlled trials comparing behavioural activation and any control conditions for post-stroke depression. Risk of bias was assessed with the Cochrane Collaboration's Risk-of-Bias 2 tool. The primary outcome was improvement in depressive symptoms in individuals with post-stroke depression. We calculated a random-effects, inverse variance weighting meta-analysis.

Of 922 initial studies, five randomised controlled trials with 425 participants met the inclusion criteria. Meta-analysis showed that behavioural activation was associated with reduced depressive symptoms in individuals with post-stroke depression at 6-month follow-up (Hedges’ g −0.39; 95% CI −0.64 to −0.14). The risk of bias was low for two (40%) of five trials, and the remaining three (60%) trials were rated as having a high risk of bias. Heterogeneity was low, with no indication of inconsistency.

Evidence from this review was too little to confirm the effectiveness of behavioural activation as a useful treatment for post-stroke depression when compared with control conditions. Further high-quality studies are needed to conclusively establish the efficacy of behavioural activation as a treatment option for post-stroke depression.