The efficacy of virtual reality interventions for depressive disorder due to another medical condition: A three-level meta-analysis.

BACKGROUND

Depressive Disorder Due to Another Medical Condition significantly impairs treatment adherence and quality of life. While established treatments face limitations like adverse drug reactions and poor adherence, Virtual Reality (VR) has emerged as a promising tool due to its immersive and controllable nature. However, systematic evidence on its efficacy and optimal parameters is insufficient.

METHODS

A systematic search was conducted across multiple databases from inception to July 31, 2025. Following PRISMA guidelines, 21 randomized controlled trials (27 effect sizes) were included. A three-level meta-analysis using Hedges' g was performed in R, employing a random-effects model to pool effect sizes, followed by heterogeneity, publication bias, and moderator analyses.

RESULTS

VR intervention demonstrated a moderate and significant therapeutic effect (g = -0. 446, 95% CI [-0. 727, -0. 166], p = 0. 0036). Moderator analyses showed significantly greater effects for patients under 60 years (g = -0. 595) than for older patients (g = -0. 295). High-frequency intervention (≥5 sessions/week, g = -0. 743) was superior to low-frequency (<5 sessions/week, g = -0. 207). Short-duration sessions (≤20 min, g = -0. 529) outperformed longer sessions (>20 min, g = -0. 344). Gamified design (g = -0. 688) yielded larger effects than virtual scene construction (g = -0. 242). All between-group differences were significant (p < 0. 05).

CONCLUSIONS

VR effectively alleviates this depressive disorder. Optimal outcomes are achieved with high-frequency, short-duration, game-based protocols, particularly for younger patients (<60 years), supporting personalized VR strategies in clinical practice.