Good mental health is vital to the nation’s population, it goes without saying ...

Juliet Jones - 24.04.2025

Good mental health is vital to the nation’s population, it goes without saying in the UK today there are millions of people suffering with depression of which the traditional approach of medications which are highly addictive and incredibly hard to refuse as this is in many cases the only option presented to the patient via their first port of call their doctor. According to Public Health England (2019), in 2018, 17% of the UK population where suffering from depression and had been prescribed anti- depressants. A Tai Chi Intervention being offered could change this quagmire of a situation the healthcare system has facilitated by propagating almost 20 percent of the nations dependence on anti-depressants. The objectives of this research study is to show that a rather less intrusive solution such as a Tai Chi intervention is more beneficial to the patients and cost effective to the National Health Service (NHS), also when looking at a long-term solution to this debilitating disease for the population, depression. Tai Chi is meditation in movement a gentle form of exercise that promotes a feeling of general well-being through the cultivation of the mind, body and spirit. The systematic reviews I will be presenting in this study will aim to show that a Tai Chi intervention is a positive solution to depression without the negative side effects anti-depressants offer, they are a cost-effective treatment to depression for the NHS also. The research approach will be a comparative study, examining existing literature reviews and studies on the benefits of a Tai Chi intervention on depression. The research will look at systematic literature reviews that have used quantitative data variables in their study, focusing on studies where random control trials have been used, therefore, providing insight into the benefits of a Tai Chi intervention to treat depression both short and long term.

Overview and Research Approach

This study looking at the effectiveness of Tai Chi on depression compares three peer reviewed, systematic and meta-analysis reviews.

Resource 1: Zeng et al., (2023). (See reference list below): This report evaluated the efficacy of Tai Chi on depression and adults over the age of 45. The objective was to see if the desired result of relieving depression in adults, middle- aged an older, was possible through Tai Chi exercise. The systematic approach was to search for randomised control trials (RCT’s) published up until 16^th April 2023, 12 RCT’s, were identified for inclusion in the literature review. Eleven from china and one from Central America with a total of 723 participants all over the age of 45, with 345 participants in the control group and 369 participants in the Tai Chi group.The review found that Tai Chi exercise for a minimum of 24 weeks with weekly duration sessions being a minimum of 2400 minutes the 24- style Tai Chi achieving the best results in the reduction of depression. For the meta- analysis review, according to Zeng et al., (2023) the study used the Cochrane Q Test (I²) and the Chi- Square test ( Chi² ) p- value, were used evaluate heterogeneity, and studies would be considered heterogeneous if the p-value was less than 0.10. The measure for heterogeneity was as documented in the report, percentage of total variation across studies was reported as I-squared ( I²)  ( I² = 0% - 40%, low heterogeneity. I² = 30% - 60% moderate heterogeneity, I² = 75% - 100%, considerable heterogeneity, according to Higgins et al.,(2022).

Resource 2: Sani et al., (2023). (See reference list below): The objective was to see if Tai Chi exercise can positively effect the mental and physical well-being of people with depression. A meta -analysis was conducted according to Sani et al.,(2023) PRISMA guidelines, RCT’s were used from 1^st January 2000 – 2022. The meta- analysis was performed using the random effects model and the heterogeneity was estimated using I² statistics. By employing the random effects model, typically when systematic reviews studies. have different methodologies, settings or populations, the random effects model, according to Higgins et al.,(2022), allows for a more generalised results when pooling data from studies with varying designs. Participants were both adolescent and adult, with reported depressive symptoms, regardless of age, gender and ethnicity were included. Eight RCT’s were used with a total of 822 participants, trials were conducted in China, Hong Kong, Australia and the USA. The results of this intervention showed a positive improvement in the participant’s mental health and well=being along with the participants’ physical well-being. This was evidenced in the report by the reductions in the participants’ depression, anxiety and the improvement in the participants’ quality of life (QOL). The Tai Chi interventions varied, 24 weeks, 12 weeks, 10 weeks and 8 weeks. According to Sani et al., (2023) the study measured the treatment effect for opposing outcomes using risk ratio (RRs) and absolute risk reduction. SMD used and assessed with 95% CI. Forest plots also used. Heterogeneity was assessed by the I² statistic, using the random effects model to pool data. The intervention focused on two control groups, one groups with Tai Chi (TC) and anti- depressants versus standard anti- depressants. According to Sani et al.,(2023) trial participants in one trial were administered the anti depressants escitalopram for a duration before the intervention. In three trials trial participants were administered anti- depressants, with exact name or specified and in four trials the participants were not administered any anti-depressants, prior to the intervention. Three trials used Yang style Tai Chi, one using KaiMai’s Tai Chi style, one using a combination of 24- form and 48 form tai chi and two trials using Tai Chi Chih, and one trial did not specify the style.

Resource 3: Kuang et al., (2024). (See reference list below): This study aimed to review and analyse the therapeutic effects of four types of Tai Chi interventions in reducing anxiety and depression in older adults. Published by Frontiers in Public Health on the 8^th January 2024. A total of 20 studies were included in both English and Chinese languages with1798 participants. Findings imply that TC can be beneficial to the reduction of anxiety and depressive symptoms, with Yang style having greater efficacy in alleviating anxiety symptoms and Tai Chi Exercise programs demonstrating higher efficacy in alleviating depressive symptoms.

Analysis and Discussion

To critically analyse the findings of these three systematic and meta-analysis reviews evaluating the efficacy of Tai Chi interventions on depression, statistical outcomes such as standardised mean differences (SMD), confidence intervals (CI), heterogeneity ( I² ), and p-values were used to compare and evaluate the strength and impact of the evidence presented in the reviews.

Resource 1: Zeng et al.,(2023). The meta-analysis, the main result of the study [ SMD = -1.23, 95% CI (-1.60, -0.85), P < 0.001], clearly verified that the depression levels of the Tai Chi participant group was considerably lower than that of the control participant group. Resulting in a standard mean difference (SMD) of -1.23 (95 % Confidence Interval (CI): - 1.60 to – 0.85), indicating a substantial reduction in depression in the Tai Chi group when  to the control group. The highly statistical significance of the result, (P < 0.001) suggests the intervention had a reliable and meaningful impact. Sensitivity analysis in [ SMD = -1.33, 95% CI ( -1.90, -0.76), I² = 80.2%, P < 0.001]. This result tests the validity of the main results of the meta-analysis. An SMD of -1.33 suggest the intervention was largely impactful in reducing depression. Compounded by the fact that the entire CI was negative, ( -1.90, -0.76), further indication the interventions outcomes were positive in effect. I² represents the degree of heterogeneity or variability between the studies included in the meta-analysis. The I² of 80.2% is considered substantial heterogeneity, meaning there is a lot of variation in the results across studies. With P < 0.001 indicating a very low probability that the effect observed is due to random variation, further strengthening the conclusion that the intervention has a meaningful impact.

Resource 2: Sani et al., (2023). The meta- analysis (SMD -0.58; 95% CI -1.13 to -0.03; I² = 92%, = 92%; p = 0.04). As illustrated in figure 4. The TC intervention reduced the depressive symptom severity when compared to the control group that used antidepressants. The meta-analysis demonstrated a moderate but statistically significant effect of the intervention, with a standardised mean difference of -0.58 (95% CI: -1.13 to -0.03, p = 0.04), suggesting a reduction in the outcome measure compared to the control group. However, the analysis revealed considerable heterogeneity across studies (I² = 92%), indicating substantial variability in study characteristics or populations, which may affect the reliability and generalisability of the pooled effect estimate. Sensitivity analysis (SMD -1.59; 95% CI -1.59 to 0.20; I² = 93%; p = 0.13). The sensitivity analysis produced a large, pooled effect size (SMD = -1.59), but the result was not statistically significant (95% CI: -1.59 to 0.20; p = 0.13), as the confidence interval included zero. Additionally, high heterogeneity was observed (I² = 93%), suggesting considerable variability among the included studies. These findings indicate that the overall effect is not robust and may vary depending on study inclusion or methodological factors.

Resource 3: Kuang et al., (2024). The meta-analysis (SMD: -0.65, 95% CI: -0.95, -0.65, p< 0.05), revealed that the Tai Chi intervention was more effective than the control group in reducing symptoms of depression amongst older adults.The pooled analysis showed a statistically significant and large reduction in the outcome for the intervention group, with a (standardised mean difference(SMD) of -1.19 (95% CI: -2.04 to -0.34, p < 0.05). This suggests the intervention had a meaningful and reliable effect in improving outcomes compared to the control group. (SMD: -1.19, 95% CI: -2.04, -0.34, p< 0.05), this meta-analysis revealed that a Tai Chi intervention was more effective than the control group in reducing anxiety. These findings suggest that the intervention was effective in significantly reducing the outcome measure compared to the control group. According to Kuang et al., (2024) the network meta-analysis in this report focused on anxiety symptoms and found that Yang – style Tai Chi had the most positive results followed by the 24-form simplified Tai Chi, however when looking at the results on depression the Tai Chi exercise program had the best performance results, followed closely by Yang style Tai Chi.

Conclusion and Recommendation

Positive findings in this independent study establish a clear connection between the positive efficacy of Tai Chi interventions on the alleviation of depressive symptoms in adults, through the analysis of systematic and meta-analytical reviews. Consistency within the studies, Zeng et al.,(2023), Sani et al ., (2023) and Kuang et al ., (2024), show significant statistical evidence that Tai Chi interventions alleviate depressive symptoms particularly among older adults. The evidence showed that the standardised mean difference (SMD) across all three studies were negative, verifying reductions in depressive symptoms, with level of effects varying in degree. Zeng et al.,(2023) findings were substantial in effect, where as Sani et al., (2023) results were found to be moderate and impactful, with Kuang et al., (2024) reinforcing the findings particularly amongst older adults. With all studies agreeing on 24 week duration and more than 60 minutes per week in duration with Tai Chi styles, Yang style , 24 form style coming out as most effective across all three studies. Negative findings in this review are the substantial heterogeneity variability across the trials in participants characteristics, intervention lengths, Tai Chi styles and outcome measures, with heterogeneity I² registering between 80% and 93%. While the findings in this conclusion verify the positive efficacy of Tai Chi interventions on depressive symptoms, the heterogeneity calls for more research specifically to gain more clarity here, specifically more random controlled trials in the United Kingdom on this subject would prove beneficial. This study therefore recommends Tai Chi interventions be promoted as a therapy in the reduction of depression. This non invasive solution to depression, that has minimal side effects and maximum benefit for the mental a physical well-being of the patient would be a cost effective way for the NHS to treat depression both long and short term, by empowering it’s patients, not subjugating them to a life long addiction of anti depressants as is the case to 17% of the UK population in 2018, according to Public Health England (2019). This would be a promising and cost-effective way forward for the NHS in tackling depression.

Reference List

British Psychological Society (BPS). (2021). Code of Human Research Ethics.

Health and Care Professions Council (HCPC). (2016). Guidance on Conduct and Ethics for Students.

Chang, S., Cheng, L., Liu, H., (2024). The Effects of Three-duration Tai Chi exercises on depression and sleep quality in older women. European Geriatric Medicine [online], 15, pp. 1141-1148.

He,G., Zhang,X., Yan,T., Wang,J.,  Li,Q. Liu,T., Oh,Y.P., (2022). The Efficacy of Tai Chi for Depression: a protocol for systematic review and meta-analysis. Medicine {online}, 101 (5), pp.1-4.

Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J. and Welch, V.A., eds., 2022. Cochrane handbook for systematic reviews of interventions. Version 6.3. Cochrane. 

Available at: https://training.cochrane.org/handbook [Accessed 27 April 2025].

Kuang, X., Dong, Y., Song, L., Dong, L., Chao, G., Zhang, X., Yang, J., (2023). The Effects of Different types of Tai Chi exercise on anxiety and depression in older adults: a systematic review and network meta-analysis. Frontiers in Public Health [online], 11, article10.

Sani, N.A., Yusoff, S.S.M., Norhayati, M. N., Zainudin, A.M., (2023). Tai chi Exercise for Mental and Physical Well- Being in Patients with Depressive Symptoms: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health [online], 20, article 2828.

World Medical Association (WMA). (2013). Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects.

Xie, X., Song, J.;  Zhu, J., Han, M., He, Y., Huang, J., Tao, J., Wu, J., (2021). The effectiveness of Tai Chi on the depressive symptom of young adults with subthreshold depression: a study protocol for randomized controlled trial. BMC [online], 22, article106.

Zeng, L., Zhao, X., Yu, Y., Hu, T., li, C., Wu, M., and Yang, F., (2023). Effects of Tai Chi on Depression of middle-aged and older adults: an updated systematic review and meta-analysis. BMC Complementary Medicine and Therapies [online], 23, article 382.