To explore the effects of repetitive transcranial magnetic stimulation (rTMS) combined with mindfulness training on sleep quality, clinical symptoms and suicide risk during depressive episodes, as well as gender differences, and observe the safety of the treatment.

A total of 200 patients with depressive episodes admitted to Huizhou Second People's Hospital from July 2024 to April 2025 were included for analysis. They were divided into control group, a mindfulness group, an rTMS group, and a combined group by random number table method, with 50 cases in each group, and then subgroups were further divided according to gender. The control group received conventional Western medicine treatment, the mindfulness group received mindfulness training based on the control group, the rTMS group received rTMS based on the control group, and the combined group received rTMS combined with mindfulness training based on the control group. The sleep monitoring indicators [total sleep time (TST), sleep latency (SL), wake time (WASO), sleep efficiency (SE), proportion of non-rapid eye movement sleep stage 1 (N1), stage 2 (N2), stage 3 (N3), proportion of rapid eye movement (REM)], clinical symptoms [Hamilton depression/anxiety scale (HAMD/HAMA)], nurses' global assessment of suicide risk (NGASR), and the occurrence of adverse reactions were compared between the four groups, as well as the gender differences of the above indicators between the four groups.

Compared with before treatment, the sleep monitoring indicators of four groups improved after treatment, and the improvement of men and women in the combined group was respectively better than that of the control group of the same sex (P<0.05). The HAMD and HAMA scores of four groups decreased after treatment, and the scores of men and women in the combined group were respectively lower than those of the same-sex group in the control group (P<0.05). The NGASR scores of four groups after treatment were lower than those before treatment, and the scores of men and women in the combined group were respectively lower than those of the same-sex group in the control group (P<0.05). Comparison of the overall incidence of adverse reactions between the four treatment groups showed no statistically significant differences (P>0.05). There was no statistically significant difference in each index among patients of different genders after treatment in the same group (P>0.05).

rTMS combined with mindfulness training can effectively improve the sleep quality and clinical symptoms of patients with depressive episodes, reduce the risk of suicide, and does not increase the risk of adverse reactions. However, no significant gender differences were found in terms of its effectiveness and safety.