TY - JOUR
T1 - Lifestyle medicine for depression
T2 - A meta-analysis of randomized controlled trials
AU - Wong, Vincent Wing Hei
AU - Ho, Fiona Yan Yee
AU - Shi, Nga Kwan
AU - Sarris, Jerome
AU - Chung, Ka Fai
AU - Yeung, Wing Fai
N1 - Funding Information:
This work was supported by the Seed Funding Support for Thesis Research, Faculty of Social Science, The Chinese University of Hong Kong (WHW, grant number 5,501,685) and the NHMRC Clinical Research Fellowship (JS, grant number APP1125000).
Publisher Copyright:
© 2021
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Background: The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined. Methods: We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons. Results: Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected. Limitations: Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured. Conclusion: Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.
AB - Background: The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined. Methods: We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons. Results: Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected. Limitations: Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured. Conclusion: Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.
KW - Depression
KW - Effectiveness
KW - Lifestyle
KW - Meta-analysis
KW - Randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85101329449&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2021.02.012
DO - 10.1016/j.jad.2021.02.012
M3 - Review article
C2 - 33609955
AN - SCOPUS:85101329449
SN - 0165-0327
VL - 284
SP - 203
EP - 216
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -