Lifestyle medicine for depression: A meta-analysis of randomized controlled trials

Vincent Wing-Hei Wong; Fiona Yan-Yee Ho; Nga-Kwan Shi; Jerome Sarris; Ka-Fai Chung; Wing-Fai Yeung

doi:10.1016/j.jad.2021.02.012

Lifestyle medicine for depression: A meta-analysis of randomized controlled trials

J Affect Disord. 2021 Apr 1:284:203-216. doi: 10.1016/j.jad.2021.02.012. Epub 2021 Feb 5.

Authors

Vincent Wing-Hei Wong¹, Fiona Yan-Yee Ho², Nga-Kwan Shi¹, Jerome Sarris³, Ka-Fai Chung⁴, Wing-Fai Yeung⁵

Affiliations

¹ Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
² Department of Psychology, The Chinese University of Hong Kong, Hong Kong. Electronic address: fionahoyy@cuhk.edu.hk.
³ Western Sydney University, NICM Heath Research Institute, Westmead, NSW, Australia; Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Australia.
⁴ Department of Psychiatry, The University of Hong Kong, Hong Kong.
⁵ School of Nursing, The Hong Kong Polytechnic University, Hong Kong.

PMID: 33609955
DOI: 10.1016/j.jad.2021.02.012

Abstract

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.

Keywords: Depression; Effectiveness; Lifestyle; Meta-analysis; Randomized controlled trial.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Depression* / therapy
Depressive Disorder, Major* / therapy
Humans
Life Style
Psychotherapy
Randomized Controlled Trials as Topic