Effectiveness of a lifestyle modification programme in the treatment of depression symptoms in primary care

Alejandra Aguilar-Latorre; Guillermo Pérez Algorta; Capilla Navarro-Guzmán; María J Serrano-Ripoll; Bárbara Oliván-Blázquez

doi:10.3389/fmed.2022.954644

Effectiveness of a lifestyle modification programme in the treatment of depression symptoms in primary care

Front Med (Lausanne). 2022 Jul 26:9:954644. doi: 10.3389/fmed.2022.954644. eCollection 2022.

Authors

Alejandra Aguilar-Latorre¹, Guillermo Pérez Algorta², Capilla Navarro-Guzmán³, María J Serrano-Ripoll^{4

5

6}, Bárbara Oliván-Blázquez^{1

7}

Affiliations

¹ Primary Healthcare Center Arrabal, Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.
² Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
³ Department of Psychology, University of the Balearic Islands, Palma, Spain.
⁴ Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain.
⁵ Research in Preventive Activities and Promotion and in Cancer Illes Balears (GRAPP-CAIB), Balearic Islands Health Research Institute (IdISBa), Palma, Spain.
⁶ Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain.
⁷ Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain.

Abstract

Background: Depression symptoms are prevalent in the general population, and their onset and continuation may be related to biological and psychosocial factors, many of which are related to lifestyle aspects. Health promotion and lifestyle modification programmes (LMPs) may be effective on reducing the symptoms. The objective of this study was to analyse the clinical effectiveness of a LMP and a LMP plus Information and Communication Technologies, when compared to Treatment as Usual (TAU) over 6 months. The interventions were offered as an adjuvant treatment delivered in Primary Healthcare Centers (PHCs) for people with depression symptoms.

Methods: We conducted an open-label, multicentre, pragmatic, randomized clinical trial. Participants were recruited from several PHCs. Those participants visiting general practitioner for any reason, who also met the inclusion criteria (scoring 10 to 30 points on the Beck II Self-Applied Depression Inventory) were invited to take part in the study. TAU+LMP consisted of six weekly 90-min group sessions focused on improving lifestyle. TAU+LMP + ICTs replicated the TAU+LMP format, plus the addition of a wearable smartwatch to measure daily minutes walked and sleep patterns. A total of 188 participants consented to participate in the study and were randomized. We used linear mixed models, with a random intercept and an unstructured covariance to evaluate the impact of the interventions compared to TAU.

Results: Both interventions showed a statistically significant reduction on depressive symptoms compared to TAU (TAU+LMP vs. TAU slope difference, b = -3.38, 95% CI= [-5.286, -1.474] p = 0.001 and TAU+LMP+ICTs vs. TAU slope difference, b = -4.05, 95% CI = [-5.919, -2.197], p < 0.001). These reductions imply a moderate effect size. In the TAU+LMP+ICTs there was a significant increase regarding minutes walking per week (b = 99.77) and adherence to Mediterranean diet (b = 0.702). In the TAU+LMP there was a significant decrease regarding bad sleep quality (b = -1.24).

Conclusion: TAU+LMPs administered in PHCs to people experiencing depression symptoms were effective on reducing these symptoms compared to TAU. They also have a positive impact on changing several lifestyle factors. These findings indicate that these interventions can be promising strategies for PHCs.

Keywords: depression; health promotion; lifestyle modification; primary care; randomized controlled trial (RCT).