Effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms: Systematic review and meta-analysis

Gómez-Gómez, Irene; Bellón, Juan Ángel; Resurrección, Davinia M.; Cuijpers, Pim; Moreno-Peral, Patrícia; Rigabert, Alina; Maderuelo‐Fernández, José Ángel; Motrico, Emma

doi:10.1016/j.ypmed.2020.106067

Cited by 35 publications

(25 citation statements)

References 90 publications

(281 reference statements)

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“…Encouragingly, no adverse effects resulting from the LM intervention were reported in this study. In line with the meta-analysis and recent RCTs, we showed that LM interventions were superior to CAU in managing depressive symptoms [33][34][35][36][37]56].…”

Section: Discussionsupporting

confidence: 86%

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial

Yeung

et al. 2021

PLoS ONE

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Given the growing evidence that a range of lifestyle factors are involved in the etiology of depression, a ‘lifestyle medicine’ approach can be potentially safe and cost-effective to prevent or treat depression. To examine the effects and acceptability of a group-based, integrative lifestyle medicine intervention as a standalone treatment for managing depressive symptoms, a pilot randomized controlled trial (RCT) was conducted in a Chinese adult population in 2018. Participants (n = 31) with PHQ-9 score above the cut-off of ≥ 10, which was indicative of moderate to severe depression, were recruited from the general community in Hong Kong and randomly assigned to lifestyle medicine group (LM group) or care-as-usual group (CAU group) in a ratio of 1:1. Participants in the LM group received 2-hour group sessions once per week for six consecutive weeks, which covered diet, exercise, mindfulness, psychoeducation, and sleep management. Linear mixed-effects model analyses showed that the LM group had a significant reduction in PHQ-9 scores compared to the CAU group at immediate posttreatment and 12-week posttreatment follow-up (d = 0.69 and 0.73, respectively). Moreover, there were significantly greater improvements in anxiety, stress, and insomnia symptoms (measured by DASS-21 and ISI) at all time points in the LM group (d = 0.42–1.16). The results suggests that our 6-week group-based, integrative lifestyle intervention program is effective in lowering depressive, anxiety, stress, and insomnia symptoms in the Chinese population. Further studies in clinical populations with a larger sample size and longer follow-up are warranted.

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Section: Discussionsupporting

confidence: 86%

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial

Yeung

et al. 2021

PLoS ONE

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“…EIRA was a health promotion intervention designed following Medical Research Council methodology [ 13 ] (including systematic reviews [ 14 – 22 ], citizen and professional participation through qualitative research [ 23 – 25 ] and a previous pilot study, among other techniques) and was based on the Transtheoretical Model [ 26 ]. Physicians and nurses applied the intervention in their routine practice in the PHC centre.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study)

Aznar-Lou

Zabaleta‐del‐Olmo

Casajuana-Closas

et al. 2021

Int J Behav Nutr Phys Act

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Background Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. Methods An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. Results The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (− 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. Conclusion The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. Trial registration Clinicaltrials.gov NCT03136211. Registered 02 May 2017 – Retrospectively registered

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Section: Introductionmentioning

confidence: 99%

“…In recent years, there has been an increasing interest in the study of the multiple lifestyle interventions on depressive symptomatology, and the results are promising [ 18 , 19 , 20 ]. A recent meta-analysis suggested that universal multiple-risk lifestyle interventions may produce a modest but statistically significant effect decreasing depressive symptomatology in adults, although the available evidence base is still low [ 18 ]. These findings are supported by another recent meta-analysis, which concluded that multicomponent lifestyle medicine interventions may be effective reducing depressive symptomatology at short-term follow-up [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Adherence to Lifestyle Interventions for Treatment of Adults with Depression: A Systematic Review and Meta-Analysis

Castro

Roca

Ricci‐Cabello

et al. 2021

IJERPH

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The aim of this systematic review was to determine the adherence to lifestyle interventions for adults with depression and to estimate the dropout rates in trials examining the impact of these interventions. A bibliographic search was conducted in PubMed, Embase, PsycINFO, the Cochrane library, and several sources of grey literature. We included randomised controlled trials examining the impact of multiple lifestyle interventions on depressive symptomatology in adults when compared to control or other active treatments. Two reviewers independently screened citations, extracted the relevant data, and assessed the risk of bias using Cochrane tools. A random effects meta-analysis of proportions was used to summarise the proportion of participants who completed the intervention and to determine the proportion of dropouts at post-treatment assessment. Multiple subgroup analyses were also carried out. We identified six trials. The meta-analysis of proportions showed that 53% (95%CI 49% to 58%) of the participants assigned to the intervention group fully adhered to the intervention program. The weighted mean proportion of completed intervention sessions was 66%. The pooled trial dropout rate was 22% (95%CI 20% to 24%). Around half of adults with depression adhere to lifestyle interventions. Future research is needed to develop interventions to support adherence to lifestyle interventions in depressive patients.

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Effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms: Systematic review and meta-analysis

Cited by 35 publications

References 90 publications

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial

Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study)

Adherence to Lifestyle Interventions for Treatment of Adults with Depression: A Systematic Review and Meta-Analysis

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