Lifestyle medicine for depression: a meta-analysis and a pilot randomized controlled trial

Despite effective treatments for depression are present, the incidence of depression is increasing worldwide at an alarming rate. The rise was likely posed by changes in lifestyle related to modernity in the past few decades. Apart from biochemical, genetic, and psychological factors, there is compelling evidence that a cascade of lifestyle factors are involved in the pathogenesis and progression of depression. Lifestyle medicine (LM), which involves the therapeutic use of lifestyle interventions, is gaining increasing popularity for managing diseases with a lifestyle-based etiology such as depression.In Study 1, a meta-analysis of 50 randomized controlled trials (RCTs) was conducted to examine the effects of LM interventions (nutrition, physical activity, stress and/or sleep management) in reducing depressive symptoms. The results revealed that LM interventions had a small effect in alleviating depressive symptoms as compared with care-as-usual (CAU) and waitlist/no intervention (WL/NI) comparisons. However, no significant difference was found in depressive symptoms when LM interventions were compared with attention control (AC). In addition to the overall analysis, the moderator analysis using subgroup analyses suggested that the number of lifestyle factors employed in LM intervention was a significant moderator for the effects of LM interventions on depressive symptoms, while disease condition, adoption of cognitive behavioral component, and mode of delivery were not significant.In Study 2, a smartphone-based LM intervention, comprising lifestyle psychoeducation, physical activity, dietary recommendation, stress management, sleep management, and motivation and goal setting techniques, for reducing depressive symptoms was developed and evaluated using a two-arm RCT design. 79 eligible participants were randomly assigned to the Lifestyle Hub intervention group (LMG; n = 39) and the waitlist control group (WLG; n = 40) groups. The linear mixed-models analysis revealed that participants in the LMG showed significant improvement in depressive, anxiety, and insomnia symptoms when compared with the WLG. Also, significant improvement was found in functional impairment, health-related quality of life, health-promoting behaviors, total activity level, and walking activity. However, no significant difference was observed in interpersonal relationship, vigorous and moderate exercise, sedentary behavior, and food frequency from the baseline to immediate posttreatment assessment.This thesis is of substantial value to (1) strengthen the evidence base of the effectiveness of LM in reducing depressive symptoms; (2) fill the gap in conventional clinical practice and pave the way for future LM intervention design for depression; and (3) provide an acceptable, easily accessible, effective, low-cost and potentially safe option for augmenting the management of depression.儘管現時存在著有效治療抑鬱症的方法，但世界各地的抑鬱症患病率仍然以驚人的速度上升。根據研究顯示，促成抑鬱症患病率上升其中的一個因素很可能與過去數十年因現代化而轉變的生活方式有關。 除了生物化學、遺傳和心理因素外，有充分的證據表明一系列的生活方式都與抑鬱症的發病機制和發展有關。養生醫學就是以生活介入的方式去管理與生活方式有關的疾病（例如，抑鬱症）。研究一使用了統合分析研究了50個以養生醫學（營養、運動、壓力和/或睡眠管理）減輕抑鬱症狀的隨機對照試驗。與恆常對照組和等待/沒有介入對照組相比，養生醫學對於減輕抑鬱症狀皆有小的效應值。然而，當養生醫學與注意力控制對照組進行比較時，抑鬱症狀並沒有顯著性差異。此外，以次群組作調節變數分析的結果表明「所採用的生活方式數量」是養生醫學對抑鬱症狀影響的顯著性調節變數，而抑鬱症狀程度、包含認知行為治療元素，及形式皆不是顯著性調節變數。研究二研發了首個以減輕抑鬱症狀為目的的養生醫學手機應用程式（其中包括生活方式與心理教育、運動、營養、壓力管理、睡眠管理以及動機和目標設定技巧），並以兩臂的隨機對照試驗探討了其初步成效。79名合資格的參加者被隨機分配到養生養心組（n = 39）或等待對照組（n = 40）。線性混合模型分析顯示，養生養心組在抑鬱、焦慮和失眠症狀方面都有顯著性改善。此外，在功能障礙、健康相關生活品質、健康促進行為、總活動量和步行量方面同樣有顯著性改善。然而，在人際關係、劇烈與中強度運動、久坐行為和食物頻率方面均未觀察到顯著性差異。本論文增強了養生醫學在減輕抑鬱症狀的基礎、同時填補了傳統臨床服務的缺口並為未來養生醫學在減輕抑鬱症狀的研究提供了設計方向，以及提供了一種容易接受、易於獲取、有效及低成本且可能安全加強抑鬱症管理的選擇。Wong, Wing Hei.M.Phil. Chinese University of Hong Kong 2020.Includes bibliographical references (leaves 74-104).Abstracts also in Chinese.Title from PDF title page (viewed on October 11, 2022)