Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
J Affect Disord. 2021 Apr 1;284:203-216. doi: 10.1016/j.jad.2021.02.012. Epub 2021 Feb 5.
The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined.
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.
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.
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.
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.
多成分 LM 干预对抑郁症状的治疗效果尚未得到检验。
我们系统地检索了六个数据库，从建库至 2020 年 2 月，以确定与常规护理（CAU）、等待名单（WL）、无干预（NI）或对照（AC）比较，任何多成分 LM 干预（身体活动、营养建议、睡眠管理和/或压力管理）对抑郁症状的随机对照试验（RCT）。
共纳入 50 项研究，涉及 8479 名参与者。多成分 LM 干预在即刻治疗后与 CAU（p >.001；d = 0.20）和 WL/NI（p >.01；d = 0.22）相比，抑郁症状显著降低。然而，与 AC 相比，差异无统计学意义。与 CAU 相比，干预效果在短期（1-3 个月随访）内保持（p >.05；d = 0.25），但在中、长期内没有保持。对多成分 LM 干预与 CAU 比较的影响进行的调节分析表明，采用的生活方式因素的数量是一个显著的调节因素。尽管疾病类型不是一个显著的调节因素，但多成分 LM 干预的临床效果在被诊断为重度抑郁症的患者中更强（d = 0.45），这是一种趋势。未发现发表偏倚。
在某些亚组分析中，可用的 RCT 数量较少，无法发现有意义的效果。结果可能无法扩展到重度抑郁症，因为纳入了二级抑郁症的数据。
多成分 LM 干预似乎能有效缓解抑郁症状，但临床效果的幅度较小。未来需要研究更全面和个体化的 LM 干预，更加强调动机和依从性方面，且仅关注抑郁症患者。
