The definition of health is not only to have no physical defects and diseases, but also to have intact physiological, psychological state and social adaptability . WHO data shows: In 2015, about 4.4% of the world's population was troubled by depression [1]; The incidence of depression and anxiety in young people is also increasing. Patients with depression usually have psychological damage to [3] and severe sequelae [4],[5]. The quality of life is generally lower than that of healthy people [6].
In 2019, the new crown epidemic spread around the world. The sudden isolation and the occurrence of a series of uncertain events seriously affected our lives. What changes follow is also our mental state, and the resulting health problems are increasingly highlighting .
A research review summarizes the occurrence of mental health problems from December 2019 to June 2020 [7]. A total of 16 studies were included in the review, 113,285 people (11 studies were from China, two were from India, and one was from Spain, Italy and Iran ). study found that during the COVID-19 pandemic, the incidence of depression, anxiety, stress, sleep problems and psychological pain increased, with the prevalence of depression at 20%, anxiety at 35%, and stress at 53%.
Although there has been a lot of progress in psychological and drug treatment for the above diseases, on a global scale, especially in some countries with low income levels, a large part of the population still cannot obtain corresponding psychological counseling and treatment due to the scarcity of social and psychological health services [8],[9].
Therefore, in addition to psychotherapy and drug interventions, lifestyle-related interventions have also gradually attracted attention. So, how big is the effect of these lifestyle improvements? What is the causal relationship between them?
Clinical Practice Guide to Emotional Disorders at Royal Psychiatric College of Australia and New Zealand [10] lists exercise, smoking reduction, healthy eating and improving sleep as the "step 0" goals, and is first performed before implementing drug treatment and/or psychotherapy.
The top journal in the field of mental health, World Psychiatry (IF: 40.595), also published a meta-analysis, which revealed the prevention and treatment effects of a series of lifestyles including physical activity, smoking cessation, healthy eating and good sleep on mental problems such as depression, anxiety and stress, schizophrenia , bipolar disorder , etc. This article summarizes 29 meta-analysis based on the prospective/ cohort study , 12 Mendel randomized studies (MR), 2 meta-analysis and reviews, and 2 meta-analysis for randomized controlled trials (RCTs) [11].
Lifestyle factors in prevention and treatment of mental illness Source: Firth J et al, World Psychiatry. 2020.
1. Exercise
Prevention and auxiliary treatment of a series of mental disorders
A large amount of research evidence shows that sports activities play a certain role in reducing the risk of certain mental disorders .In addition, the meta-analysis based on RCTh also shows that exercise intervention can be used as an adjunctive treatment for depression, anxiety and stress-related diseases, psychiatric disorders and attention deficit/hyperactivity disorder (ADHD), but it still needs to be repeated further in high-quality RCT.
Currently, the "American Sports Activities Guide" [12] and the UK's "Agency Guide" [13] has included exercise in the recommendation, believing that it can reduce the risk of depression (including postpartum depression ). The European Psychiatric Association [14] even proposed that there is sufficient evidence to recommend that structured exercise training can be an effective first-line treatment option for moderate depression and as an auxiliary intervention measure to improve symptoms of severe mental illness.
Tips
. Performing 150 minutes of moderate-intensity activities or 75 minutes of vigorous activities every week can reduce the risk of adults' various health conditions [17],[18].
. Cooperating with some muscle strength and resistance training, it can also effectively improve the symptoms of mental and mental illnesses [15],[16],[17].
2. Sleep deprivation
related to the occurrence and worsening of mental illness
Large-scale meta-analysis and MR studies show that lack of sleep is related to the occurrence of various mental illnesses, and there is a causal relationship with bipolar disorder . In addition, Sleep disorder will also significantly increase the risk of suicide behavior in patients with mental illness [18]. The RCT-based meta-analysis also supports the effect of sleep intervention in reducing symptoms of depression.
Tips
Try insomnia cognitive behavioral therapy (CBT-I) , which mainly includes five aspects: sleep hygiene education, stimulation control, sleep restriction, relaxation therapy and cognitive therapy. Research shows that it can be used as a non-drug option to effectively improve sleep and mental health problems [19],[20].
3. Smoking
Common and important causes of serious mental illness
Multiple meta-analysis shows that smoking is related to the increased expected risk of mental disorders, early onset age and other adverse outcomes [21],[22]. Genome-wide association analysis (GWAS) studies also revealed causal relationships between smoking and severe depression, bipolar disorder and schizophrenia.
Tips
quit smoking early, including e-cigarettes.
4. Healthy diet pattern
Improve depression-related symptoms
Some meta-analysis suggests that healthy diet pattern can reduce the risk of depression-related symptoms. Several recent RCTs also reported the significant improvement of Mediterranean diet on depression [23],[24],[25]. In 2021, a meta-analysis of 18 studies studied the correlation between vitamins, especially vitamins B2, B6, B12, and the risk of depression. The results show that intake of these vitamins in female groups is significantly negatively correlated with the risk of depression [26].However, the impact of dietary factors on common and serious mental illnesses needs to be further confirmed.
Tips
Try
In short, a healthy lifestyle (exercise [29], Mediterranean diet [30][30]m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m 2, good sleep [31] and quit smoking [32]) plays an important role in the prevention and treatment of mental illnesses. The potential mechanism may be to improve inflammation [33]. At the same time, since intestinal bacterial will be affected by exercise [34] and diet [35], it is also regarded as another potential way to affect mental health. However, the field is still in its infancy and deserves further exploration in future research. The definition of health is not only to have no physical defects and diseases, but also to have intact physiological, psychological state and social adaptability . WHO data shows: In 2015, about 4.4% of the world's population was troubled by depression [1]
In 2019, the new crown epidemic spread around the world. The sudden isolation and the occurrence of a series of uncertain events seriously affected our lives. What changes follow is also our mental state, and the resulting health problems are increasingly highlighting .
A research review summarizes the occurrence of mental health problems from December 2019 to June 2020 [7]. A total of 16 studies were included in the review, 113,285 people (11 studies were from China, two were from India, and one was from Spain, Italy and Iran ). study found that during the COVID-19 pandemic, the incidence of depression, anxiety, stress, sleep problems and psychological pain increased, with the prevalence of depression at 20%, anxiety at 35%, and stress at 53%.
Although there has been a lot of progress in psychological and drug treatment for the above diseases, on a global scale, especially in some countries with low income levels, a large part of the population still cannot obtain corresponding psychological counseling and treatment due to the scarcity of social and psychological health services [8],[9].
Therefore, in addition to psychotherapy and drug interventions, lifestyle-related interventions have also gradually attracted attention. So, how big is the effect of these lifestyle improvements? What is the causal relationship between them?
Clinical Practice Guide to Emotional Disorders at Royal Psychiatric College of Australia and New Zealand [10] lists exercise, smoking reduction, healthy eating and improving sleep as the "step 0" goals, and is first performed before implementing drug treatment and/or psychotherapy.
The top journal in the field of mental health, World Psychiatry (IF: 40.595), also published a meta-analysis, which revealed the prevention and treatment effects of a series of lifestyles including physical activity, smoking cessation, healthy eating and good sleep on mental problems such as depression, anxiety and stress, schizophrenia , bipolar disorder , etc. This article summarizes 29 meta-analysis based on the prospective/ cohort study , 12 Mendel randomized studies (MR), 2 meta-analysis and reviews, and 2 meta-analysis for randomized controlled trials (RCTs) [11].
Lifestyle factors in prevention and treatment of mental illness Source: Firth J et al, World Psychiatry. 2020.
1. Exercise
Prevention and auxiliary treatment of a series of mental disorders
A large amount of research evidence shows that sports activities play a certain role in reducing the risk of certain mental disorders .In addition, the meta-analysis based on RCTh also shows that exercise intervention can be used as an adjunctive treatment for depression, anxiety and stress-related diseases, psychiatric disorders and attention deficit/hyperactivity disorder (ADHD), but it still needs to be repeated further in high-quality RCT.
Currently, the "American Sports Activities Guide" [12] and the UK's "Agency Guide" [13] has included exercise in the recommendation, believing that it can reduce the risk of depression (including postpartum depression ). The European Psychiatric Association [14] even proposed that there is sufficient evidence to recommend that structured exercise training can be an effective first-line treatment option for moderate depression and as an auxiliary intervention measure to improve symptoms of severe mental illness.
Tips
. Performing 150 minutes of moderate-intensity activities or 75 minutes of vigorous activities every week can reduce the risk of adults' various health conditions [17],[18].
. Cooperating with some muscle strength and resistance training, it can also effectively improve the symptoms of mental and mental illnesses [15],[16],[17].
2. Sleep deprivation
related to the occurrence and worsening of mental illness
Large-scale meta-analysis and MR studies show that lack of sleep is related to the occurrence of various mental illnesses, and there is a causal relationship with bipolar disorder . In addition, Sleep disorder will also significantly increase the risk of suicide behavior in patients with mental illness [18]. The RCT-based meta-analysis also supports the effect of sleep intervention in reducing symptoms of depression.
Tips
Try insomnia cognitive behavioral therapy (CBT-I) , which mainly includes five aspects: sleep hygiene education, stimulation control, sleep restriction, relaxation therapy and cognitive therapy. Research shows that it can be used as a non-drug option to effectively improve sleep and mental health problems [19],[20].
3. Smoking
Common and important causes of serious mental illness
Multiple meta-analysis shows that smoking is related to the increased expected risk of mental disorders, early onset age and other adverse outcomes [21],[22]. Genome-wide association analysis (GWAS) studies also revealed causal relationships between smoking and severe depression, bipolar disorder and schizophrenia.
Tips
quit smoking early, including e-cigarettes.
4. Healthy diet pattern
Improve depression-related symptoms
Some meta-analysis suggests that healthy diet pattern can reduce the risk of depression-related symptoms. Several recent RCTs also reported the significant improvement of Mediterranean diet on depression [23],[24],[25]. In 2021, a meta-analysis of 18 studies studied the correlation between vitamins, especially vitamins B2, B6, B12, and the risk of depression. The results show that intake of these vitamins in female groups is significantly negatively correlated with the risk of depression [26].However, the impact of dietary factors on common and serious mental illnesses needs to be further confirmed.
Tips
Try
In short, a healthy lifestyle (exercise [29], Mediterranean diet [30][30]m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m2m 2, good sleep [31] and quit smoking [32]) plays an important role in the prevention and treatment of mental illnesses. The potential mechanism may be to improve inflammation [33]. At the same time, since intestinal bacterial will be affected by exercise [34] and diet [35], it is also regarded as another potential way to affect mental health. However, the field is still in its infancy and deserves further exploration in future research.
References
1 World Health Organization. Depression and other common mental disorders:Global health estimates 2017. Published 2017.
2 Patalay P, Gage SH. Changes in millennial adolescent mental health and health-related behaviours over 10 years: a population cohort comparison study. Int J Epidemiol 2019;48:1650-64.
3 Holahan CJ, Pahl SA, Cronkite RC, et al. Depression and vulnerability to incident physical illness across 10 years. J Affect Disord. 2010;123:222–229.
4 Rhebergen D, Beekman AT, De Graaf R, et al. Trajectories of recovery of social and physical functioning in major depression, dynamic disorder and double depression: a 3-year follow-up. J Affect Disord. 2010;124:148–156.
5 Pratt LA, Brody DJ. Depression in the U.S. household population. NCHS Data Brief. 2009;2014:1–8.
6 2. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry 2016;3:171-8.
7 Lakhan R, Agrawal A, Sharma M. Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic. J Neurosci Rural Pract. 2020 Oct;11(4):519-525. doi: 10.1055/s-0040-1716442. Epub 2020 Sep 11. PMID: 33144785; PMCID: PMC7595780.
8 Patel V, Saxena S, Lund C et al. The Lancet Commission on global mental health and sustainable development. Lancet 2018;392:1553-98. 4. Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry 2018;17:49-60.
9 4. Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry 2018;17:49-60.
10 Malhi GS, Bassett D, Boyce P et al. Royal Australian and New Zealand College of Psychiatists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015;49:1087-206.
11 Firth J, Solmi M, Wootton RE, Vancampfort D, Schuch FB, Hoare E, Gilbody S, Torous J, Teasdale SB, Jackson SE, Smith L, Eaton M, Jacka FN, Veronese N, Marx W, Ashdown-Franks G, Siskind D, Sarris J, Rosenbaum S, Carvalho AF, Stubbs B. A meta-review of "lifestyle psychology": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020 Oct;19(3):360-380. doi: 10.1002/wps.20773. PMID: 32931092; PMCID: PMC7491615.
12 Piercy KL, Troiano RP, Ballard RM et al. The physical activity guidelines for Americans. JAMA 2018;320:2020-8.
13 Department of Health and Social Care. UK Chief Medical Officers’ Physical Activity Guidelines. www.gov.uk/government/news/new-physical-activityguidelines
14 Stubbs B, Vancampfort D, Hallgren M et al. EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and position statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). Eur Psychiatry 2018;54:124-44.
15 Ortega FB, Silventoinen K, Tynelius P et al. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ 2012;345:e7279.
16 Gordon BR, McDowell CP, Lyons M et al. Associations between grip strength and generalized anxiety disorder in older adults: results from the Irish longitudinal study on ageing. J Affect Disord 2019;255:136-41.
17 Gordon BR, McDowell CP, Hallgren M et al. Association of efficiency of resistance exercise training with depression symptoms meta-analysis and meta-regression: analysis of randomized clinical trials. JAMA Psychiatry 2018;75:566-76.
18 Wang X, Cheng S, Xu H. Systemic review and meta-analysis of the relationship between sleep disorders and suicidal behavior in patients with depression. BMC Psychiatry 2019;19:303.
19 Ye Y-Y, Chen N-K, Chen J et al. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open 2016;6:e010707.
20 96. Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry 2019;18:337-52
21 Gurillo P, Jauhar S, Murray RM et al. Does tobacco use cause psychology? Systematic review and meta-analysis. Lancet Psychiatry 2015;2:718-25.
22 Sankaranarayanan A, Mancuso S, Wilding H et al. Smoking, suicidality and psychology: a systematic meta-analysis. PLoS One 2015;10:e0138147.
23 Francis HM, Stevenson RJ, Chambers JR et al. A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. PLoS One 2019;14:e0222768.
24 . Jacka FN, O’Neil A, Opie R et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med 2017;15:23
25 Parletta N, Zarnowiecki D, Cho J et al. A Mediterranean-style dietary intervention supplemented with fish oil improvements diet quality and mental health in people with depression: a randomized controlled trial (HELFIMED). Nutr Neurosci 2019;22:474-87.
26 Wu Y, Zhang L, Li S, Zhang D. Associations of dietary vitamin B1, vitamin B2, vitamin B6, and vitamin B12 with the risk of depression: a systematic review and meta-analysis. Nutr Rev. 2021 Apr 29:nuab014. doi: 10.1093/nutrit/nuab014. Epub ahead of print. PMID: 33912967.
27 . Firth J, Torous J, Stubbs B et al. The “online brain”: how the Internet may be changing our cognition. World Psychiatry 2019;18:119-29.
28 Linardon J, Cuijpers P, Carlbring P et al. The efficiency of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials. World Psychiatry 2019;18:325-36.
29 . Gleeson M, Bishop NC, Stensel DJ et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nature Rev Immunol 2011;11:607-15.
30 Kastorini C-M, Milionis HJ, Esposito K et al. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 2011;57:1299-313.
31 Chen H-Y, Cheng I-C, Pan Y-J et al. Cognitive-behavioral therapy for sleep disorder decreases inflammation cytokines and oxidative stress in hemodialysis patients. Kidney Int 2011;80:415-22.
32 Reichert V, Xue X, Bartscherer D et al. A pilot study to examine the effects of smoking cessation on serum markers of inflammation in women at risk for cardiovascular disease. Chest 2009;136:212-9.
33 Yuan N, Chen Y, Xia Y et al. Inflammation-related biomarkers in major psychiatric disorders: a cross-disorder assessment of reproductivity and Specificity in 43 meta-analyses. Transl Psychiatry 2019;9:1-13.
34 Mailing LJ, Allen JM, Buford TW et al. Exercise and the gut microbiome: a review of the evidence, potential mechanisms, and implications for human health. Exerc Sport Sci Rev 2019;47:75-85.
35 Ghosh T, Rampelli S, Jeffery I. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across five European countries. Gut 2020;69:1218-28.
