抑郁症高发的背后，可能与这些生活方式有关

健康的定义不仅是没有身体的缺陷和疾病,还要有完好的生理、心理状态和社会适应能力。世界卫生组织数据显示：2015年全球约有4.4%的人口饱受抑郁症的困扰[1]；抑郁和焦虑在年轻人中的发病率也越来越高[2]。抑郁症患者通常存在社会心理损伤[3]和严重的后遗症[4],[5]，生活质量普遍低于健康人群[6]。

2019年，新冠疫情肆虐全球，突如其来的隔离以及一系列不确定事件的发生严重影响着我们的生活。随之发生改变的还有我们的心理状态，由此导致的健康问题也日益凸显。

一篇研究综述总结了2019年12月至2020年6月期间心理健康问题的发生情况[7]。综述共纳入16项研究、113,285人（11项研究来自中国，两项来自印度，各一项来自西班牙、意大利和伊朗）。研究发现，在新冠大流行期间，抑郁、焦虑、压力、睡眠问题和心理痛苦感的发生率均有所增加，抑郁症的患病率为20%，焦虑为35%，压力为53%。

尽管针对上述疾病的心理和药物治疗已经取得了大量进展，但在全球范围内，尤其是在一些收入水平较低的国家，由于社会心理卫生服务的稀缺，很大一部分人口仍无法获得相应的心理辅导和治疗[8],[9]。

因此，除了心理治疗和药物干预，生活方式相关的干预措施也逐渐受到了关注。那么，这些生活方式的改善作用到底有多大呢？它们之间的因果关系又是如何呢？

澳大利亚和新西兰皇家精神病学院的情绪障碍临床实践指南[10]将锻炼、减少吸烟、健康饮食和改善睡眠列为“第 0 步”目标，在实施药物治疗和/或心理治疗之前要首先进行。

精神卫生领域的顶级期刊World Psychiatry（IF：40.595）也发表了一篇荟萃分析，为我们揭示了一系列生活方式包括身体活动、戒烟、健康饮食和良好睡眠等对抑郁、焦虑和压力、精神分裂症、双相情感障碍等精神问题的预防和治疗作用。该文章汇总了29项基于前瞻性/队列研究的meta分析、12项孟德尔随机研究（MR）、2项meta分析和综述以及2项针对随机对照试验（RCT）的meta分析[11]。

精神疾病预防和治疗中的生活方式因素 图源：Firth J et al, World Psychiatry. 2020.

01. 运动

预防及辅助治疗一系列精神障碍

大量研究证据表明，体育活动在降低某些精神障碍发生风险方面具有一定的作用。此外，基于RCT的荟萃分析结果也表明，运动干预可以作为抑郁症、焦虑和压力相关疾病、精神失常和注意力缺陷/多动障碍（ADHD）的辅助治疗措施，但仍需在高质量RCT中进一步重复。

当前，《美国人体育活动指南》[12]和英国的《体育活动指南》[13]已经将运动纳入了建议，认为可以降低抑郁症的风险（包括产后抑郁症）。欧洲精神病学协会[14]更是提出，当前有足够证据推荐结构化运动训练可以作为中度抑郁症的有效的一线治疗选择，并作为改善严重精神疾病症状的辅助干预措施。

Tips

1.每周进行150分钟的中等强度活动或 75 分钟的剧烈活动，可以降低成人发生各种健康状况的风险[17],[18]。

2. 配合一些肌肉力量和阻力训练，也可以有效改善精神和心理疾病相关症状[15],[16],[17]。

02. 睡眠不足

与精神疾病的发生和恶化有关

大规模荟萃分析和MR研究显示睡眠不足与多种精神疾病的发生有关，并且与双相情感障碍存在因果关系。除此之外，睡眠障碍还会显著增加精神疾病患者的自杀行为风险[18]。而基于RCT的荟萃分析也支持睡眠干预在减轻抑郁症状方面的效果。

Tips

试试失眠认知行为疗法（CBT-I），它主要包括五方面的内容：睡眠卫生教育、刺激控制、睡眠限制、松弛疗法和认知治疗。研究显示，它可以作为一种非药物选择，有效改善睡眠和心理健康问题[19],[20]。

03. 吸烟

常见和严重精神疾病发生的重要原因

多项荟萃分析表明，吸烟与精神障碍预期风险增加、发病年龄提前及其他不良结局相关[21],[22]。全基因组关联分析（GWAS）研究也揭示了吸烟与严重抑郁症、双相情感障碍和精神分裂症存在因果关系。

Tips

及早戒烟，包括电子烟。

04. 健康的饮食模式

改善抑郁相关症状

一些荟萃分析提示健康的饮食模式可降低抑郁相关症状的发生风险。最近的几项 RCT也报告了地中海饮食对抑郁症的显著改善作用[23],[24],[25]。2021年，一个纳入18项研究的荟萃分析研究了维生素，尤其是维生素B2，B6，B12，与抑郁症风险的相关性。结果显示，在女性群体中，这几种维生素的摄入量与抑郁症风险呈显著负相关[26] 。但饮食因素对常见和严重精神疾病的影响有待进一步确认。

Tips

试试

总之，健康的生活方式（运动[29]、地中海饮食[30]、良好的睡眠[31]和戒烟[32]）在精神疾病的预防和治疗中发挥着重要作用，其潜在机制可能是通过改善炎症[33]。同时，由于肠道菌群会受到运动[34]和饮食[35]的影响，也被视为另一种影响心理健康的潜在途径。然而，该领域仍处于起步阶段，值得我们在未来的研究中进一步探索。

参考文献

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, dysthymic 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 Psychiatrists 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 psychiatry": 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 efficacy of resistance exercise training with depressive symptoms meta-analysis and meta-regression: analysis of randomized clinical trials. JAMA Psychiatry 2018;75:566-76.

18 Wang X, Cheng S, Xu H. Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour 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 psychosis? Systematic review and meta-analysis. Lancet Psychiatry 2015;2:718-25.

22 Sankaranarayanan A, Mancuso S, Wilding H et al. Smoking, suicidality and psychosis: 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 improves 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 efficacy 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 disturbance decreases inflammatory 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 reproducibility 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.