抑鬱症高發的背後，可能與這些生活方式有關

健康的定義不僅是沒有身體的缺陷和疾病,還要有完好的生理、心理狀態和社會適應能力。世界衛生組織數據顯示：2015年全球約有4.4%的人口飽受抑鬱症的困擾[1]；抑鬱和焦慮在年輕人中的發病率也越來越高[2]。抑鬱症患者通常存在社會心理損傷[3]和嚴重的後遺症[4],[5]，生活質量普遍低於健康人群[6]。

2019年，新冠疫情肆虐全球，突如其來的隔離以及一系列不確定事件的發生嚴重影響着我們的生活。隨之發生改變的還有我們的心理狀態，由此導致的健康問題也日益凸顯。

一篇研究綜述總結了2019年12月至2020年6月期間心理健康問題的發生情況[7]。綜述共納入16項研究、113,285人（11項研究來自中國，兩項來自印度，各一項來自西班牙、意大利和伊朗）。研究發現，在新冠大流行期間，抑鬱、焦慮、壓力、睡眠問題和心理痛苦感的發生率均有所增加，抑鬱症的患病率為20%，焦慮為35%，壓力為53%。

儘管針對上述疾病的心理和藥物治療已經取得了大量進展，但在全球範圍內，尤其是在一些收入水平較低的國家，由於社會心理衛生服務的稀缺，很大一部分人口仍無法獲得相應的心理輔導和治療[8],[9]。

因此，除了心理治療和藥物干預，生活方式相關的干預措施也逐漸受到了關注。那麼，這些生活方式的改善作用到底有多大呢？它們之間的因果關係又是如何呢？

澳大利亞和新西蘭皇家精神病學院的情緒障礙臨床實踐指南[10]將鍛煉、減少吸煙、健康飲食和改善睡眠列為“第 0 步”目標，在實施藥物治療和/或心理治療之前要首先進行。

精神衛生領域的頂級期刊World Psychiatry（IF：40.595）也發表了一篇薈萃分析，為我們揭示了一系列生活方式包括身體活動、戒煙、健康飲食和良好睡眠等對抑鬱、焦慮和壓力、精神分裂症、雙相情感障礙等精神問題的預防和治療作用。該文章匯總了29項基於前瞻性/隊列研究的meta分析、12項孟德爾隨機研究（MR）、2項meta分析和綜述以及2項針對隨機對照試驗（RCT）的meta分析[11]。

精神疾病預防和治療中的生活方式因素 圖源：Firth J et al, World Psychiatry. 2020.

01. 運動

預防及輔助治療一系列精神障礙

大量研究證據表明，體育活動在降低某些精神障礙發生風險方面具有一定的作用。此外，基於RCT的薈萃分析結果也表明，運動干預可以作為抑鬱症、焦慮和壓力相關疾病、精神失常和注意力缺陷/多動障礙（ADHD）的輔助治療措施，但仍需在高質量RCT中進一步重複。

當前，《美國人體育活動指南》[12]和英國的《體育活動指南》[13]已經將運動納入了建議，認為可以降低抑鬱症的風險（包括產後抑鬱症）。歐洲精神病學協會[14]更是提出，當前有足夠證據推薦結構化運動訓練可以作為中度抑鬱症的有效的一線治療選擇，並作為改善嚴重精神疾病癥狀的輔助干預措施。

Tips

1.每周進行150分鐘的中等強度活動或 75 分鐘的劇烈活動，可以降低成人發生各種健康狀況的風險[17],[18]。

2. 配合一些肌肉力量和阻力訓練，也可以有效改善精神和心理疾病相關癥狀[15],[16],[17]。

02. 睡眠不足

與精神疾病的發生和惡化有關

大規模薈萃分析和MR研究顯示睡眠不足與多種精神疾病的發生有關，並且與雙相情感障礙存在因果關係。除此之外，睡眠障礙還會顯著增加精神疾病患者的自殺行為風險[18]。而基於RCT的薈萃分析也支持睡眠干預在減輕抑鬱癥狀方面的效果。

Tips

試試失眠認知行為療法（CBT-I），它主要包括五方面的內容：睡眠衛生教育、刺激控制、睡眠限制、鬆弛療法和認知治療。研究顯示，它可以作為一種非藥物選擇，有效改善睡眠和心理健康問題[19],[20]。

03. 吸煙

常見和嚴重精神疾病發生的重要原因

多項薈萃分析表明，吸煙與精神障礙預期風險增加、發病年齡提前及其他不良結局相關[21],[22]。全基因組關聯分析（GWAS）研究也揭示了吸煙與嚴重抑鬱症、雙相情感障礙和精神分裂症存在因果關係。

Tips

及早戒煙，包括電子煙。

04. 健康的飲食模式

改善抑鬱相關癥狀

一些薈萃分析提示健康的飲食模式可降低抑鬱相關癥狀的發生風險。最近的幾項 RCT也報告了地中海飲食對抑鬱症的顯著改善作用[23],[24],[25]。2021年，一個納入18項研究的薈萃分析研究了維生素，尤其是維生素B2，B6，B12，與抑鬱症風險的相關性。結果顯示，在女性群體中，這幾種維生素的攝入量與抑鬱症風險呈顯著負相關[26] 。但飲食因素對常見和嚴重精神疾病的影響有待進一步確認。

Tips

試試

總之，健康的生活方式（運動[29]、地中海飲食[30]、良好的睡眠[31]和戒煙[32]）在精神疾病的預防和治療中發揮着重要作用，其潛在機制可能是通過改善炎症[33]。同時，由於腸道菌群會受到運動[34]和飲食[35]的影響，也被視為另一種影響心理健康的潛在途徑。然而，該領域仍處於起步階段，值得我們在未來的研究中進一步探索。

參考文獻

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