Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce

Author: Wolfgang Marx1, Sam H Manger2,3, Mark Blencowe3, Greg Murray4, Fiona Yan-Yee Ho5, Sharon Lawn6,7, James A Blumenthal8, Felipe Schuch9, Brendon Stubbs10, Anu Ruusunen1,11,12, Hanna Demelash Desyibelew13, Timothy G Dinan14, Felice Jacka1, Arun Ravindran15, Michael Berk1, Adrienne O'Neil1
1 Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.
2 College of Medicine and Dentistry, James Cook University, Queensland, Australia.
3 Australasian Society of Lifestyle Medicine, Melbourne, Australia.
4 Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
5 Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR.
6 Lived Experience Australia Ltd, Adelaide, Australia.
7 College of Medicine and Public Health, Flinders University, Adelaide, Australia.
8 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
9 Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil.
10 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
11 Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
12 Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.
13 Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
14 APC Microbiome Ireland, University College Cork, Cork, Ireland.
15 Department of Psychiatry & Institute of Medical Sciences, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.
Conference/Journal: World J Biol Psychiatry
Date published: 2022 Oct 6
Other: Special Notes: doi: 10.1080/15622975.2022.2112074. , Word Count: 394

The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings.

Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria.

Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework.

Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.

Keywords: Major depressive disorder; guidelines; lifestyle; mental health; treatment.

PMID: 36202135 DOI: 10.1080/15622975.2022.2112074