11.1 An Umbrella Review: Eating, Sleeping, and Moving Recommendations in Pediatric Depression Guidelines

Abstract

Current treatments for pediatric depression demonstrate mild to moderate effectiveness. This has spurred a growing body of literature on lifestyle recommendations pertaining to nutrition, sleep, and exercise for treating pediatric depression. Pediatric depression clinical practice guidelines (CPGs) were reviewed for quality and to catalog recommendations pertaining to nutrition, sleep, and exercise made by higher-quality CPGs. Searches were conducted in MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL, and grey-literature CPG databases. Eligible CPGs with a minimum or high-quality level using the AGREE-II (Appraisal of Guidelines for Research and Evaluation) instrument were included if they were: 1) pediatric; 2) clinical practice guidelines, or practice parameter or consensus or expert committee recommendations; 3) for depression; 4) the latest version; and 5) lifestyle recommendations for nutrition, sleep, or exercise. Key information extracted included author(s), language, year of publication, country, the institutional body issuing the CPG, target disorder, age group, lifestyle recommendation, and methods used to determine CPG lifestyle recommendations. Ten pediatric CPGs for depression with a minimum or high quality level contained recommendations on nutrition, sleep, or exercise. Lifestyle recommendations were predominately qualitative with quantitative details only outlined in 2 CPGs for exercise. Most recommendations were brief general statements, with 50% lacking supporting evidence from the literature. Interest in lifestyle interventions as ingredients for treatment in child and youth depression is growing. However, current CPG lifestyle recommendations for nutrition, sleep, or exercise are based more on expert opinion than on clinical trials.