Abstract
The aim of this systematic review was to determine the adherence to lifestyle interventions for adults with depression and to estimate the dropout rates in trials examining the impact of these interventions. A bibliographic search was conducted in PubMed, Embase, PsycINFO, the Cochrane library, and several sources of grey literature. We included randomised controlled trials examining the impact of multiple lifestyle interventions on depressive symptomatology in adults when compared to control or other active treatments. Two reviewers independently screened citations, extracted the relevant data, and assessed the risk of bias using Cochrane tools. A random effects meta-analysis of proportions was used to summarise the proportion of participants who completed the intervention and to determine the proportion of dropouts at post-treatment assessment. Multiple subgroup analyses were also carried out. We identified six trials. The meta-analysis of proportions showed that 53% (95%CI 49% to 58%) of the participants assigned to the intervention group fully adhered to the intervention program. The weighted mean proportion of completed intervention sessions was 66%. The pooled trial dropout rate was 22% (95%CI 20% to 24%). Around half of adults with depression adhere to lifestyle interventions. Future research is needed to develop interventions to support adherence to lifestyle interventions in depressive patients.
Highlights
Depression is considered the most common mental disorder in general population [1,2], affecting more than 264 million people worldwide [3].Regarding its comorbidity with other diseases, there is a strong association between depression and specific physical illnesses [4], with a prevalence of coexisting chronic physical illness and depressive disorders ranging from 9.3% to 23.0% [5]
We we examined examinedthe theadherence adherencetoto lifestyle interventions adults with with depression depression and thethe dropout rates in trials evaluating the impact of adults andestimated estimated dropout rates in trials evaluating the impact interventions
If we compare our findings with face-to-face cognitive behaviour therapy (CBT), adherence to lifestyle interventions is substantially lower: van Ballegooijen et al, 2014 [22], carried out a meta-analysis to examine the adherence to face-to-face CBT for depression and found that 84.7% completed the entire intervention
Summary
Depression is considered the most common mental disorder in general population [1,2], affecting more than 264 million people worldwide [3].Regarding its comorbidity with other diseases, there is a strong association between depression and specific physical illnesses [4], with a prevalence of coexisting chronic physical illness and depressive disorders ranging from 9.3% to 23.0% [5]. Major depressive disorder is more common in patients with neurological, oncological, or liver disease [6] These comorbidities are associated with poorer quality of life, higher mortality rates, higher economic costs, and greater disability and functional impact on the patient compared to depression or physical illness when presented alone [5,7]. Previous research has demonstrated the association between depression and lifestyle behaviours, such as sedentary lifestyle, unhealthy diet, insomnia, social withdrawal, and stress, among others [8–10]. For these reasons, psychopharmacotherapy and psychotherapy are effective treatments for depression [11–13], it is important to contemplate “Lifestyle Medicine” techniques for the prevention and treatment of depression [14]
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