A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

Abstract

There is increasing academic and clinical interest in how "lifestyle factors" traditionally associated with physical health may also relate to mental health and psychological well-being. In response, international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta-review of the top-tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta-analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta-reviews, and two meta-analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress-related disorders, schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non-pharmacological sleep-focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels.

Keywords: Lifestyle factors; anxiety disorders; bipolar disorder; depression; dietary patterns; mental disorders; physical activity; psychological well-being; schizophrenia; sedentary behavior; sleep; tobacco smoking.

Figure 1

Lifestyle factors in the prevention and treatment of mental illness. The dashed line indicates evidence for protective benefit from either prospective meta‐analyses (P‐MAs) or Mendelian randomization studies (MRs). The double‐dashed line indicates evidence for protective effects from both P‐MAs and MRs. The solid line indicates evidence for efficacy in treatment of mental illness from MAs of randomized controlled trials (RCTs). The double solid line indicates convergent evidence from MRs or P‐MAs with MAs of RCTs. The treble solid line indicates convergent evidence from all three (P‐MAs + MRs + MAs of RCTs). ADHD – attention‐deficit/hyperactivity disorder.