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Review
. 2024 Nov 13;12(22):2263.
doi: 10.3390/healthcare12222263.

The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Sohrab Amiri  1 , Nailah Mahmood  2 , Syed Fahad Javaid  3 , Moien Ab Khan  4
Affiliations
Review

The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Sohrab Amiri et al. Healthcare (Basel). .

Abstract

Background/objectives: Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations.

Methods: Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges' g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined.

Results: Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g -0.21, 95% confidence interval -0.26, -0.15; p < 0.001; I2 = 56.57), anxiety (Hedges g -0.24, 95% confidence interval -0.32, -0.15; p < 0.001; I2 = 59.25), and stress (-0.34, -0.11; p < 0.001; I2 = 61.40).

Conclusions: Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.

Keywords: anxiety; depression; lifestyle; mental disorders; meta-analysis; stress; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart diagram of screening studies included in this meta-analysis [51]. * Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). ** If automation tools were used, indicate how m7 any records were excluded by a human and how many were excluded by automation tools.
Figure 2
Figure 2
Forest plot for lifestyle intervention on depression in women [66,70,76,81,85,94,101,102,104,109,120,121,124,125,128,133,137,138,147,150,156,157].
Figure 3
Figure 3
Forest plot of lifestyle intervention on anxiety [65,66,68,71,75,79,80,81,82,83,85,89,90,92,94,96,97,98,102,103,104,107,108,109,110,112,113,117,118,122,124,127,128,129,135,136,138,142,143,150,151,155,157,158,159,160].
Figure 4
Figure 4
Forest plot for lifestyle intervention on anxiety based on diseases [66,68,71,80,81,82,83,90,93,94,96,97,98,102,107,108,109,113,118,122,128,129,135,136,143,150,155,157,158,160].
Figure 5
Figure 5
Forest plot for lifestyle intervention on anxiety in women [66,81,85,94,102,104,109,124,128,138,150,157].
Figure 6
Figure 6
Forest plot for lifestyle intervention on anxiety based on anxiety scales [65,68,71,75,79,80,81,82,83,85,89,90,92,93,94,97,98,102,103,104,107,108,109,112,117,118,122,127,128,129,135,136,138,143,150,155,157,158,159,160].
Figure 7
Figure 7
Forest plot for lifestyle intervention on stress [65,68,69,82,85,87,92,94,96,103,104,109,112,113,117,119,121,122,125,128,130,133,142,145,150,151,161].
Figure 8
Figure 8
Forest plot for lifestyle intervention on stress based on diseases [68,69,82,94,96,113,119,122,125,128,133,145,150].
Figure 9
Figure 9
Forest plot for lifestyle intervention on stress in women [85,87,94,103,109,121,125,128,133,138,150].
Figure 10
Figure 10
Forest plot for lifestyle intervention on stress based on stress scales [65,68,69,82,85,87,94,96,103,109,112,113,117,119,121,122,125,128,130,133,138,142,144,145,147,150,151].
Figure 11
Figure 11
Funnel plot for lifestyle intervention and depression.
Figure 12
Figure 12
Funnel plot for lifestyle intervention and anxiety.
Figure 13
Figure 13
Funnel plot for lifestyle intervention and stress.
See this image and copyright information in PMC

References

    1. Santomauro D.F., Herrera A.M., Shadid J., Zheng P., Ashbaugh C., Pigott D.M., Abbafati C. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398:1700–1712. doi: 10.1016/S0140-6736(21)02143-7. - DOI - PMC - PubMed
    1. GBD 2019 Mental Disorders Collaborators Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9:137–150. doi: 10.1016/S2215-0366(21)00395-3. - DOI - PMC - PubMed
    1. GBD 2019 Diseases and Injuries Collaborators Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222. doi: 10.1016/S0140-6736(20)30925-9. - DOI - PMC - PubMed
    1. Fang Y., Ji B., Liu Y., Zhang J., Liu Q., Ge Y., Xie Y., Liu C. The prevalence of psychological stress in student populations during the COVID-19 epidemic: A systematic review and meta-analysis. Sci. Rep. 2022;12:12118. doi: 10.1038/s41598-022-16328-7. - DOI - PMC - PubMed
    1. Kirkbride J.B., Anglin D.M., Colman I., Dykxhoorn J., Jones P.B., Patalay P., Pitman A., Soneson E., Steare T., Wright T., et al. The social determinants of mental health and disorder: Evidence, prevention and recommendations. World Psychiatry. 2024;23:58–90. doi: 10.1002/wps.21160. - DOI - PMC - PubMed

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