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

Joseph Firth; Marco Solmi; Robyn E Wootton; Davy Vancampfort; Felipe B Schuch; Erin Hoare; Simon Gilbody; John Torous; Scott B Teasdale; Sarah E Jackson; Lee Smith; Melissa Eaton; Felice N Jacka; Nicola Veronese; Wolfgang Marx; Garcia Ashdown-Franks; Dan Siskind; Jerome Sarris; Simon Rosenbaum; André F Carvalho; Brendon Stubbs

doi:10.1002/wps.20773

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

World Psychiatry. 2020 Oct;19(3):360-380. doi: 10.1002/wps.20773.

Authors

Joseph Firth^{1

2}, Marco Solmi³, Robyn E Wootton⁴, Davy Vancampfort^{5

6}, Felipe B Schuch⁷, Erin Hoare⁸, Simon Gilbody⁹, John Torous¹⁰, Scott B Teasdale¹¹, Sarah E Jackson¹², Lee Smith¹³, Melissa Eaton², Felice N Jacka¹⁴, Nicola Veronese¹⁵, Wolfgang Marx¹⁴, Garcia Ashdown-Franks^{16

17

18}, Dan Siskind^{19

20}, Jerome Sarris^{2

21}, Simon Rosenbaum¹¹, André F Carvalho^{22

23}, Brendon Stubbs^{17

18}

Affiliations

¹ Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
² NICM Health Research Institute, Western -Sydney University, Westmead, NSW, Australia.
³ Department of Neurosciences, University of Padua, Padua, Italy.
⁴ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
⁵ KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
⁶ University Psychiatric Centre KU Leuven, Kortenberg, Belgium.
⁷ Department of Sports Methods and -Techniques, Federal University of Santa Maria, Santa Maria, Brazil.
⁸ UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of -Cambridge, Cambridge, UK.
⁹ Mental Health and Addictions Research Group, Department of Health Sciences, University of York, York, UK.
¹⁰ Department of Psychiatry, Beth Israel Deaconess Medical Canter, Harvard Medical School, Boston, MA, USA.
¹¹ School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, -Australia.
¹² Department of Behavioural Science and Health, University College London, London, UK.
¹³ Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, -Cambridge, UK.
¹⁴ Food & Mood Centre, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
¹⁵ Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
¹⁶ Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada.
¹⁷ South London and Maudsley NHS Foundation Trust, London, UK.
¹⁸ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁹ Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia.
²⁰ School of Medicine, University of Queensland, Brisbane, QLD, Australia.
²¹ Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Melbourne, VIC, Australia.
²² Centre for Addiction & Mental Health, Toronto, ON, Canada.
²³ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

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.

Abstract

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