Our study aimed to determine the effectiveness of lifestyle interventions on health-related quality of life, in patients presenting with concurrent mental and physical health disorders.
The systematic review was conducted using the JBI methodology. EBSCOHost (APA Psychinfo, CINAHL complete), Medline, LiLACS, Scopus, PEDro and Cochrane Central Register of Controlled Trials were searched to identify published randomised control studies available in English from 2011 to 2022. The inclusion criteria were adults with comorbid physical and MHDs who received lifestyle interventions (including stress management strategies) to improve health-related quality of life. Group interventions were excluded.
A total of 888 participants were enrolled in the different randomised trials, which considered depression and diabetes (2 articles), depression and obesity (1 article) and asthma and anxiety (1 article). All studies included cognitive behavioural therapy (CBT), two studies included physical activity in the form of yoga and walking and all studies were conducted over three to twelve months. The i-CARE intervention for diabetes and depression improved HRQOL at six months (SF-8 (Physical): MD 1.5 95% CI [0.7, 3.2]. P=.13 Cohens d = 0.13; SF-8 (Mental): MD 2.9 (95% [CI=0.7, 5.0]). P value=.01. Cohens’ d= 0.37), but these were not maintained one year later. Both mindfulness-based cognitive therapy and CBT had larger improvements in wellbeing (both P.001) with large between group effect sizes when compared to waitlist (Cohen's d range = 0.82-0.97) in patients with diabetes. CBT also led to decreased anxiety in asthma-specific quality of life and these findings were statistically significant compared with changes in controls (ANCOVA -1.18, 95% [CI = - 2.26 to -0.10]) but were not significant one year later. A walking programme and telephone delivered CBT did not improve glycaemic control but did improve HRQOL including depressive symptoms, blood pressure and physical activity.
Lifestyle interventions may be effective in the shorter term to help manage patients with comorbid physical and MHDs. Studies with group activities were excluded, which excluded a large range of other lifestyle interventions.
Stress management modalities such as CBT may be effective in the shorter term to help manage patients with comorbid physical and MHDs, however these studies were limited to therapies at the individual patient level. Studies with group activities were excluded, which excluded a large range of other lifestyle interventions. This review may provide a basis for future recommendations for lifestyle intervention
comorbidities
mental health
