The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials

Croatto, Giovanni; Vancampfort, Davy; Miola, Alessandro; Olivola, Miriam; Fiedorowicz, Jess G.; Firth, Joseph; Alexinschi, Ovidiu; Găină, Marcel-Alexandru; Makkai, Vladimir; Soares, Fernanda Cunha; Cavaliere, Leandro; Vianello, Giorgia; Stubbs, Brendon; Fusar‐Poli, Paolo; Carvalho, André F.; Vieta, Eduard; Cortese, Samuele; Smıth, Lee; Correll, Christoph U.; Solmi, Marco

doi:10.1038/s41380-022-01770-w

Cited by 17 publications

(17 citation statements)

References 46 publications

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“…This finding is comparable with the effect sizes of general medicines and psychiatric drugs reported in a frequently cited meta-analyses overview of psychological health, even though the longer-term effect of ACT beyond 6 months is yet to be established. This result is encouraging, as 75% of people with psychological distress prefer nonpharmacological treatment with minimal adverse effects . In addition, the current study identified positive effects of ACT on psychological flexibility of caregivers, including experiential avoidance, value-based living, mindfulness, and cognitive fusion.…”

Section: Discussionsupporting

confidence: 53%

“…This result is encouraging, as 75% of people with psychological distress prefer nonpharmacological treatment with minimal adverse effects. [74][75][76] In addition, the current study identified positive effects of ACT on psychological flexibility of caregivers, including experiential avoidance, value-based living, mindfulness, and cognitive fusion. These outcomes suggest that ACT may cultivate psychological flexibility by improving the acceptance of emotions, clarifying a valuesoriented life, promoting living in the present moment, distancing from negative feelings, and eventually, mediating the effects of the intervention on depressive, anxiety, and stress symptoms.…”

Section: Overall Efficacymentioning

confidence: 72%

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Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions

Ye,

Lee,

Xue

et al. 2023

JAMA Netw Open

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ImportanceAlthough there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health conditions, the great variation in intervention designs among published studies limits its application.ObjectivesTo identify intervention characteristics of ACT that are associated with improved psychological health and to assess the acceptability of ACT among informal caregivers.Data SourcesSeven English- and 3 Chinese-language databases without limits on publication dates, the reference lists of previous reviews, and gray literature were searched up to February 2023.Study SelectionRandomized clinical trials comparing the effect of ACT vs control groups on improving psychological health among informal caregivers.Data Extraction and SynthesisTwo reviewers independently screened searched records and extracted data from eligible studies. Random-effects meta-analysis and mixed-effects metaregression were performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed.Main Outcomes and MeasuresPsychological health outcomes (eg, depressive symptoms) measured by valid measurements and the acceptability of ACT based on identified parameters.ResultsA total of 29 studies with 2010 participants, published between 2015 and 2023, were identified. ACT showed moderate to large effect sizes for improving psychological health at postintervention assessments (Hedges g range, −0.55 [95% CI, −0.98 to −0.12] to −1.14 [95% CI, −1.83 to −0.45]) and at 1-to-3–month and 4-to-6–month follow-ups (Hedges g range, −0.47 [95% CI, −0.69 to −0.25] to −1.29 [95% CI, −2.33 to −0.24]). Multivariable metaregression analysis regarding intervention characteristics found that ACT delivered in a mixed individual- and group-based format, face-to-face, or through more intervention sessions was associated with greater improvements for experiential avoidance (face-to-face: β = −1.170 [95% CI, −2.020 to −0.319]; number of sessions: β = −0.242 [95% CI, −0.353 to −0.130]), depressive symptoms (mixed delivery format: β = −2.583 [95% CI, −4.845 to −0.321]; face-to-face: β = −1.555 [95% CI, −3.002 to −0.108]), or anxiety symptoms (face-to-face: β = −1.241 [95% CI, −2.337 to −0.146]). In general, ACT had low attrition rates (11%), and participants’ adherence (51%-80%) and satisfactory ratings (72%-95%) lend support to its acceptability.Conclusions and RelevanceThis systematic review and meta-analysis found that ACT was consistently associated with improvements in psychological health, supporting its application to improve informal care for chronic disease management. This review provides specific details on the design parameters of ACT for achieving greater efficacy.

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Section: Discussionsupporting

confidence: 53%

Section: Overall Efficacymentioning

confidence: 72%

Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions

Ye,

Lee,

Xue

et al. 2023

JAMA Netw Open

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“…In addition to improving depressive symptoms, antidepressant medication may have positive effects on physical disease outcomes. For example, a recent umbrella review found that SSRIs may im prove fasting glucose/HbA1c and pain 332 , and may reduce hospital ization rates in coronary artery disease 281 . Among individuals with diabetes mellitus, antidepressant treatment is reported by RCTs to improve glycemic control 292 , and is associated with lower mor tality 333 and a lower risk for myocardial infarction 334 .…”

Section: Effect Of Mdd Treatments On Physical Disease Outcomesmentioning

confidence: 99%

“…There is also tentative evidence that psychotherapies may improve physical health‐related quality of life and fasting glucose/HbA1C 332 , and have a positive impact on physical outcomes in people with ischemic heart disease 318 . However, results are limited by the low quality of trials, and recent advances in medical care may have outweighed previously demonstrated benefits of psychotherapy 318 .…”

Section: Clinical Managementmentioning

confidence: 99%

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

Berk,

Köhler‐Forsberg,

Turner

et al. 2023

World Psychiatry

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Populations with common physical diseases – such as cardiovascular diseases, cancer and neurodegenerative disorders – experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug‐drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic‐pituitary‐adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio‐environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

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“…According to the Global Burden of Diseases, Injuries, and Risk Factors Study, which provides a systematic scientific evaluation of published and contributed data on the incidence, prevalence, and mortality of 369 diseases and injuries for 204 countries and territories, depression is the most frequently found mental health condition among the general population, with a combined rate of 3440.1 (per 100,000) for both sexes, and being higher among women (rate, 4158.4/100,000) than in men (rate, 2713.3/100,000) [ 1 ]. This disease has become a global health issue, which not only affects people’s mental health but also increases the risk of comorbidities in comparison to the general population [ 2 ], and demands continuous effort from both families and society [ 3 , 4 , 5 ]. Based on forecasts of economic and social development worldwide, the Global Burden of Disease Project estimated that depression will be among the top three causes of disease burden by 2030 [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Physical Exercise on Executive Function in Adults with Depression: A Systematic Review and Meta-Analysis

Contreras-Osorio

Ramírez‐Campillo

Cerda-Vega

et al. 2022

IJERPH

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Executive function is among the most affected cognitive dimensions in depression. Physical exercise may improve executive function (e.g., working memory, inhibition, cognitive flexibility), although this is without consensus on adults with depression. Through this systematic review, we aim to elucidate the effects of physical exercise programs on executive functions in adults with depression. The literature search was performed in four relevant electronic databases, combining keywords and medical subject headings, from inception until September 2022. Controlled interventions, involving adults with depression, and reporting working memory, inhibition, and/or cognitive flexibility pre-post-intervention data, were considered includable. Results from meta-analyses included effect size (ES, i.e., Hedges’ g) values reported with 95% confidence intervals (95%CIs), with p set at ≤0.05. Seven studies were included, including 202 men and 457 women (age: 21.0–51.2 years; mild–moderate depression). For working memory, a small favoring effect was observed in the experimental groups compared with controls (ES = 0.33, 95%CI = 0.04–0.61; p = 0.026; I2 = 64.9%). For inhibition, physical exercise had a small favoring non-significant effect compared with controls (ES = 0.28, 95%CI = −0.17–0.74; p = 0.222; I2 = 72.4%). Compared with the control group, physical exercise had a trivial effect on cognitive flexibility (ES = 0.09, 95%CI = −0.21–0.39; p = 0.554; I2 = 68.4%). In conclusion, physical exercise interventions may improve working memory behavioral measures in adults with mild-to-moderate depression when compared with active and passive control conditions. However, the reduced number of available high-quality studies precludes more lucid conclusions.

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The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials

Cited by 17 publications

References 46 publications

Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions

Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

Effects of Physical Exercise on Executive Function in Adults with Depression: A Systematic Review and Meta-Analysis

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