Review article
The Effect of Interventions That Target Multiple Modifiable Health Behaviors on Symptoms of Anxiety and Depression in Young People: A Meta-Analysis of Randomized Controlled Trials

https://doi.org/10.1016/j.jadohealth.2021.08.005Get rights and content

Abstract

Purpose

This meta-analysis aimed to determine the effect of interventions targeting multiple modifiable health behaviors (i.e., physical activity/sedentary behaviors, nutrition/diet, sleep, substance use) on depression and anxiety in young people.

Methods

A search of electronic databases from inception until May 2020 was conducted. Randomized controlled trials (RCTs) that explicitly targeted at least two modifiable health behaviors, measured anxiety or depression at baseline and after intervention using a validated instrument, and included participants with an average age between 12 and 25 years were included. The effect of interventions was synthesized using random effects meta-analysis.

Results

A total of 14 RCTs reporting on depression and six RCTs reporting on anxiety were included in the quantitative synthesis. Results showed that although interventions targeting multiple modifiable health behaviors did not produce significant reductions in symptoms of depression (g¯ = -.16, 95% confidence interval [CI] = [-.34, .02], 95% prediction interval [PI] = [-.80, .48], very low certainty evidence) or anxiety (g¯ = -.55, 95% CI = [-1.36, .26], 95% PI = [-3.48, 2.83], very low certainty evidence) across all young people, there was a significant difference in the effect of interventions on depression based on intervention type (Q = 8.37, df = 2, p = .012). Specifically, interventions targeting multiple modifiable health behaviors delivered to groups of young people with an elevated risk of depression had a favorable effect (g¯ = -.28, 95% CI = [-.52, -.05], 95% PI = [-1.04, .47]) on symptoms of depression compared with controls.

Conclusions

Although not universally effective, this meta-analysis establishes the potential efficacy of targeted interventions aiming to improve multiple modifiable health behaviors to address depression in young people at elevated risk of depression. More research is needed to understand the effect of such interventions on symptoms of anxiety in young people.

Section snippets

Methods

This systematic review and meta-analysis was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [31] and was preregistered in the International Prospective Register For Systematic Reviews database (ID: CRD42019148544).

Study selection

After removing duplicates, the literature search yielded 9463 potentially relevant articles; 9300 articles were removed based on title and abstract screening, and 163 full texts were retrieved. Of the full texts screened, 149 articles were considered ineligible (see Figure 1 for reasons), and 14 relevant articles were identified. One additional article was identified after checking the reference list of relevant articles. In total, 15 articles, reporting on 15 unique RCTs, met the inclusion

Discussion

This meta-analysis aimed to determine the effect of interventions targeting multiple modifiable health behaviors, including physical activity/sedentary behaviors, nutrition/diet, sleep, and substance use, on symptoms of depression and anxiety in adolescents and young adults. A total of 15 RCTs were identified, 14 of which were included in the meta-analysis for depression (n = 2,522) and six in the meta-analysis for anxiety (n = 1,096). The current meta-analysis provides mixed support for the

Funding Sources

No funding was received for this report.

Acknowledgments

J.F. is supported by a University of Manchester Presidential Fellowship (P123958) and a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1). F.N.J. has received support from the Brain and Behaviour Research Institute, the National Health and Medical Research Council (NHMRC), Australian Rotary Health, the Geelong Medical Research Foundation, the Ian Potter Foundation, and The University of Melbourne. A.G.P. has received support from the National Health and Medical Research Council

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    Conflicts of interest: J.F. has received honoraria/consultancy fees from Atheneum, ParachuteBH, and Nirakara, independent of this work. F.N.J. has received industry support for research from Meat and Livestock Australia, Woolworths Limited, the A2 Milk Company, and Be Fit Foods; philanthropic support from the Fernwood Foundation, Wilson Foundation, the JTM Foundation, the Serp Hills Foundation, the Roberts Family Foundation, and the Waterloo Foundation; and travel support and speakers honoraria from Sanofi-Synthelabo, Janssen Cilag, Servier, Pfizer, Network Nutrition, Angelini Farmaceutica, Eli Lilly, and Metagenics. F.N.J. has written two books for commercial publication.

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