Lifestyle interventions can help pediatricians meet the growing need for adolescent depression management

Lifestyle interventions can help pediatricians meet the growing need for adolescent depression management

With the increasing prevalence of depression in adolescents, screening demands are increasingly falling on pediatric primary care physicians who are encountering more at-risk patients. A new literature review in the Harvard Review of Psychiatry highlights evidence that nontraditional, so-called lifestyle interventions can help providers meet the growing need for youth depression management. The journal is published in the Lippincott portfolio of Wolters Kluwer.

The article reviews studies of lifestyle medicine interventions related to physical activity, sleep, nutrition, substance use, social connectedness, and stress management and provides recommendations for clinical practice. “Additional and more comprehensive detail about such lifestyle recommendations could help physicians incorporate specific advice into advance guidelines, management and treatment plans,” suggest Talia S. Benheim, BA, and colleagues at Massachusetts General Hospital, along with Michelle Dalal, MD, of the University of Massachusetts Chan Medical School, and Daniel Hosker, MD, in the September/October issue of the Harvard Review of Psychiatry.

Lifestyle medicine interventions can alleviate the lack of access to traditional mental health treatments

Depression in adolescents is strongly associated with negative academic, occupational, and health outcomes well into adulthood, and studies point to the importance of early and timely access to mental health interventions. However, inaccessibility to mental health services remains, particularly among marginalized populations.

The benefits, versatility and cost-effectiveness of lifestyle interventions are well known. They can be used by both licensed and unlicensed providers; implemented independently or as part of a larger treatment plan; administered in person or virtually, with an individual patient or in groups; and are often more cost-effective and adapt to patients' unique cultural situations.

The article examines evidence for lifestyle interventions on physical activity, sleep, nutrition, substance use, social connectedness, and stress and demonstrates the effectiveness or feasibility in reducing depressive symptoms in adolescents. The studies included clinical trials, quantitative studies and qualitative studies, as well as the authors' own clinical experience.

Regardless of whether physical activity is considered light or rigorous, many studies show the effectiveness of physical activity in reducing symptoms of depression. For example, one showed that a two-hour reduction in sedentary activity in patients ages 12 to 16 reduced depression scores by 16% to 22% by age 18.

Sleep problems in adolescents persist into adulthood and have been linked to lack of response to depression treatment and are even a risk factor for suicide. However, one study showed that simple and specific guidelines for healthy sleep habits improved depressive symptoms. Bedtime routines such as keeping a diary or relaxation activities, as well as cognitive behavioral therapy for insomnia, are also important.

Nutritional studies show that a healthy, plant- and whole-food-based diet can relieve or reduce depressive symptoms. The authors suggest a number of simple intervention approaches, such as: B. Tip sheets or recipes, the involvement of professional nutritionists and instructions for so-called mindful or intuitive eating.

Cannabis, alcohol and nicotine are also linked to depression in adolescents and can hinder effective treatment of both. Studies show that immediate intervention is paramount. An online program in Australia has shown that increased knowledge about substances, depression and anxiety reduces the likelihood of drinking.

In adolescents, loneliness correlates with depression, and lack of social connectedness is a predictor of suicidal ideation. One study found that increases in connectedness over time led to a corresponding decrease in adolescent suicidal ideation. Many forms of connection—for example, through extracurricular activities such as clubs and sports—have been shown to reduce depressive symptoms and may overlap with other lifestyle interventions.

Finally, interventions to help patients manage and cope with stress may favorably influence the onset, maintenance, and severity of depression. Successful interventions include deep breathing, meditation, muscle relaxation techniques, and mindfulness-based cognitive therapy.

The authors note that interventions that involve significant behavior change can be difficult, particularly without social, financial, or cultural support. Despite the lack of randomized controlled trials of psychological and behavioral health (e.g., physical activity) promoting interventions, Benheim, Dalal, and colleagues believe that these interventions can help meet the increasing need for mental health services and provide teens and families with opportunities to strengthen the knowledge, skills, and habits to combat depression.

Source:

Wolters Klüwer

Reference:

Benheim, T.S., et al. (2022) Back to Basics: Lifestyle Interventions for Adolescent Depression. Harvard Review of Psychiatry. doi.org/10.1097/HRP.0000000000000343.

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