Patient-reported outcomes of lifestyle interventions in patients with severe mental illness: a systematic review and meta-analysis

Background Lifestyle interventions for severe mental illness (SMI) are known to have small to modest effect on physical health outcomes. Little attention has been given to patient-reported outcomes (PROs). Aim To systematically review the use of PROs and their measures, and quantify the effects of lifestyle interventions in patients with SMI on these PROs. Methods Five electronic databases were searched (PubMed/Medline, Embase, PsycINFO, CINAHL, and Web of Science) from inception until 12 November 2020 (PROSPERO: CRD42020212135). Randomised controlled trials (RCTs) evaluating the efficacy of lifestyle interventions focusing on healthy diet, physical activity, or both for patients with SMI were included. Outcomes of interest were PROs. Results A total of 11.267 unique records were identified from the database search, 66 full-text articles were assessed, and 36 RCTs were included, of which 21 were suitable for meta-analyses. In total, 5.907 participants were included across studies. Lifestyle interventions had no significant effect on quality of life ( g = 0.13; 95% CI = − 0.02 to 0.27), with high heterogeneity ( I 2 = 68.7%). We found a small effect on depression severity ( g = 0.30, 95% CI = 0.00 to 0.58, I 2 = 65.2%) and a moderate effect on anxiety severity ( g = 0.56, 95% CI = 0.16 to 0.95, I 2 = 0%). Discussion This meta-analysis quantifies the effects of lifestyle interventions on PROs. Lifestyle interventions have no significant effect on quality of life, yet they could improve mental health outcomes such as depression and anxiety symptoms. Further use of patient-reported outcome measures in lifestyle research is recommended to fully capture the impact of lifestyle interventions.