@article{ref1,
title="Combined healthy lifestyle and depressive symptoms: a meta-analysis of observational studies",
journal="Journal of affective disorders",
year="2021",
author="Wang, Xiaowen and Arafa, Ahmed and Liu, Keyang and Eshak, Ehab S. and Hu, Yonghua and Dong, Jia-Yi",
volume="289",
number="",
pages="144-150",
abstract="BACKGROUND: To systematically summarize the association between combined lifestyle (at least three factors, including but not limited to smoking, drinking, physical activity, body mass index, diet) and depressive symptoms by a meta-analysis in general populations. <br><br>METHODS: Multiple electronic databases were searched for observational studies investigating combined lifestyle factors and depressive symptoms published before September 2020. Pooled risk estimates were calculated using random-effects models. Publication bias was conducted using the Egger's and Begg's tests. <br><br>RESULTS: A total of 12 studies with 185,899 participants were included. The pooled OR of depressive symptoms in meta-analysis of 7 cross-sectional studies was 0.53 (0.39, 0.72), I(2) = 83.6%, P for heterogeneity <0.001 and the pooled RR was 0.33 (0.12, 0.89), I(2) = 95.3%, P for heterogeneity <0.001 in meta-analysis of 5 cohort studies for people with the highest versus lowest score of heathy lifestyles. In sensitivity analyses, the heterogeneity was significantly reduced in cross-sectional studies (pooled OR = 0.74 [0.65, 0.85], I(2) = 21.7%, P for heterogeneity = 0.27) and cohort studies (pooled RR = 0.53 [0.38, 0.74], I(2) = 15.2%, P for heterogeneity = 0.32). The publication bias corrected by &quot;trim-and-fill&quot; analysis yielded unchanged results. LIMITATIONS: Limitations included residual confounding in original studies, heterogeneity between studies, and potential publication bias in the analysis of cross-sectional studies. <br><br>CONCLUSION: The healthy lifestyle was associated with a reduced risk of depressive symptoms. Adherence to overall healthy lifestyles is essential for the primary prevention of depression in general populations.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2021.04.030",
url="http://dx.doi.org/10.1016/j.jad.2021.04.030"
}