Objectives:The primary objectives of these international guidelines were to provide a global audience of clinicians with(a)a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder(MDD)and(b)a series of implementation considerations that may be applicable across a range of settings.

Methods:Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of task force members.The focus of the guidelines was eight lifestyle domains:physical activity and exercise,smoking cessation,work-directed interventions,mindfulness-based and stress manage ment therapies,diet,sleep,loneliness and social support,and green space interaction.The fol lowing electronic bibliographic databases were searched for articles published prior to June 2020:PubMed,EMBASE,The Cochrane Library(Cochrane Database of Systematic Reviews,Cochrane Central Register of Controlled Trials(CENTRAL),Cochrane Methodology Register),CINAHL,PsycINFO.Evidence grading was based on the level of evidence specific to MDD and risk of bias,in accordance with the World Federation of Societies for Biological Psychiatry criteria.

Results:Nine recommendations were formed.The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise,relaxation techniques,work directed interventions,sleep,and mindfulness-based therapies(Grade 2).Interventions related to diet and green space were recommended,but with a lower strength of evidence(Grade 3).Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion.Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach,the importance of partnering such recommendations with behaviour change support,and the need to deliver interventions using a biopsychosocial-cultural framework.

Conclusions:Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder,where other evidence-based therapies can be added or used in combination.The findings and recommenda tions of these guidelines support the need for further research to address existing gaps in efficacy and implementation research,especially for emerging lifestyle-based approaches(e.g.green space,loneliness and social support interventions)where data are limited.Further work is also needed to develop innovative approaches for delivery and models of care,and to support the training of health professionals regarding lifestyle-based mental health care.

目的：这些国际指南的主要目的是为全球临床医生提供以下信息：(a) 在临床实践中为重度抑郁症 (MDD) 成人提供基于生活方式的精神卫生保健的一系列循证建议和 (b) 可能适用于一系列环境的一系列实施考虑。

方法：建议和相关的循证分级是基于一系列已发表研究的系统性文献检索以及工作组成员的临床专业知识。指南的重点是8个生活方式领域：体力活动和运动、戒烟、工作导向的干预、正念和压力管理疗法、饮食、睡眠、孤独和社会支持以及绿地互动。在PubMed、EMBASE、Cochrane Library(Cochrane Database of Systematic Reviews,Cochrane Central Register of Controlled Trials(Central) ,Cochrane Methodology Register) ,CINAHL,PsycINFO.证据分级是基于 MDD 特有的证据等级和偏倚风险，根据世界生物精神病学会联合会标准。

结果：提出了9项建议。改善 MDD 评级最高的建议是使用体力活动和运动、放松技巧、工作指导、睡眠和正念疗法（2级）。推荐与饮食和绿地相关的干预措施，但证据强度较低（3级）。关于戒烟和孤独以及社会支持的建议是基于专家意见。关键的实施考虑包括需要联合医疗专业人员的投入和实施这类方法的网络支持，以及将这些建议与行为改变支持合作的重要性，需要使用活检社会文化框架提供干预措施。

结论：建议将生活方式干预措施作为重度抑郁症成人患者临床实践中心理卫生保健的基础组成部分，在临床实践中可以添加或联合使用其他循证疗法。这些指南的发现和建议支持需要进一步研究，以解决疗效和实施研究中的现有差距，特别是对于数据有限的新兴的基于生活方式的方法（例如，绿地、孤独和社会支持干预）。还需要进一步的工作来开发创新的护理方法和护理模式，并支持对医疗保健专业人员进行基于生活方式的心理卫生保健培训。