Gender-responsive Lifestyle Psychiatry for Individuals with Significant Mental Health Difficulty: Do single sex studies offer new insights? A scoping review.

HSE Southeast Psychology Research Symposium and Trainee Launch
Abstract for Symposium 06.02.2024

Gender-responsive Lifestyle Psychiatry for Individuals with Significant Mental Health Difficulty – Do single sex studies offer new insights? A scoping review
Andrea Buckley1 , Noel Richardson2, Denise Rogers3, Jeyachandran Chandrakanth3 , Rebekah Carney4, Grace McKeon5, Evan Matthews1
Background
People with significant mental health difficulty have high rates of physical comorbidities, reducing their quality of life and lifespan by 10-20 years compared to the general population. Lifestyle Psychiatry (LP) is a developing field including modifiable interventions that can improve mental health outcomes, namely physical activity, diet, sleep, and smoking cessation interventions (Firth et al., 2020, Noordsy, 2019). The two different but intersecting concepts sex and gender are linked to outcomes of physical and mental health, with sex defined as biological, and gender as socially constructed (Heidari et al., 2016). Gender is incorporated into the United Nations (UN) 2030 Agenda for Sustainable Development Goals (SDGs) to reduce health inequities, indicating an importance for gender-responsive consideration in LP. This scoping review explored how sex and gender were considered within LP as recommended in key policy to reduce gender inequities and improve physical and mental health.
Methods
Guidance of the Joanna Briggs Institute`s (JBI) were followed and their Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) applied (Peters et al., 2021). The search strategy included terms relating to “severe mental illness”, “lifestyle psychiatry”, and “sex/gender”, regarding adults over 18 years, in all study types except review protocols in peer-reviewed literature in English from 2012 to 2022. Databases CINAHL, Scopus and PubMed searches identified N=9,441 articles, after duplicate removal titles and abstracts of 9,432 articles were screened, and 14 gender-specific studies retrieved that met the inclusion criteria.
Data was extracted using an author developed standardised form, findings mapped and reported in a narrative synthesis.
Results
There were N=10 female- and N=4 male-specific studies included in this review. The preliminary findings show lifestyle interventions with choices of physical activity and additional supports initiated early in treatment work well with respect to LP efficacy. Gender-specific differences in psychiatric illness presentation were noted as supported by recent literature on gender-sensitive research (Otten et al., 2021). No non-binary studies were retrieved, despite of inclusion in the search criteria. The extent to which these findings are subject to gender bias remains to be explored. An important option for gender-responsive targeted treatment is to include the experiences of staff and patients to attain sustainable physical and mental health improvements.
The next steps in this collaborative PhD project aim to explore experiences and attitudes of staff and service users in mental health services in the South East of Ireland. The aim is to develop guidance for gender-responsive Lifestyle Psychiatry to support mental health services for enhanced future care.

References:
Firth, J. et al. (2020). A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry, [online] 19(3), pp. 360-380. https://doi.org/10.1002/wps.20773
Heidari, S. et al. (2016). Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Research Integrity and Peer Review, 1(1). https://doi.org/10.1186/S41073-016-0007-6
Noordsy, D. L. (Ed.). (2019). Lifestyle Psychiatry. American Psychiatric Association Publishing.
Otten, D., Tibubos, A. N., Schomerus, G., Brähler, E., Binder, H., Kruse, J., Ladwig, K. H., Wild, P. S., Grabe, H. J., & Beutel, M. E. (2021). Similarities and Differences of Mental Health in Women and Men: A Systematic Review of Findings in Three Large German Cohorts. In Frontiers in Public Health (Vol. 9). Frontiers Media S.A. https://doi.org/10.3389/fpubh.2021.553071

Peters, M. D. J. et al. (2021). Updated methodological guidance for the conduct of scoping reviews. (JBI Evidence Implementation, 19(1), 3–10. https://doi.org/10.1097/XEB.0000000000000277
WHO (2011). Gender mainstreaming for health managers: a practical approach. Geneva: World Health Organization (http://www.who.int/gender-equity-rights/knowledge/health_managers_guide/en).

Affiliations
1. School of Health Sciences, South East Technological University (SETU), Ireland
2. National Centre for Men`s Health, SETU, Ireland
3. Waterford Wexford Mental Health Services, Southeast Community Healthcare, Health Service Executive (HSE), Ireland
4. Greater Manchester West Mental Health National Health Service (NHS) Foundation Trust, Manchester, United Kingdom, University of Manchester, United Kingdom
5. School of Population Health, University of New South Wales, Australia,
Discipline of Psychiatry and Mental Health, University of New South Wales, Australia