title: Study protocol for a systematic review of evidence for lifestyle interventions targeting smoking, sleep, alcohol/other drug use, physical activity, and healthy diet in people with bipolar disorder.
abstract: People with bipolar disorder (BD) have a mortality gap of up to 20 years compared to the general population. Physical conditions, such as cardiovascular disease (CVD) and cancer, cause the majority of excess deaths in psychiatric populations and are the leading causes of mortality in people with BD. However, comparatively little attention has been paid to reducing the risk of physical conditions in psychiatric populations. Unhealthy lifestyle behaviors are among the potentially modifiable risk factors for a range of commonly comorbid chronic medical conditions, including CVD, diabetes, and obesity. This systematic review will identify and evaluate the available evidence for effective interventions to reduce risk and promote healthy lifestyle behaviors in BD.
  
  
  
  We will search MEDLINE, Embase, PsychINFO, Cochrane Database of Systematic Reviews, and CINAHL for published research studies (with at least an abstract published in English) that evaluate behavioral or psychosocial interventions to address the following lifestyle factors in people with BD: tobacco use, physical inactivity, unhealthy diet, overweight or obesity, sleep-wake disturbance, and alcohol/other drug use. Primary outcomes for the review will be changes in tobacco use, level of physical activity, diet quality, sleep quality, alcohol use, and illicit drug use. Data on each primary outcome will be synthesized across available studies in that lifestyle area (e.g., tobacco abstinence, cigarettes smoked per day), and panel of research and clinical experts in each of the target lifestyle behaviors and those experienced with clinical and research with individuals with BD will determine how best to represent data related to that primary outcome. Seven members of the systematic review team will extract data, synthesize the evidence, and rate it for quality. Evidence will be synthesized via a narrative description of the behavioral interventions and their effectiveness in improving the healthy lifestyle behaviors in people with BD.
  
  
  
  The planned review will synthesize and evaluate the available evidence regarding the behavioral or psychosocial treatment of lifestyle-related behaviors in people with BD. From this review, we will identify gaps in our existing knowledge and research evidence about the management of unhealthy lifestyle behaviors in people with BD. We will also identify potential opportunities to address lifestyle behaviors in BD, with a view to reducing the burden of physical ill-health in this population.
  
  
  
  PROSPERO CRD42015019993.
authors.affiliation: National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. f.kaylambkin@unsw.edu.au.|Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia. f.kaylambkin@unsw.edu.au.
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Kay-Lambkin
authors.affiliation: National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Thornton
authors.affiliation: Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Lappin
authors.affiliation: Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia.|School of Psychology, University of Newcastle, Newcastle, Australia.
authors.forename: Tanya
authors.initials: T
authors.lastname: Hanstock
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Sylvia
authors.affiliation: IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia.
authors.forename: Felice
authors.initials: F
authors.lastname: Jacka
authors.affiliation: Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Baker
authors.affiliation: IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia.
authors.forename: Michal
authors.initials: M
authors.lastname: Berk
authors.affiliation: Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia.
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Mitchell
authors.affiliation: School of Biomedical Sciences and Pharmacy, Faculty of Medicine, The University of Newcastle, Newcastle, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Callister
authors.affiliation: Brain and Mind Institute, University of Sydney, Sydney, Australia.
authors.forename: Naomi
authors.initials: N
authors.lastname: Rogers
authors.affiliation: National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Webster
authors.affiliation: School of Psychology, University of Newcastle, Newcastle, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Dennis
authors.affiliation: CReDITSS, Hunter Medical Research Institute, Newcastle, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Oldmeadow
authors.affiliation: The University of Melbourne, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: MacKinnon
authors.affiliation: CReDITSS, Hunter Medical Research Institute, Newcastle, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Doran
authors.affiliation: Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia.|IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia.
authors.forename: Alyna
authors.initials: A
authors.lastname: Turner
authors.affiliation: National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Hunt
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects / Q000517:prevention & control* / Q000523:psychology; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control; D000072001:Diet, Healthy; D055317:Evidence-Based Practice; D015444:Exercise; D005247:Feeding Behavior / Q000523:psychology; D006801:Humans; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012890:Sleep; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D000074606:Smoking Prevention; D019966:Substance-Related Disorders / Q000517:prevention & control*; D000078202:Systematic Reviews as Topic
keywords: Alcohol/other drug use; Bipolar disorder; Depression; Diet; Interventions; Mania; Morbidity; Mortality; Physical activity; Prevention; Risk; Sleep; Smoking; Tobacco; Treatment; Weight loss