Faculty Bibliography

BACKGROUND:Social support is associated with improved prognosis and quality of life after a cancer diagnosis. However, less is known about patients' experiences with disclosing their diagnosis to access support. This study investigated diagnosis disclosure patterns and the illness experiences of patients with multiple myeloma and precursor plasma cell disorders. METHODS:A 34-question survey was distributed between April-November 2023 to patients with plasma cell disorders via HealthTree Foundation's Patient Portal. Deidentified survey responses were analyzed using summary statistics, Fisher's exact test for group comparisons, and qualitative coding of open-ended answers. RESULTS:Among 510 survey respondents, 98% shared their diagnosis. Of these (n = 501), most shared within a day or week (88%), primarily in person (86%), and most frequently with spouses/partners (81%) and friends (81%). Sharers reported improved coping (84%) and stronger relationships (55%), whereas nonsharers (n = 9) reported feeling more isolated (56%). The majority of sharers (87%) did not regret disclosing their diagnosis to anyone. Compared to patients with multiple myeloma (n = 328; 78%), patients with precursor disorders (n = 44; 56%) were less likely to report coping well with their diagnosis (P < .001). Overall, participants advised newly diagnosed patients to consider disclosure timing, prioritize sharing with close contacts, maintain privacy, and educate themselves before sharing. CONCLUSION/CONCLUSIONS:Patients considered diagnosis disclosure to be beneficial to their coping and relationships, and recommended considering various factors when disclosing, including timing, personal relationships, and privacy. Patients with precursor disorders were less likely to indicate they were coping well, suggesting that this group may benefit from additional support resources.

Lifestyle-related behaviours-such as sedentary behaviour, physical inactivity, poor nutrition, disrupted sleep and substance use-are increasingly recognised as important factors in the onset and persistence of mental illness. Evidence for the efficacy and cost-efficiency of lifestyle interventions in mental health is growing, and such approaches are now embedded in international guidelines and endorsed by major health organisations and associations as 'lifestyle psychiatry'. Nevertheless, despite this progress, these interventions remain underused in mental healthcare and support. One contributing factor is the lack of a shared conceptual understanding of 'lifestyle psychiatry', which risks fragmented practice, inconsistency in research and uncertainty around its role in policy, care and support. This paper presents a conceptual framework for lifestyle psychiatry, developed through an iterative, collaborative process involving 43 contributors across 15 countries, representing clinical, academic, policy and lived experience expertise. The framework defines core domains, outlines key challenges to behaviour change specific to mental health populations and emphasises multilevel and equity-oriented approaches. It aligns with person-centred and recovery-oriented care and serves as a shared reference point for practical application and future development. With this, we aim to support the structured, context-sensitive integration of lifestyle psychiatry into mental healthcare and support.

The field of Lifestyle Psychiatry aims to prevent, treat, and sometimes reverse chronic physical and mental health conditions through evidence-based interventions. The foundational pillars of this field are physical activity & exercise, nutrition, restorative sleep, stress management, toxic exposure reduction, and connectedness. Connection has been defined as "feeling part of something larger than yourself, feeling close to another person or group, feeling welcomed, and understood." Within Lifestyle Psychiatry, however, we emphasize that connectedness encompasses not only our relationships with other individuals but also our connection to ourselves and with the world at large. We have identified these three relationships as three core or pivotal needs. Similarly, we have expanded our previous model of connectedness to include six domains: (1) Happiness, (2) Purpose in Life & Meaning-Making, (3) Empathy & Compassion, (4) Social Connection & Community, (5) Nature, and (6) Spirituality & Religion. In this paper, we present psychological and scientific data supporting the necessity of the six domains of connectedness. By combining the six domains with the three core needs, practitioners of lifestyle psychiatry can develop impactful and sustainable interventions that promote connectedness, decrease negative health outcomes, and promote psychological growth through increasing resilience, emotional development, and the ability to be alone without loneliness.

The field of psychiatry has evolved over the past 2500 years. Between dynamic psychotherapy and psychopharmacology, lifestyle psychiatry holds a different space. This approach capitalizes on the lifestyle medicine movement, as it promotes change within 6 domains of activity. Apart from incorporating these lifestyle pillars as adjunctive therapy for either psychodynamic therapy or psychotropic medication regimens, lifestyle psychiatry is on the frontier similar to the other growing fields of precision psychiatry, advanced learning in psychiatry, psychedelics in psychiatry, digital mental health, and psychiatric genetics. Any disruption into the historical practice of psychiatry, particularly with the prescription of medications, can be met with scrutiny. We encourage the field of psychiatry to keep an open mind as our field continues to evolve. What makes lifestyle psychiatry particularly powerful and unique in its ability to assess and evaluate internal and external factors that contribute to individual behaviors, and may impact the ability to incorporate healthy lifestyle actions. Internal factors include: emotional regulation, internalized trauma, cognitive factors, and personality traits. On the other hand, external factors include environmental barriers and work-related burnout.

The incidence of substance use and behavioral addictions continues to increase throughout the world. The Global Burden of Disease Study shows a growing impact in disability-adjusted life years due to substance use. Substance use impacts families, communities, health care, and legal systems; yet, the vast majority of individuals with substance use disorders do not seek treatment. Within the United States, new legislation has attempted to increase the availability of buprenorphine, but the impact of substance use continues. Although medications and group support therapy have been the mainstay of treatment for substance use, lifestyle medicine offers a valuable adjunct therapy that may help strengthen substance use recovery through healthy neuroplastic changes.

Posttraumatic stress disorder is part of a spectrum of psychological symptoms that are frequently linked with a single defining traumatic experience. Symptoms can vary over the lifespan in intensity based on additional life stressors, individual stability, and connectedness to purpose. Historically, treatment has centered on psychotropic agents and individual and group therapy to increase the individual's window of tolerance, improve emotional dysregulation, and strengthen relationships. Unfortunately, there is a growing segment of individuals with posttraumatic stress disorder who do not respond to these traditional treatments, perhaps because they do not address the multidirectional relationships between chronic cortisol, changes in the brain gut microbiota system, neuroinflammation, and posttraumatic symptoms. We will review the literature and explain how trauma impacts the neuroendocrine and neuroimmunology within the brain, how these processes influence the brain gut microbiota system, and provide a mechanism for the development of posttraumatic stress disorder symptoms. Finally, we will show how the lifestyle psychiatry model provides symptom amelioration.

Climate change is becoming the most significant global challenge and must be addressed on a global scale. At the time that this article is being written, the planetary heat in 2023 was the hottest on record. Similarly, the World Health Organization reports that 99% of the world's population lives in regions of unhealthy air pollution. Similarly, depression has become one of the leading causes of global mental and physical disabilities, and the impact of depression is predicted to only worsen over the next 25 years. It is interesting to note that climate experts often overlook the adoption of nutrition via a whole plant-based diet as a solution to both mental illness and climate change. In this review, we will touch upon the role of nutrition in gut microbiota and mental health, the impact diet has on greenhouse gases, the role of ultra-processed food, and environmental factors such as air pollution and increasing planetary heat and their growing impacts on mental health. In the end, the promotion of plant-based foods has the potential to improve personal mental and physical health while improving planetary health.