Appendix
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Lifestyle Medicine

Lifestyle Mental Wellbeing for the Primary Care Visit

Lifestyle medicine is the evidence-based practice of helping patients adopt and sustain behaviors that promote health and improve quality of life. Lifestyle medicine emphasizes six pillars of healthy habits: nutrition, exercise, relationships, stress, sleep, and substance use. Combined, these habits become a risk or protective factor for each person's physical and mental health and can also be modified to improve quality of life. This activity reviews the relationship between emotional distress

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • In Australian populations, those with severe mental illness have a 10 to 20-year decrease in life expectancy compared to the general population.
  • The consequence is our mental health, evidenced by major depressive disorder becoming the leading cause of disability worldwide.
  • Mental illness also complicates co-existing medical conditions, making them more challenging and expensive to manage.
  • In addition, referrals are common when mental health disorders are comorbid with specific physical illnesses (eg, diabetes and depression) or the patient presents with severe mental illness (SMI) or suicidality.
  • Identify screening tools for stress, depression, and anxiety;
  • data from screening measures for mood typically already used in primary care can be utilized (eg, Patient Health Questionnaire (PHQ-2/PHQ-9), Generalized Anxiety Disorder Scale (GAD-2/GAD-7), Perceived Stress Scale (PSS-10), Multidimensional Scale of Perceived Social Support (MSPSS)).
  • Two primary assessments screen patients' status in the 6 lifestyle medicine pillars.
  • For patients who screen positive, further evaluation is necessary.
Patient Health Questionnaire
PHQ-2/PHQ-9
Generalized Anxiety Disorder Scale
GAD-2/GAD-7
Perceived Stress Scale
PSS-10
Multidimensional Scale of Perceived Social Support
MSPSS
  • Lifestyle medicine emphasizes six pillars of healthy habits: nutrition, exercise, relationships, stress, sleep, and substance use.
  • In the primary care visit, the first line of advice to patients at risk for hypertension or hyperlipidemia, both risk factors for cardiovascular disease, is to make lifestyle changes such as diet and exercise.
  • Lifestyle Medicine would additionally emphasize lifestyle modification, including addressing a sedentary lifestyle, poor diet, and caffeine and alcohol use.
  • Lifestyle interventions delivered by PCPs that appear most effective offer specific behavior prescriptions, personalized advice according to patient factors and goals, and behavioral supports like patient-facing informational handouts, referrals, and follow-up.
  • Action planning, helping patients move toward action, and coping planning, helping patients identify their barriers to change and proactively create plans to manage them, are 2 techniques that help the goal-setting and achievement process.
  • While medication and therapy are used as first-line treatments to treat the symptoms of mental illness, as the name indicates, Lifestyle Medicine can address patients’ habits that are modifiable risk factors.
  • Referral to a mental health provider with knowledge of lifestyle medicine can complement and strengthen any additional treatment that might be necessary.
  • Referral options vary by setting/organization: self-help, guided self-help, group treatment, integrated primary care (IPC), referrals within the organization, and outside referrals.
  • For patients who struggle with adherence to lifestyle medicine recommendations, a referral to behavioral health (eg, a health psychologist or psychiatrist) may address the barriers interfering with meeting health goals.
  • Telehealth can also be an effective tool for those with mobility barriers or who need to travel a long distance to meet in person.
  • The patient's self-assessment results would also be part of ongoing monitoring for the efficacy of the prescribed treatment.
  • Follow-up also resulted in increased effects compared to initial referral only.
  • Strategies like SMART goals (Specific, Measurable, Achievable, Relevant, and Time-Bound) can be enhanced with SMARTER (Evaluated, Readjust) and SMART-EST (Evidence-based, Strategic, Tailored to the patient), which specifically target the importance of follow-up.
  • Computerized screening allows for integration with electronic health records, which may optimize diagnosis, treatment, and follow-up and provide consistent data on outcome metrics.
  • review
    Lifestyle Mental Wellbeing for the Primary Care Visit. StatPearls [Internet] — Lei Kang, Liana Abascal, Jeremy D. Schroeder — StatPearls Publishing, 2022

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov