A longitudinal study of lifestyle behaviours in emerging adulthood and risk for symptoms of depression, anxiety, and stress.

BACKGROUND: Little research has examined how lifestyle behaviours cluster together to contribute to mental health outcomes. The current study aimed to identify latent classes of emerging adult lifestyle behaviours (diet, physical activity, sedentary time, smoking, alcohol, cannabis, and other drug use) at age 20 years and their associations with depression, anxiety, and stress symptoms at age 22 and 27 years. METHODS: Participants were 616 emerging adults enrolled in the Raine Study. Lifestyle classes at baseline were identified using latent class analysis. Longitudinal associations between latent class membership and risk of depression, anxiety, and stress symptoms were examined using logistic regression models. RESULTS: Three lifestyle classes were identified: Class 1 (healthier pattern, n = 399 [64.8 %]), Class 2 (predominantly female, high substance-use, low physical activity pattern, n = 121 [19.6 %]), and Class 3 (predominantly male, high substance-use, poor diet pattern, n = 96 [15.6 %]). Following adjustment, Class 2 were at a higher risk of depression, anxiety, and stress symptoms at age 22 years, and a higher risk of anxiety and stress symptoms at age 27 years, compared to Class 1. LIMITATIONS: This study was limited by reliance on self-report data, lack of available indicators for parental socioeconomic status, and some measurement inconsistencies across variables. Adherence to lifestyle clusters over time was not assessed. CONCLUSIONS: Latent classes of lifestyle behaviours were identified among emerging adults, and differences in mental health outcomes were found among the classes at two prospective time points. Future research and prevention strategies for common mental disorders should target emerging adults and focus on lifestyle patterns.

Universal depression prevention: An umbrella review of meta-analyses.

Depression is a disabling, highly prevalent, frequently chronic, and difficult-to-treat disorder with an immense cognitive, social, and economic burden. Given that many of the advances in other non-communicable disorders like cancer have been in prevention rather than treatment, the prevention of depression is currently an unmet public health priority. We sought to provide an overview of the meta-analytic literature through conducting a systematic umbrella review of universally delivered preventive interventions for depression. The search was conducted on March 18, 2021 utilising the following databases (all accessed through EBSCOHost); Allied and Complementary Medicine Database, CINAHL Complete, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete and APA PsychArticles. The following search terms related to depression, prevention, and trial study design. Two authors independently screened articles and a third resolved discrepancies. Eligibility criteria sought to identify meta-analyses that investigated the prevention of depression (i.e., reduced incidence) through intervention studies that were universal, in that they were designed to be delivered to entire populations Six meta-analyses on psychological interventions, two school-based meta-analyses, and one eHealth meta-analysis were included in this umbrella review. Findings indicated that all identified studies were of good quality and one was of fair quality. One previous meta-review that examined physical activity to prevent depression was included in results, comprising eight meta-analyses. Preventive interventions have primarily and successfully utilized psychological therapeutic components, delivered at the school, community, and workplace settings. Both school- and eHealth-based interventions hold some utility for depression prevention. There is meta-analytic evidence that physical activity is efficacious for depression prevention. However, universal prevention is inconsistently defined. There is a pressing need for well-designed randomized controlled preventative interventions for depression before recommendations can be universally accepted with convincing level of evidence.

The Dietary Inflammatory Index and Human Health: An Umbrella Review of Meta-Analyses of Observational Studies.

Numerous observational studies have investigated the role of the Dietary Inflammatory Index (DII®) in chronic disease risk. The aims of this umbrella review and integrated meta-analyses were to systematically synthesize the observational evidence reporting on the associations between the DII and health outcomes based on meta-analyses, and to assess the quality and strength of the evidence for each associated outcome. This umbrella review with integrated meta-analyses investigated the association between the DII and a range of health outcomes based on meta-analyses of observational data. A credibility assessment was conducted for each outcome using the following criteria: statistical heterogeneity, 95% prediction intervals, evidence for small-study effect and/or excess significance bias, as well as effect sizes and P values using calculated random effects meta-analyses. In total, 15 meta-analyses reporting on 38 chronic disease-related outcomes were included, incorporating a total population of 4,360,111 subjects. Outcomes (n = 38) were examined through various study designs including case-control (n = 8), cross-sectional (n = 5), prospective (n = 5), and combination (n = 20) study designs. Adherence to a pro-inflammatory dietary pattern had a significant positive association with 27 (71%) of the included health outcomes (P value < 0.05). Using the credibility assessment, Class I (Convincing) evidence was identified for myocardial infarction only, Class II (Highly suggestive) evidence was identified for increased risk of all-cause mortality, overall risk of incident cancer, and risk of incident site-specific cancers (colorectal, pancreatic, respiratory, and oral cancers) with increasing (more pro-inflammatory) DII score. Most outcomes (n = 31) presented Class III (Suggestive) or lower evidence (Weak or No association). Pro-inflammatory dietary patterns were nominally associated with an increased risk of many chronic disease outcomes. However, the strength of evidence for most outcomes was limited. Further prospective studies are required to improve the precision of the effect size.

A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders.

There is increasing academic and clinical interest in how "lifestyle factors" traditionally associated with physical health may also relate to mental health and psychological well-being. In response, international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta-review of the top-tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta-analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta-reviews, and two meta-analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress-related disorders, schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non-pharmacological sleep-focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels.

Association of Child and Adolescent Mental Health With Adolescent Health Behaviors in the UK Millennium Cohort.

Importance: There is potential for mental health status to act as a determinant of an individual's ability to engage in healthful lifestyle behaviors. Objective: To investigate the associations of parent-reported mental health problems during childhood and self-reported mental health problems in adolescence with health behaviors in adolescence. Design, Setting, and Participants: This cohort study used data from wave 4 (collected in 2008) and wave 6 (collected in 2015) of the Millennium Cohort Study, a UK population-representative longitudinal study of young people born during 2000 to 2001. Wave 4 included data on parent-reported mental health issues for children at age 7 years. Wave 6 included data on self-reported mental health problems as well as health behaviors for the same children at age 14 years. Data were analyzed July 5, 2020. Exposures: Mental health problems at age 7 years were parent-reported using Strengths and Difficulties Questionnaire. Mental health problems at age 14 years were self-reported using the Short Mood and Feelings Questionnaire. Main Outcomes and Measures: Health behaviors at age 14 years were the main outcome of interest. Sleep duration; fruit, vegetable, and soft drink consumption; and social media use were self-reported using recall on a typical day. Regression models were calculated for each lifestyle variable, with mental health change from ages 7 to 14 years as the exposure variable. Data were weighted to account for the potential clustering of region of sampling and adjusted for nonresponse. Results: A total of 9369 participants were included in waves 4 and 6 of the Millennium Cohort Study, including 4665 (48.1%) girls and 6014 participants (81.9%) who were born in England. Adolescents who self-reported mental health problems at age 14 years only were less likely to have at least 9 hours of sleep (odds ratio [OR], 0.39; 95% CI, 0.34-0.45) and to consume fruit (OR, 0.55; 95% CI, 0.46-0.65) and vegetables (OR, 0.66; 95% CI, 0.52-0.83) reported greater use of social media (b = 0.62; 95% CI, 0.49-0.75) compared with individuals who did not have mental health problems at both time points. Similarly, those with mental health problems at both time points were less likely to achieve 9 hours sleep (OR, 0.68; 95% CI, 0.51-0.90), consume fruit (OR, 0.39; 95% CI, 0.26-0.58) and vegetables (OR, 0.57; 95% CI, 0.35-0.91), and reported greater social media use (b = 0.63; 95% CI, 0.34-0.91). Conclusions and Relevance: These findings suggest that the presence of depressive symptoms at ages 7 and 14 years and at age 14 years only were associated with some health behaviors in adolescence. These findings are particularly important given that independent health behaviors can deteriorate and become habitual during adolescence, and adolescence is a known time for the first emergence of mental health problems that continue into adulthood.

Lifestyle behavioural risk factors and emotional functioning among schoolchildren: The Healthy Growth Study.

BACKGROUND: There is an increasing focus on lifestyle as a factor in the pathogenesis of mental health disorders; however, this has been relatively underexplored in child populations. This study aimed to assess the relationships between behavioural lifestyle factors and emotional functioning in a large, population-representative sample of schoolchildren in Greece. METHODS: A representative sample of 2,240 schoolchildren, aged 9-13 years, participated in the Healthy Growth Study during 2007-2010. Emotional functioning was measured using the Dartmouth COOP Functional Health Assessment charts/World Organization of Family Doctors Charts. A score of 3 or higher out of 5 indicated poorer emotional functioning. Participants self-reported dietary intake via three 24-h dietary recalls; fruit, vegetable and soft drink consumption were the dietary variables of interest. Participants' self-reported daily time spent in moderate to vigorous physical activity, and watching TV or playing video games were used to assess physical activity and sedentary behaviour. RESULTS: In fully adjusted models, females were at a greater risk of experiencing impaired emotional functioning compared to males (OR 1.76, 95%CI 1.44, 2.15, p < 0.01). Overweight/obesity compared to normal body weight (OR 1.52, 95%CI 1.31, 1.77, p < 0.01) was associated with poorer emotional functioning. Three hours or more of daily average physical activity compared to less than one hour (OR 0.59, 95%CI 0.40, 0.86, p < 0.01) was associated with improved emotional functioning. Consuming soft drinks compared to non-consumption (OR 1.24, 95%CI 1.02, 1.51) was associated with poorer emotional functioning; this became non-significant after corrections for multiple comparisons were made. Clustering of municipalities was accounted for in all models. CONCLUSIONS: Whilst findings were cross-sectional and causality cannot be inferred, this study highlights the interdependence of emotional and physical functioning in schoolchildren. This points to the potential for targeting shared risk factors for both physical chronic diseases and emotional and mental health conditions among children. Further longitudinal evidence will identify the potential for such shared intervention targets. Adopting a comprehensive, integrated approach to children's emotional, mental, and physical health is warranted.

Variation in the prevalence of depression and patterns of association, sociodemographic and lifestyle factors in community-dwelling older adults in six low- and middle-income countries.

BACKGROUND: Data from the World Health Organization Study on global AGEing and adult health (SAGE) were used to estimate the prevalence of depression in older adults in six low- and middle-income countries (LMICs), namely China, Ghana, India, Mexico, the Russian Federation, and South Africa, and to examine the relationship between demographic and lifestyle characteristics and depression. METHOD: A total of 33,421 participants aged ≥ 50 years were included. A set of diagnostic questions from the World Mental Health Survey was used within SAGE to define depression. RESULTS: The crude population prevalence of depression was 7.4% [95%CI: 6.5%-8.3%] ranging from 1.5% in China to 15.2% in India. It was higher in females 8.6% [7.6%-9.6%] compared to males 6.1% [5.0%-7.2%]. The age-standardized prevalence of depression was 7.8% [6.3%-9.6%] in pooled data, 8.9% [6.9%-11.1%] in females and 6.6% [4.6%-9.0%] in males. Greater fruit (0.89[0.84-0.93]) and vegetable intake (0.94 [0.89-1.00]) was associated with a lower prevalence of depression. Furthermore, those who were older, female, underweight, and with lower education and lower wealth, had higher prevalence of depression. LIMITATIONS: The cross-sectional design of this study precluded conclusions on causality. CONCLUSION: In nationally-representative samples of older adults in six LMICs, an average of one in every 13 participants suffered from depression. The prevalence of depression varied considerably between countries, sexes, and with wealth and educational disadvantage. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden.

Sex-Specific Lifestyle and Biomedical Risk Factors for Chronic Disease among Early-Middle, Middle and Older Aged Australian Adults.

Evidence suggests age and sex differences in risk factors for chronic disease. This study examined lifestyle and biomedical risk factors among men (m) and women (w) in early-middle (25⁻51 years), middle (52⁻64) and older (65+) adulthood. Cross-sectional data from the 2011⁻2012 Australian Health Survey (n = 3024) were analysed. Self-reported dietary, activity, sleep behaviours and collected biomedical data were analysed. Early-middle adults failed to meet fruit, vegetable (95.3%) and sugar-sweetened beverage (SSB, 34.9%) recommendations. Older adults had higher prevalence of overweight/obesity (70%), high blood pressure (38.0%) and fewer met physical activity guidelines (36.3%). Prior to older adulthood, more men consumed SSBs (early-middle m 45.6%, w 24.4%; middle m 26.0%, w 19.3%), and fewer met sedentary behaviour recommendations (early-middle m 43.2%, w 62.1%; middle m 46.4%, w 63.9%). Differences in overweight/obese women in early-middle (44.8%) to middle adulthood (64.7%) were significant. Biomedical risk was greatest in middle age; abnormal cholesterol/lipids increased specifically for women (total cholesterol early-middle 24.9% middle 56.4%; abnormal LDL-cholesterol early-middle 23.1% middle 53.9%). Adherence to lifestyle guidelines was low; particularly among men. While men exhibited greater clinical risk overall, this significantly increased among women in middle-adulthood. Public health strategies to improve lifestyle, monitor and intervene among middle-aged women are warranted.

Sex-Specific Associations in Nutrition and Activity-Related Risk Factors for Chronic Disease: Australian Evidence from Childhood to Emerging Adulthood.

Global assessments of burden of disease suggests there are sex differences in risk factors for chronic disease, including overweight/obesity, dietary patterns and habitual physical activity. Given that prevention efforts aim to target such factors to reduce disease risk, the age at which sex differences may occur is of particular interest. Early life to young adulthood is the optimal time for intervention, with lifestyle habits typically forming during this period. This study aimed to identify the sex differences in risk factors for chronic disease during childhood (5-9 years), adolescence (10-17 years) and emerging adulthood (18-25 years) in a large population-representative Australian sample. Among children in this study (n = 739), no sex-related differences were observed. Among adolescents (n = 1304), females were more likely than males to meet daily fruit and vegetable recommendations (12.9% vs. 7.5%; OR = 1.84, 95% CI = 1.16, 2.93, p < 0.05). Among emerging adults (n = 909), females were less likely to be overweight/obese (30.1% vs. 39.8%; OR = 0.65, 95% CI = 0.44, 0.95, p < 0.05) and more likely to meet physical activity recommendations (52.1% vs. 42.3%; OR = 1.44, 95% CI = 1.01, 2.06, p < 0.05). These findings suggest that sex differences for risk factors of chronic disease occur during adolescence and emerging adulthood, although the differences are not consistent across age periods. From adolescence onwards, it appears that females exhibit lower risk factors than males and a life span approach to risk factor monitoring is warranted.

Australian adults' behaviours, knowledge and perceptions of risk factors for heart disease: A cross-sectional study.

This research aimed to determine Australian adults' perceptions of risk factors for heart disease, self-reported behaviours relating to modifiable risk factors, and knowledge of leading causes of death. This study reports on HeartWatch survey data collected between January 2015 and December 2015 in a sample of Australian adults. The setting of the research was Australian communities, with all states and territories represented in the final sample. Participants were Australian adults aged 30-59 years (n = 8425), and were representative of the wider Australian population based on key demographic and health characteristics. Half of the sample overall correctly identified heart disease as the biggest underlying cause of death of males, and 26% for women. For risk factors for heart disease, respondents most frequently reported; poor diet (58.2%, 95%CI 57.0-59.1), physical inactivity (49.0%, 95%CI 47.9-50.1) and smoking (38.7%, 95%CI 37.7-39.8). A low proportion (< 10%) recognised underlying clinical risk factors for heart disease including high blood pressure (6.3%, 95%CI 5.8-6.8) and dyslipidaemia (9.8%, 95%CI 9.2-10.5). This study revealed broad misconceptions with regard to the leading cause of death and risk factors for heart disease among Australian men and women. Overall the lack of understanding in all groups suggests the need for a comprehensive national campaign reaching schools and the broad adult population. The health system alone cannot achieve national and international targets for disease prevention without understanding and engagement in the general community.

School-based systems change for obesity prevention in adolescents: outcomes of the Australian Capital Territory 'It's Your Move!'

OBJECTIVE: The Australian Capital Territory 'It's Your Move!' (ACT-IYM) was a three-year (2012-2014) systems intervention to prevent obesity among adolescents. METHODS: The ACT-IYM project involved three intervention schools and three comparison schools and targeted secondary students aged 12-16 years. The intervention consisted of multiple initiatives at individual, community, and school policy level to support healthier nutrition and physical activity. Intervention school-specific objectives related to increasing active transport, increasing time spent physically active at school, and supporting mental wellbeing. Data were collected in 2012 and 2014 from 656 students. Anthropometric data were objectively measured and behavioural data self-reported. RESULTS: Proportions of overweight or obesity were similar over time within the intervention (24.5% baseline and 22.8% follow-up) and comparison groups (31.8% baseline and 30.6% follow-up). Within schools, two of three the intervention schools showed a significant decrease in the prevalence of overweight and obesity (p<0.05). CONCLUSIONS: There was some evidence of effectiveness of the systems approach to preventing obesity among adolescents. Implications for public health: The incorporation of systems thinking has been touted as the next stage in obesity prevention and public health more broadly. These findings demonstrate that the use of systems methods can be effective on a small scale.