This study aimed to identify different patterns of unhealthy lifestyle among Chinese adolescents with or without obesity and to assess the association between unhealthy lifestyle patterns and depressive and anxiety symptoms. A total of 32,046 adolescents aged 11–19 years were included in this study. We observed different patterns of lifestyle in adolescents with or without obesity. The associations between different patterns of unhealthy lifestyle and depressive and anxiety symptoms were significant. It is noteworthy that the risk of depression and anxiety was significantly greater in the pattern with insufficient sleep than in other patterns of unhealthy lifestyle. These findings have significant implications for the implementation of precise and concerted interventions during adolescence to promote healthy lifestyle and prevent depression and anxiety.
AndersonARKurzASSzaboYZ, et al. (2022) Exploring the longitudinal clustering of lifestyle behaviors, social determinants of health, and depression. Journal of Health Psychology27(13): 2922–2935.
2.
AndreacchiATOzUEBassimC, et al. (2021) Clustering of obesity-related characteristics: A latent class analysis from the Canadian longitudinal study on aging. Preventive medicine153: 106739.
3.
BerkMWilliamsLJJackaFN, et al. (2013) So depression is an inflammatory disease, but where does the inflammation come from?BMC Medicine11: 200.
4.
CaoRGaoTHuY, et al. (2020) Clustering of lifestyle factors and the relationship with depressive symptoms among adolescents in northeastern China. Journal of Affective Disorders274: 704–710.
5.
CaoRGaoTRenH, et al. (2022) Unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents. International Journal of Social Psychiatry68(2): 354–364.
6.
CarliVHovenCWWassermanC, et al. (2014) A newly identified group of adolescents at “invisible” risk for psychopathology and suicidal behavior: Findings from the SEYLE study. World Psychiatry13(1): 78–86.
7.
ChenYZhengZYiJ, et al. (2014) Associations between physical inactivity and sedentary behaviors among adolescents in 10 cities in China. BMC Public Health14: 744.
8.
ChenZRenSHeR, et al. (2023) Prevalence and associated factors of depressive and anxiety symptoms among Chinese secondary school students. BMC Psychiatry23(1): 580.
9.
CoombsNSheltonNRowlandsA, et al. (2013) Children’s and adolescents’ sedentary behaviour in relation to socioeconomic position. Journal of Epidemiology and Community Health67(10): 868–874.
10.
ErnerssonAFrismanGHSepa FrostellA, et al. (2010) An obesity provoking behaviour negatively influences young normal weight subjects’ health related quality of life and causes depressive symptoms. Eating Behaviors11(4): 247–252.
11.
FirthJSolmiMWoottonRE, 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 Psychiatry19(3): 360–380.
12.
GalloLCMatthewsKA (2003) Understanding the association between socioeconomic status and physical health: do negative emotions play a role?Psychological Bulletin129(1): 10–51.
13.
GBD 2019 Mental Disorders Collaborators (2022) Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: A systematic analysis for the global burden of disease study 2019. Lancet Psychiatry9(2): 137–150.
14.
HendryxMDinhPChowA, et al. (2020) Lifestyle and psychosocial patterns and diabetes incidence among women with and without obesity: A prospective latent class analysis. Prevention Science21(6): 850–860.
15.
HermanJPMcKlveenJMGhosalS, et al. (2016) Regulation of the hypothalamic-pituitary-adrenocortical stress response. Comprehensive Physiology6(2): 603–621.
16.
HrafnkelsdottirSMBrychtaRJRognvaldsdottirV, et al. (2018) Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents. PLoS One13(4): e0196286.
17.
HutchessonMJDuncanMJOftedalS, et al. (2021) Latent class analysis of multiple health risk behaviors among Australian university students and associations with psychological distress. Nutrients13(2): 425.
KamataKTokudaYGuY, et al. (2018) Public knowledge and perception about antimicrobials and antimicrobial resistance in Japan: A national questionnaire survey in 2017. PLoS One13(11): e0207017.
20.
KeyesKMGaryDO’MalleyPM, et al. (2019) Recent increases in depressive symptoms among US adolescents: Trends from 1991 to 2018. Social Psychiatry and Psychiatric Epidemiology54(8): 987–996.
21.
KonjarskiMMurrayGLeeVV, et al. (2018) Reciprocal relationships between daily sleep and mood: A systematic review of naturalistic prospective studies. Sleep Medicine Reviews42: 47–58.
22.
KroenkeKSpitzerRLWilliamsJB, et al. (2007) Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine146(5): 317–325.
23.
LangloisJOmorouAYVuilleminA, et al. (2017) Association of socioeconomic, school-related and family factors and physical activity and sedentary behaviour among adolescents: Multilevel analysis of the PRALIMAP trial inclusion data. BMC Public Health17(1): 175.
24.
LaxerREBrownsonRCDubinJA, et al. (2017) Clustering of risk-related modifiable behaviours and their association with overweight and obesity among a large sample of youth in the COMPASS study. BMC Public Health17(1): 102.
25.
LiangJHuangSJiangN, et al. (2023) Association between joint physical activity and dietary quality and lower risk of depression symptoms in US adults: Cross-sectional NHANES study. JMIR Public Health and Surveillance9: e45776.
26.
LiSLiXWangJ, et al. (2024) Associations between insufficient sleep, skipping breakfast and depressive symptoms in children and adolescents: A school-based cross-sectional study in China. Preventive Medicine184: 107978.
27.
LiuYZhangELiH, et al. (2024) Physical activity, recreational screen time, and depressive symptoms among Chinese children and adolescents: A three-wave cross-lagged study during the COVID-19 pandemic. Child and Adolescent Psychiatry and Mental Health18(1): 11.
28.
MarwahaSPalmerESuppesT, et al. (2023) Novel and emerging treatments for major depression. Lancet401(10371): 141–153.
29.
MielkeGIBrownWJNunesBP, et al. (2017) Socioeconomic correlates of sedentary behavior in adolescents: Systematic review and meta-analysis. OA Sports Medicine47(1): 61–75.
30.
MirandaVPNCoimbraDRBastosRR, et al. (2021) Use of latent class analysis as a method of assessing the physical activity level, sedentary behavior and nutritional habit in the adolescents’ lifestyle: A scoping review. PLoS One16(8): e0256069.
31.
NylundKLAsparouhovTMuthénBO (2008) Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study (vol 14, pg 535, 2007). Structural Equation Modeling A Multidisciplinary Journal15(1): 535–182.
32.
QinNLiYDuanYL, et al. (2024) Associations between healthy lifestyle behavioral patterns and mental health problems: A latent class analysis of 161,744 Chinese young adults. Journal of Affective Disorders347: 414–421.
33.
RadloffLS (1991) The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults. Journal of Youth and Adolescence20(2): 149–166.
34.
ShiBShenJ (2007) The relationships among family SES, intelligence, intrinsic motivation and creativity. Psychological Development and Education23(1): 30–34.
35.
SilvaDRAraujoRHOWerneckAO, et al. (2023) Are more physical education classes related to less time in leisure-time sedentary behavior? An analysis including adolescents from 73 countries. BMC Public Health23(1): 1943.
36.
TangZYangXTanW, et al. (2024) Patterns of unhealthy lifestyle and their associations with depressive and anxiety symptoms among Chinese young adults: A latent class analysis. Journal of Affective Disorders352: 267–277.
37.
VartanianLRShaprowJG (2008) Effects of weight stigma on exercise motivation and behavior: A preliminary investigation among college-aged females. Journal of Health Psychology13(1): 131–138.
38.
WalshR (2011) Lifestyle and mental health. American Psychologist66(7): 579–592.
39.
WangSHouWTaoY, et al. (2022) Mapping network connection among symptoms of anxiety, depression, and sleep disturbance in Chinese high school students. Frontiers in Public Health10: 1015166.
40.
WuXTaoSRutayisireE, et al. (2017) The relationship between screen time, nighttime sleep duration, and behavioural problems in preschool children in China. European Child & Adolescent Psychiatry26(5): 541–548.
41.
YangXWangX (2022) Dietary guidelines for Chinese people 2022. Food and Nutrition in China28(08): 2.
42.
YiXLiuZQiaoW, et al. (2020) Clustering effects of health risk behavior on mental health and physical activity in Chinese adolescents. Health and Quality of Life Outcomes18(1): 211.
43.
YuYLiuJSkokauskasN, et al. (2023) Prevalence of depression and anxiety, and associated factors, among Chinese primary and high school students: A cross-sectional, epidemiological study. Asia-Pacific Psychiatry15(1): e12523.
44.
ZhangEChenJLiuY, et al. (2024) Associations between joint lifestyle behaviors and depression among children and adolescents: A large cross-sectional study in China. Journal of Affective Disorders352: 110–114.
45.
ZhangXYangHZhangJ, et al. (2021) Prevalence of and risk factors for depressive and anxiety symptoms in a large sample of Chinese adolescents in the post-COVID-19 era. Child and Adolescent Psychiatry and Mental Health15(1): 80.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
