Elsevier

Preventive Medicine

Volume 38, Issue 6, June 2004, Pages 865-875
Preventive Medicine

Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample

https://doi.org/10.1016/j.ypmed.2003.12.028Get rights and content

Abstract

Background. Previous research has shown significant associations between depression and substance use and eating disordered behaviors. However, no research to date has described associations between depressive symptoms and nutritional intake or physical activity among adolescents in a nonclinical, population-based sample.

Methods. Classroom surveys were completed by 4,734 ethnically diverse, middle- and high school students. Based on their depressive symptom scores, males and females were categorized with low-, moderate-, or high-depressive symptom status. Linear models were used to examine eating and health behavior variables by depressive symptom groups.

Results. Depressive symptoms were positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use, including caffeine. Depressive symptoms were negatively associated with health-promoting behaviors such as eating breakfast, lunch, and dinner. However, most associations between depressive symptoms and dietary micronutrients were not statistically significant. Health-promoting moderate-to-vigorous physical activity was negatively associated with depressive symptoms among males.

Conclusions. Adolescents who report depressive symptoms are at risk for other health-compromising attitudes and behaviors and are also less likely to engage in health-promoting behaviors. Depressive symptoms may be an underlying trait in the expression of health behaviors among adolescents.

Introduction

Point prevalence of mood disorders such as major depressive disorder (MDD) ranges from 0.4% and 8% for adolescents [1], [2], [3], and lifetime prevalence rates are as high as 15–21% [4], [5]. Subclinical depression or reports of depressive symptoms are even more common with approximately 30% of adolescents reporting at least one current symptom of a major depressive episode [3]. Research has shown significant relationships between depression and health behaviors among adolescents, particularly regarding the use of tobacco, alcohol, and other drug use among adolescents (e.g., [6], [7]). Less is known about the relationships between depression or depressive symptoms and other health behaviors such as eating, nutrition, and physical activity among adolescents in nonclinical settings.

The relationship between depressive symptoms and health behaviors among adolescents can be conceptualized in two major ways [8]. First, depressive symptoms can be associated with higher rates of “health-compromising” behaviors that put adolescents at risk for other health consequences beyond the psychological domain. Second, depressive symptoms can be associated with lower rates of “health-promoting” behaviors and may inhibit full-health potential across multiple domains of health. Problem Behavior Theory is a theoretical framework that postulates that health-compromising behaviors cluster together and are based on common underlying traits [9], [10]. Examining the correlates of depressive symptoms among adolescents within this framework may help to understand the extent to which adolescent depressive symptoms are associated with the health and well-being of adolescents in many areas of their lives.

There is a substantial body of research supporting a strong relationship between depression and health-compromising eating disorders among adolescents in clinical settings (e.g., Ref. [11]). In population-based male and female adolescent samples, depression or negative mood has also been linked with health-compromising attitudes and behaviors such as weight dissatisfaction [12], negative body image [13], [14], binge eating [14], [15], disordered eating [16], [17], [18], [19], and bulimic symptoms [20]. Samples limited to female adolescents have also shown higher rates of binging [21], [22], [23] and purging [22], [23] and dieting [24] among girls who report depressed mood. One study has also shown a significant negative relationship between depressed mood and health-promoting eating behaviors such as eating breakfast and lunch [7]. Skipping meals, particularly breakfast, may affect concentration and learning [25]. To the authors' knowledge, no research to date has examined the relationship between depressed mood and health-related attitudes or behaviors regarding healthy eating. A few studies have examined the associations between depression and nutritional intake among adults, particularly, vitamin D, folate, and the B-vitamins, as these vitamins have the potential to be related to depression [26], [27]. However, no studies have examined the relationship between depression and nutritional intake among adolescents. These issues are particularly interesting given the fact that depression is often related to appetite changes [28]. With depression, appetite may be increased or decreased, and could potentially result in overconsumption of nutrients or nutritional inadequacy, respectively. Nutritional inadequacies may be particularly critical during the adolescent phase of rapid growth and development [29], [30].

Considerably more research has examined the relationships between depressed mood and health-compromising behaviors related to substance use. In particular, cigarette smoking has been found to be significantly related to depression among adolescents [6], [7], [31], [32], [33], [34], [35]. Moreover, the relationship between nicotine dependence and depression may be solidified by age 16 [36]. However, even in longitudinal research, there is some disagreement about the causal relationship between smoking and depression with some research suggesting that smoking precedes depression [6] and other research suggesting that depressed mood is a risk factor for cigarette smoking initiation [35]. Research has also documented the strong relationships between depressed mood and consumption of alcohol [7], marijuana, and other drugs [7], [37]. Less is known about the relationships between depressed mood and caffeine intake, and although caffeine is a legal substance, it is an addictive, mood-altering substance frequently ingested by adolescents. Given the increasing rates of soft drink consumption among teens [38] and the proliferation of coffee shops, particularly within school cafeterias [39], caffeine deserves attention.

Physical activity is a health-promoting behavior that is associated with positive mood and physical health [40]. Little research has examined the relationship between depressed mood and physical activity among adolescents in nonclinical populations.

Gender differences are apparent in adolescent rates of depression and depressive symptoms, with girls reporting more depression than boys [2], [4], [13], [32], [41], [42]. Older adolescents also appear to have higher levels of depressed mood than younger adolescents [43]. Given the emergence of gender differences in the prevalence of depression, and the increased prevalence associated with developmental changes, middle-to-late adolescence (ages 15–18) may be a critical period for studying vulnerability to depression [4].

The goals of the present study were to describe the relationships between depressive symptoms and a variety of health-compromising behaviors and health-promoting behaviors among an ethnically diverse population-based sample of male and female adolescents, with an emphasis on eating-related attitudes and behaviors.

Section snippets

Subjects

Participants in the present study were a subset of 4,734 adolescents (n = 2377 boys and n = 2357 girls) who participated in Project EAT (Eating Among Teens). Project EAT is a comprehensive study of obesity and nutrition among adolescents from 31 middle- and high schools in the Minneapolis/St. Paul 7-county metropolitan area. Background characteristics by gender are provided in Table 1.

Procedure

During the 1998–1999 school year, trained research staff administered a survey to students during class time,

Eating attitudes

Health-promoting attitudes such as caring about eating healthy food, and caring about staying fit and exercising were significantly negatively associated with depressive symptoms for males (see Table 2); caring about eating healthy food was significantly negatively associated with depressive symptoms for females (see Table 3). Both health-compromising attitudes regarding perceived barriers of convenience and food preference to healthy eating were significantly positively associated with

Discussion

In the present study, depressive symptoms were found to be significantly positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use among male and female adolescents. Adolescents who reported more depressive symptoms were also less likely to engage in health-promoting behaviors such as eating breakfast, lunch, and dinner.

Acknowledgements

This study was supported by Grant MCJ-270834 (D. Neumark-Sztainer, principal investigator) from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Service Administration, U.S. Department of Health and Human Services.

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