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Cross-sectional and prospective associations of lifestyle risk behaviors clustering with elevated depressive symptoms among middle-aged and older adults

  • André O. Werneck
    Correspondence
    Corresponding author at: Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP). Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo-SP, 01246-904, São Paulo, Brazil.
    Affiliations
    Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, Brazil
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  • Miguel Peralta
    Affiliations
    CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal

    ISAMB, University of Lisbon, Lisbon, Portugal
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  • Riki Tesler
    Affiliations
    Department of Health Systems Management, Ariel University, Ariel, Israel
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  • Adilson Marques
    Affiliations
    CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal

    ISAMB, University of Lisbon, Lisbon, Portugal
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Published:September 27, 2021DOI:https://doi.org/10.1016/j.maturitas.2021.09.010

      Highlights

      • Physical inactivity, smoking and a low intake of fruits and vegetables were all associated with elevated depressive symptoms.
      • The risk for developing elevated depressive symptoms increased with the increment of risk behaviors.
      • Interventions integrating multiple health behaviors are warranted among older adults.

      Abstract

      Objectives

      To investigate the cross-sectional and prospective associations of lifestyle risk behaviors clustering with elevated depressive symptoms and to explore synergic prospective associations of different combinations of lifestyle risk behaviors with subsequent depressive symptoms.

      Study design

      Prospective cohort study. Data on 31,190 middle-aged and older adults from waves 4 (2011) and 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used.

      Main outcome measures

      Elevated depressive symptoms were estimated using the EURO-D 12-item scale. Lifestyle risk behaviors composing the cluster included physical inactivity, inadequate consumption of fruit and/or vegetables, binge drinking, and tobacco smoking. Gender, age group, education, place of residence, country, number of chronic diseases and body mass index were considered as confounders.

      Results

      With the exception of binge drinking, all lifestyle risk behaviors were associated with higher odds of elevated depressive symptoms in cross-sectional and prospective analyses. The clustering of unhealthy lifestyle behaviors was cross-sectionally associated with elevated depressive symptoms and the clustering of two [odds ratio [OR]: 1.39; 95%CI: 1.28–1.51) and three or four (OR: 1.60; 95%CI: 1.38–1.85) were prospectively associated with elevated depressive symptoms. There were no interactions between the pairs of behaviors in the association with later elevated depressive symptoms.

      Conclusions

      Our findings support the need for interventions integrating multiple health behaviors to prevent elevated depressive symptoms among middle-aged and older adults.

      Keywords

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