Relationship Between Co-Occurring Health Behaviors On Mental Health Outcomes Among A Large, Aging US Population

The synergistic effects of multiple unhealthy behaviors may increase the risk of anxiety and depression, yet most studies focus on these behaviors one at a time. It is unclear how the combination of multiple health behaviors impacts future depression and anxiety outcomes. PURPOSE: To examine the longitudinal association of adhering to the American Cancer Society (ACS) Guidelines for Cancer Prevention in 2015 and self-reported anxiety and depression in 2021. METHODS: Participants included 88,643 women (79%) and 23,273 men (21%) with a mean (SD) age of 53 (10) years old in the Cancer Prevention Study-3. The ACS Guideline score captures co-occurring health behaviors including diet, alcohol consumption, body weight via body mass index (BMI), and physical activity (PA). Scores ranged from 0 to 8, with higher scores indicating higher adherence/optimal behaviors. Associations between ACS Guideline scores and self-reported anxiety and depression via Patient Health Questionnaire-4 (PHQ-4) were assessed using multivariate logistic regression models adjusted for age, sex, energy intake, and other sociodemographic factors. Further analysis included: 1) a sensitivity analysis excluding participants with pre-existing depression and/or anxiety diagnoses and those taking medications for depression and/or anxiety (n = 66,594); and 2) a stratified analysis accounting for the occurrence of the COVID-19 pandemic during follow-up years restricted to 107,699 participants with data on pandemic-related changes in PHQ-4. RESULTS: Among 112,016 participants, 32% reported both depression and anxiety, 10% reported anxiety symptoms, and 6.6% had symptoms of depression at follow-up. Participants with higher adherence to the ACS Guidelines (i.e., scores of 7-8) were less likely to experience future symptoms of depression and/or anxiety compared to those with lower adherence represented by scores of 0-2 (OR = 0.58; 95% CI: 0.55-0.61). Supplemental analyses resulted in attenuated, though still statistically significant findings, addressing concerns of reverse causality. CONCLUSION: These findings suggest that following the recommended health behaviors outlined in the ACS Guidelines for Cancer Prevention is associated with a decrease in future symptoms of depression and anxiety. Supported by: The American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-3 cohort.