Breakfast Consumption Moderates the Association Between Bullying Victimization and Anxiety and Depressive Symptoms in Adolescents

Background: Bullying victimization among adolescents is common and has been consistently associated with higher risks of anxiety and depressive symptoms among adolescents exposed to bullying. Breakfast consumption may function as a daily regulatory resource that supports emotional regulation and coping; however, whether breakfast consumption patterns moderate the associations between bullying victimization and mental health outcomes among adolescents remains unclear. This study examined the associations among bullying victimization, breakfast consumption, and anxiety and depressive symptoms among adolescents and tested the moderating role of breakfast consumption. Methods: Using a multistage stratified cluster sampling design, 67,683 adolescents were recruited from 234 schools across 13 cities in Heilongjiang Province, China. Standardized anonymous questionnaires assessed adolescents’ experiences of bullying victimization, breakfast consumption, anxiety and depressive symptoms, and relevant covariates. Multivariable mixed-effects logistic regression models were applied to estimate the associations between bullying victimization and mental health outcomes among adolescents. Linear trend tests and interaction terms between breakfast frequency and bullying frequency were used to examine moderating effects. Results: Except for verbal victimization (items 1 and 6), among adolescents exposed to most forms of bullying victimization, those reporting higher breakfast frequency had lower risks of anxiety and depressive symptoms (all trend p < 0.05). Among adolescents exposed to relational, physical, and cyber victimization, breakfast frequency moderated the associations between bullying frequency and anxiety and depressive symptoms (all p for interaction < 0.05), with sex-stratified sensitivity analyses yielding consistent results. Among adolescents who consumed breakfast daily, greater breakfast diversity (≥3 vs. 1–2 food groups) was associated with lower risks of anxiety and depressive symptoms. Specifically, among adolescents who experienced physical victimization “sometimes,” those consuming breakfast with ≥3 food groups had a 29% lower risk of anxiety symptoms (ROR = 0.71, 95% CI: 0.48–0.98) and a 30% lower risk of depressive symptoms (ROR = 0.70, 95% CI: 0.46–0.97) than those consuming 1–2 food groups. Among adolescents exposed to cyber victimization, those consuming breakfast with ≥3 food groups had a 32% lower risk of depressive symptoms at the “sometimes” frequency (ROR = 0.68, 95% CI: 0.45–0.98) and had a 32% lower risk of anxiety symptoms (ROR = 0.68, 95% CI: 0.42–0.96) and a 35% lower risk of depressive symptoms (ROR = 0.65, 95% CI: 0.40–0.95) at the “often” frequency than those consuming 1–2 food groups. Conclusions: Among adolescents exposed to bullying victimization—particularly relational, physical, and cyber victimization—those reporting higher breakfast frequency had lower risks of anxiety and depressive symptoms than those who skipped breakfast. Greater breakfast diversity was also associated with lower risks, particularly among adolescents exposed to physical and cyber victimization.