Longitudinal lifestyle changes and subsequent risks of depression and anxiety: a prospective cohort study

Abstract Background The extent to which overall lifestyle changes over time affect subsequent risk of depression and anxiety remains unclear. We examined the associations of lifestyle deterioration, maintenance, and improvement with incident depression and anxiety. Methods This prospective population-based cohort study included 18,678 UK Biobank participants free of depression and anxiety who completed lifestyle assessments at baseline (2006-10) and at a repeat assessment (2012-13). A healthy lifestyle score (HLS, range 0–7) was derived from smoking, alcohol consumption, diet, body mass index, physical activity, sleep, and sedentary behavior. Lifestyle change was assessed using differences in HLS between assessments. Joint lifestyle change patterns were created by baseline lifestyle profiles and subsequent changes. Results Independent of baseline lifestyle status, lifestyle deterioration was associated with increased risk of depression (HR 1.41, 95% CI 1.20–1.67) and anxiety (HR 1.26, 95% CI 1.06–1.50). Each additional healthy lifestyle factor adopted over time was associated with an 18% lower risk of depression (HR, 0.82, 95% CI 0.76–0.88) and a 7% lower risk of anxiety (HR 0.93, 95% CI 0.86–1.00). Participants maintaining poor lifestyle patterns (0–3 healthy lifestyle factors) experienced 2.86-fold and 1.72-fold higher risk of depression and anxiety, respectively, than those maintained an ideal lifestyle pattern (6–7 healthy factors). Conclusions Lifestyle deterioration was associated with increased risk of depression and anxiety, whereas lifestyle improvement was associated with lower risk of both outcomes, highlighting maintaining and promoting healthier lifestyle for the prevention of depression and anxiety.