Environmental Health and Preventive Medicine

, Volume 21, Issue 6, pp 410–421 | Cite as

The associations between lifestyles and mental health using the General Health Questionnaire 12-items are different dependently on age and sex: a population-based cross-sectional study in Kanazawa, Japan

  • Daisuke HoriEmail author
  • Hiromasa Tsujiguchi
  • Yasuhiro Kambayashi
  • Toshio Hamagishi
  • Masami Kitaoka
  • Junko Mitoma
  • Hiroki Asakura
  • Fumihiko Suzuki
  • Enoch Olando Anyenda
  • Thao Thi Thu Nguyen
  • Yuri Hibino
  • Aki Shibata
  • Koichi Hayashi
  • Takiko Sagara
  • Shinichiro Sasahara
  • Ichiyo Matsuzaki
  • Kotaro Hatta
  • Tadashi Konoshita
  • Hiroyuki Nakamura
Regular Article



The aim of this study was to examine potential differences of the associations between mental health and lifestyle factors across a wide range of age.


In August/September 2011, data were collected from 4693 males (age 51.6 ± 19.5) and 5678 females (age 52.4 ± 19.4) living in Kanazawa, Japan. A cross-sectional community-based survey was conducted with self-administered questionnaire including the General Health Questionnaire (GHQ) 12-item version, sociodemographic, and lifestyle factors. Associations between the GHQ scores and other variables were examined using two-way analysis of variance (ANOVA) followed by multiple comparisons and logistic regression stratified by age and gender.


Multiple comparisons indicated that people aged 20–39 or 40–64 had higher GHQ scores than older aged. The two-way ANOVA revealed significant interaction between body mass index and age group, and between exercise and age group. Overweight or underweight males aged 40–64 had poorer mental health than those at normal weight. In the elderly, being underweight was significantly associated with poor mental health. There were no significant effects of exercise on mental health for young adults. The logistic regression showed significant negative effects of short-time sleep in adults.


The associations between mental health and lifestyles differ across age groups. Further study is needed to reveal effects of aging on lifestyle and mental health with a longitudinal design.


Aging Cross sectional Lifestyle The General Health Questionnaire Mental health 



The authors wish to express their gratitude to the leaders and staff of the City of Kanazawa and the neighborhood associations for their support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Kawakami N, Takeshima T, Ono Y, Uda H, Hata Y, Nakane Y, et al. Twelve-month prevalence, severity, and treatment of common mental disorders in communities in Japan: preliminary finding from the World Mental Health Japan Survey 2002–2003. Psychiatry Clin Neurosci. 2005;59:441–52.CrossRefPubMedGoogle Scholar
  2. 2.
    Belloc NB. Relationship of health practices and mortality. Prev Med. 1973;2:67–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Johansson SE, Sundquist J. Change in lifestyle factors and their influence on health status and all-cause mortality. Int J Epidemiol. 1999;28:1073–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33:585–92.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Ford ES, Bergmann MM, Boeing H, Li C, Capewell S. Healthy lifestyle behaviors and all-cause mortality among adults in the United States. Prev Med. 2012;55:23–7.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ezoe S, Morimoto K. Behavioural lifestyle and mental health status of Japanese factory workers. Prev Med. 1994;23:98–105.CrossRefPubMedGoogle Scholar
  7. 7.
    Rohrer JE, Rush Pierce J, Blackburn C. Lifestyle and mental health. Prev Med. 2005;40:438–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Kawada T, Otsuka T, Inagaki H, Wakayama Y, Katsumata M, Li Q, et al. Relationship among lifestyles, aging and psychological wellbeing using the General Health Questionnaire 12-items in Japanese working men. Aging Male. 2011;14:115–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen X, Sekine M, Hamanishi S, Wang H, Gaina A, Yamagami T, et al. Lifestyles and health-related quality of life in Japanese school children: a cross-sectional study. Prev Med. 2005;40:668–78.CrossRefPubMedGoogle Scholar
  10. 10.
    Matsuzaki I, Sagara T, Oshita Y, Nagase H, Ogino K, Sasahara S, et al. Psychological factors including sense of coherence and some lifestyles are related to General Health Questionnaire-12 (GHQ-12) in elderly workers in Japan. Environ Health Prev Med. 2007;12:21–7.CrossRefGoogle Scholar
  11. 11.
    Sagara T, Hitomi Y, Kambayashi Y, Hibino Y, Matsuzaki I, Sasahara S, et al. Common risk factors for changes in body weight and psychological well-being in Japanese male middle-aged workers. Environ Health Prev Med. 2009;14:319–27.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Schwartz FJ, Susan JP. The state of civil society in Japan. Cambridge: Cambridge University Press; 2003.CrossRefGoogle Scholar
  13. 13.
    Goldberg DP, Rickels K, Downing R, Hesbacher P. A comparison of two psychiatric screening tests. Br J Psychiatry. 1976;129:61–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Minowa M. Factor structure of the 12-item General Health Questionnaire in the Japanese general adult population. Psychiatry Clin Neurosci. 2003;57:379–83.CrossRefPubMedGoogle Scholar
  15. 15.
    Baksheev GN, Robinson J, Cosgrave EM, Baker K, Yung AR. Validity of the 12-item General Health Questionnaire (GHQ-12) in detecting depressive and anxiety disorders among high school students. Psychiatry Res. 2011;187:291–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Goldberg DP, Oldehinkel T, Ormel J. Why GHQ threshold varies from one place to another. Psychol Med. 1998;28:915–21.CrossRefPubMedGoogle Scholar
  17. 17.
  18. 18.
    Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007;335:194.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284–94.CrossRefPubMedGoogle Scholar
  20. 20.
    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1–6.CrossRefGoogle Scholar
  21. 21.
    Gallicchio L, Kalesan B. Sleep duration and mortality: a systematic review and meta-analysis. J Sleep Res. 2009;18:148–58.CrossRefPubMedGoogle Scholar
  22. 22.
    Asztalos M, De Bourdeaudhuij I, Cardon G. The relationship between physical activity and mental health varies across activity intensity levels and dimensions of mental health among women and men. Public Health Nutr. 2010;13:1207–14.CrossRefPubMedGoogle Scholar
  23. 23.
    Artazcoz L, Borrell C, Cascant L. Gender perspective in the analysis of the relationship between long workhours, health and health-related behavior. Scand J Work Environ Heal. 2007;33:344–50.CrossRefGoogle Scholar
  24. 24.
    De Moor MHM, Beem AL, Stubbe JH, Boomsma DI, De Geus EJC. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med. 2006;42:273–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Christensen H, Jorm AF, Mackinnon AJ, Korten AE, Jacomb PA, Henderson AS, et al. Age differences in depression and anxiety symptoms: a structural equation modelling analysis of data from a general population sample. Psychol Med. 1999;29:325–39.CrossRefPubMedGoogle Scholar
  26. 26.
    Jorm AF, Windsor TD, Dear KBG, Anstey KJ, Christensen H, Rodgers B. Age group differences in psychological distress: the role of psychosocial risk factors that vary with age. Psychol Med. 2005;35:1253–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Molarius A, Berglund K, Eriksson C, Eriksson HG, Lindén-Boström M, Nordström E, et al. Mental health symptoms in relation to socio-economic conditions and lifestyle factors—a population-based study in Sweden. BMC Public Health. 2009;9:302.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Honda A, Date Y, Abe Y, Aoyagi K, Honda S. Work-related stress, caregiver role, and depressive symptoms among Japanese workers. Saf Health Work. 2014;5:7–12.CrossRefPubMedGoogle Scholar
  29. 29.
    Kikuzawa S. Elder care, multiple role involvement, and well-being among middle-aged men and women in Japan. J Cross Cult Gerontol. 2015;30:423–38.CrossRefPubMedGoogle Scholar
  30. 30.
    Mather M, Canli T, English T, Whitfield S, Wais P, Ochsner K, et al. Amygdala responses to emotionally valenced stimuli in older and younger adults. Psychol Sci. 2004;15:259–63.CrossRefPubMedGoogle Scholar
  31. 31.
    Hozawa A, Okamura T, Oki I, Murakami Y, Kadowaki T, Nakamura K, et al. Relationship between BMI and all-cause mortality in Japan: NIPPON DATA80. Obesity. 2008;16:1714–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Tamakoshi A, Yatsuya H, Lin Y, Tamakoshi K, Kondo T, Suzuki S, et al. BMI and all-cause mortality among Japanese older adults: findings from the Japan collaborative cohort study. Obesity. 2010;18:362–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Ul-Haq Z, Mackay DF, Fenwick E, Pell JP. Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36. Obesity. 2013;21:322–7.CrossRefGoogle Scholar
  34. 34.
    Matsuzawa Y, Nakamura T, Takahashi M, Ryo M, Inoue S, Ikeda Y, et al. New criteria for “obesity disease” in Japan. Circ J. 2002;66:987–92.CrossRefGoogle Scholar
  35. 35.
    Krueger PM, Friedman EM. Sleep duration in the united states: a cross-sectional population-based study. Am J Epidemiol. 2009;169:1052–63.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Tamakoshi A, Ohno Y. Self-reported sleep duration as a predictor of all-cause mortality: results from the JACC study, Japan. Sleep. 2004;27:51–4.PubMedGoogle Scholar
  37. 37.
    Tanaka H, Shirakawa S. Sleep health, lifestyle and mental health in the Japanese elderly: ensuring sleep to promote a healthy brain and mind. J Psychosom Res. 2004;56:465–77.CrossRefPubMedGoogle Scholar
  38. 38.
    Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol. 2002;156:328–34.CrossRefPubMedGoogle Scholar
  39. 39.
    Brown WJ, Ford JH, Burton NW, Marshall AL, Dobson AJ. Prospective study of physical activity and depressive symptoms in middle-aged women. Am J Prev Med. 2005;29:265–72.CrossRefPubMedGoogle Scholar
  40. 40.
    Steptoe A, Butler N. Sports participation and emotional wellbeing in adolescents. Lancet. 1996;347:1789–92.CrossRefPubMedGoogle Scholar
  41. 41.
    Allison KR, Adlaf EM, Irving HM, Hatch JL, Smith TF, Dwyer JJM, et al. Relationship of vigorous physical activity to psychologic distress among adolescents. J Adolesc Health. 2005;37:164–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Cotman CW, Berchtold NC. Exercise: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci. 2002;25:295–301.CrossRefPubMedGoogle Scholar
  43. 43.
    Nakamura K, Hoshino Y, Kodama K, Yamamoto M. Reliability of self-reported body height and weight of adult Japanese women. J Biosoc Sci. 1999;31:555–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Wada K, Tamakoshi K, Tsunekawa T, Otsuka R, Zhang H, Murata C, et al. Validity of self-reported height and weight in a Japanese workplace population. Int J Obes. 2005;29:1093–9.CrossRefGoogle Scholar

Copyright information

© The Japanese Society for Hygiene 2016

Authors and Affiliations

  • Daisuke Hori
    • 1
    Email author
  • Hiromasa Tsujiguchi
    • 1
  • Yasuhiro Kambayashi
    • 1
  • Toshio Hamagishi
    • 1
  • Masami Kitaoka
    • 1
  • Junko Mitoma
    • 1
  • Hiroki Asakura
    • 1
  • Fumihiko Suzuki
    • 1
  • Enoch Olando Anyenda
    • 1
  • Thao Thi Thu Nguyen
    • 1
  • Yuri Hibino
    • 1
  • Aki Shibata
    • 1
  • Koichi Hayashi
    • 3
  • Takiko Sagara
    • 1
  • Shinichiro Sasahara
    • 2
  • Ichiyo Matsuzaki
    • 2
  • Kotaro Hatta
    • 4
  • Tadashi Konoshita
    • 5
  • Hiroyuki Nakamura
    • 1
  1. 1.Department of Environmental and Preventive Medicine, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
  2. 2.Faculty of MedicineUniversity of TsukubaTsukubaJapan
  3. 3.Department of Food Sciences and Nutrition, School of Human Environmental SciencesMukogawa Women’s UniversityNishinomiyaJapan
  4. 4.Department of PsychiatryJuntendo University School of MedicineTokyoJapan
  5. 5.Third Department of Internal MedicineFukui University School of MedicineYoshida-gunJapan

Personalised recommendations