Translational Behavioral Medicine

, Volume 3, Issue 1, pp 104–113 | Cite as

Longitudinal associations between health behaviors and mental health in low-income adults

  • Jennifer L Walsh
  • Theresa E Senn
  • Michael P Carey
Original Research


Although there are established relationships between physical and mental health, few studies have explored the relationship between health behaviors and mental health over time. To explore rates of health-compromising behaviors (HCBs) and the longitudinal relationship between HCBs and depression, anxiety, and stress, five waves of data were collected over 1 year from 482 patients at an urban public health clinic (47 % female, 68 % African-American, Mage = 28). Smoking (61 %), binge drinking (52 %), illegal drug use (53 %), unprotected sex with non-primary partners (55 %), and fast food consumption (71 %) were common, while consumption of fruits or vegetables (30 %) and breakfast (17 %) were rare. Cross-lagged models identified within-time associations between HCBs and depression/anxiety and stress. Additionally, depression/anxiety and stress predicted later HCBs, but HCBs did not predict later mental health. Results suggest that targeting mental health may be important to promoting improvements across multiple health behaviors.


Health behavior Mental health Depression Anxiety Perceived stress 


  1. 1.
    Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA. 2010;303:1159-1166.PubMedCrossRefGoogle Scholar
  2. 2.
    Singh GK, Siahpush M. Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25–64 years by area socioeconomic status, 1969–1998. Int J Epidemiol. 2002;31:600-613.PubMedCrossRefGoogle Scholar
  3. 3.
    Mackenbach JP, Bos V, Andersen O, et al. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003;32:830-837.PubMedCrossRefGoogle Scholar
  4. 4.
    Chaix B, Bean K, Leal C, et al. Individual/neighborhood social factors and blood pressure in the RECORD Cohort Study which risk factors explain the associations? Hypertension. 2010;55:769-775.PubMedCrossRefGoogle Scholar
  5. 5.
    Brummett BH, Babyak MA, Siegler IC, et al. Systolic blood pressure, socioeconomic status, and biobehavioral risk factors in a nationally representative US young adult sample. Hypertension. 2011;58:161-166.PubMedCrossRefGoogle Scholar
  6. 6.
    Marmot MG, Stansfeld S, Patel C, et al. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337:1387-1393.PubMedCrossRefGoogle Scholar
  7. 7.
    Jakovljević D, Sarti C, Sivenius J, et al. Socioeconomic status and ischemic stroke. Stroke. 2001;32:1492-1498.PubMedCrossRefGoogle Scholar
  8. 8.
    Chaturvedi N, Jarrett J, Shipley MJ, Fuller JH. Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall study and the WHO multinational study of vascular disease in diabetes. BMJ. 1998;316:100-105.PubMedCrossRefGoogle Scholar
  9. 9.
    Kogevinas M, Marmot MG, Fox AJ, Goldblatt PO. Socioeconomic differences in cancer survival. J Epidemiol Community Health. 1991;45:216-219.PubMedCrossRefGoogle Scholar
  10. 10.
    Adler NE. Socioeconomic status and health: the challenge of the gradient. Am Psychol. 1993;49:15.CrossRefGoogle Scholar
  11. 11.
    Shimakawa T, Sorlie P, Carpenter MA, et al. Dietary intake patterns and sociodemographic factors in the atherosclerosis risk in communities study. Prev Med. 1994;23:769-780.PubMedCrossRefGoogle Scholar
  12. 12.
    Winkleby MA, Fortmann SP, Barrett DC. Social class disparities in risk factors for disease: eight-year prevalence patterns by level of education. Prev Med. 1990;19:1-12.PubMedCrossRefGoogle Scholar
  13. 13.
    Stunkard AJ, Sorensen TIA. Obesity and socioeconomic status—a complex relation. N Engl J Med. 1993;329:1036-1037.PubMedCrossRefGoogle Scholar
  14. 14.
    Ford ES, Merritt RK, Heath GW, et al. Physical activity behaviors in lower and higher socioeconomic status populations. Am J Epidemiol. 1991;133:1246-1256.PubMedGoogle Scholar
  15. 15.
    Nogueira A, Marcopito L, Lanas F, et al. Socio-economic status and risk factors for cardiovascular disease: a multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN). J Clin Epidemiol. 1994;47:1401-1409.CrossRefGoogle Scholar
  16. 16.
    Reynes JF, Lasater TM, Feldman H, Assaf AR, Carleton RA. Education and risk factors for coronary heart disease: results from a New England community. Am J Prev Med. 1993;9:365.PubMedGoogle Scholar
  17. 17.
    Strand BH, Tverdal A. Can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease and from other heart diseases? 26 year follow up of 50 000 Norwegian men and women. J Epidemiol Community Health. 2004;58:705-709.PubMedCrossRefGoogle Scholar
  18. 18.
    Lantz PM, House JS, Lepkowski JM, et al. Socioeconomic factors, health behaviors, and mortality. JAMA. 1998;279:1703-1708.PubMedCrossRefGoogle Scholar
  19. 19.
    Laaksonen M, Talala K, Martelin T, et al. Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years. Eur J Public Health. 2008;18:38-43.PubMedCrossRefGoogle Scholar
  20. 20.
    Ng DM, Jeffery RW. Relationships between perceived stress and health behaviors in a sample of working adults. Heal Psychol. 2003;22:638-642.CrossRefGoogle Scholar
  21. 21.
    Steptoe A, Wardle J, Pollard TM, Canaan L, Davies GJ. Stress, social support and health-related behavior: a study of smoking, alcohol consumption and physical exercise. J Psychosom Res. 1996;41:171-180.PubMedCrossRefGoogle Scholar
  22. 22.
    Steptoe A, Lipsey Z, Wardle J. Stress, hassles and variations in alcohol consumption, food choice and physical exercise: a diary study. Br J Heal Psychol. 1998;3:51-63.CrossRefGoogle Scholar
  23. 23.
    Ameringer KJ, Leventhal AM. Applying the tripartite model of anxiety and depression to cigarette smoking: an integrative review. Nicotine Tob Res. 2010;12:1183-1194.PubMedCrossRefGoogle Scholar
  24. 24.
    Conner KR, Pinquart M, Gamble SA. Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abus Treat. 2009;37:127-137.CrossRefGoogle Scholar
  25. 25.
    Strine TW, Chapman DP, Kobau R, Balluz L. Associations of self-reported anxiety symptoms with health-related quality of life and health behaviors. Soc Psychiatry Psychiatr Epidemiol. 2005;40:432-438.PubMedCrossRefGoogle Scholar
  26. 26.
    Hassan I, Ali R. The association between somatic symptoms, anxiety disorders and substance use. A literature review. Psychiatr Q. 2011;82:315-328.PubMedCrossRefGoogle Scholar
  27. 27.
    Jané-Llopis E, Matytsina I. Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Rev. 2006;25:515-536.PubMedCrossRefGoogle Scholar
  28. 28.
    Leas L, McCabe M. Health behaviors among individuals with schizophrenia and depression. J Heal Psychol. 2007;12:563-579.CrossRefGoogle Scholar
  29. 29.
    Carey MP, Carey KB, Maisto SA, Gordon CM, Vanable PA. Prevalence and correlates of sexual activity and HIV-related risk behavior among psychiatric outpatients. J Consult Clin Psychol. 2001;69:846.PubMedCrossRefGoogle Scholar
  30. 30.
    Carey MP, Carey KB, Maisto SA, et al. HIV-risk behavior among outpatients at a state psychiatric hospital: prevalence and risk modeling. Behav Ther. 1999;30:389-406.PubMedCrossRefGoogle Scholar
  31. 31.
    Mazza M, Della Marca G, Mennuni GF, Bria P, Mazza S. Sleep disturbances and depression: a review. Minerva Psichiatr. 2005;46:175-188.Google Scholar
  32. 32.
    Kim E-J, Dimsdale JE. The effect of psychosocial stress on sleep: a review of polysomnographic evidence. Behav Sleep Med. 2007;5:256-278.PubMedCrossRefGoogle Scholar
  33. 33.
    Wills TA, Shiffman S. Coping and substance use: a conceptual framework. Coping Subst Use. 1985;3–24.Google Scholar
  34. 34.
    Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer; 1984.Google Scholar
  35. 35.
    Dallman MF, Pecoraro N, Akana SF, et al. Chronic stress and obesity: a new view of “comfort food”. Proc Natl Acad Sci. 2003;100:11696.PubMedCrossRefGoogle Scholar
  36. 36.
    Dallman MF, Pecoraro NC, la Fleur SE. Chronic stress and comfort foods: self-medication and abdominal obesity. Brain Behav Immun. 2005;19:275-280.PubMedCrossRefGoogle Scholar
  37. 37.
    Friedman EM, Hayney MS, Love GD, et al. Social relationships, sleep quality, and interleukin-6 in aging women. Proc Natl Acad Sci U S A. 2005;102:18757.PubMedCrossRefGoogle Scholar
  38. 38.
    Parrott AC. Does cigarette smoking cause stress? Am Psychol. 1999;54:817-820.PubMedCrossRefGoogle Scholar
  39. 39.
    Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev. 2001;21:33-61.PubMedCrossRefGoogle Scholar
  40. 40.
    Connolly T, Zeelenberg M. Regret in decision making. Curr Dir Psychol Sci. 2002;11:212-216.CrossRefGoogle Scholar
  41. 41.
    Roese NJ, Epstude K, Fessel F, et al. Repetitive regret, depression, and anxiety: findings from a nationally representative survey. J Soc Clin Psychol. 2009;28:671-688.CrossRefGoogle Scholar
  42. 42.
    Peele S, Brodsky A. Exploring psychological benefits associated with moderate alcohol use: a necessary corrective to assessments of drinking outcomes? Drug Alcohol Depend. 2000;60:221-247.PubMedCrossRefGoogle Scholar
  43. 43.
    Lipton RI. The effect of moderate alcohol use on the relationship between stress and depression. Am J Public Health. 1994;84:1913-1917.PubMedCrossRefGoogle Scholar
  44. 44.
    Benowitz NL. Pharmacology of nicotine: addiction and therapeutics. Annu Rev Pharmacol Toxicol. 1996;36:597-613.PubMedCrossRefGoogle Scholar
  45. 45.
    DiClemente RJ, Wingood GM, Crosby RA, et al. A prospective study of psychological distress and sexual risk behavior among black adolescent females. Pediatrics. 2001;108:e85.PubMedCrossRefGoogle Scholar
  46. 46.
    Heinrich KM, Maddock J. Multiple health behaviors in an ethnically diverse sample of adults with risk factors for cardiovascular disease. Perm J. 2011;15:12-18.PubMedGoogle Scholar
  47. 47.
    De Vries H, van’t Riet J, Spigt M, et al. Clusters of lifestyle behaviors: results from the Dutch SMILE study. Prev Med. 2008;46:203-208.PubMedCrossRefGoogle Scholar
  48. 48.
    Dufour MC. What is moderate drinking? Defining “drinks” and drinking levels. Alcohol Res Health. 1999;23:10.Google Scholar
  49. 49.
    Carey MP, Senn TE, Vanable PA, Coury-Doniger P, Urban MA. Brief and intensive behavioral interventions to promote sexual risk reduction among STD clinic patients: results from a randomized controlled trial. AIDS Behav. 2010;14:504-517.PubMedCrossRefGoogle Scholar
  50. 50.
    Carey MP, Vanable PA, Senn TE, Coury-Doniger P, Urban MA. Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R). Contemp Clin Trials. 2008;29:569-586.PubMedCrossRefGoogle Scholar
  51. 51.
    Centers for Disease Control and Prevention. Fact Sheets: Binge Drinking. Atlanta, GA: Centers for Disease Control and Prevention; 2010.Google Scholar
  52. 52.
    U.S. Department of Health and Human Services. Healthy People. Washington, D.C.: U.S. Department of Health and Human Services; 2020:2010.Google Scholar
  53. 53.
    Civic D. College students’ reasons for nonuse of condoms within dating relationships. J Sex Marital Ther. 2000;26:95-105.PubMedCrossRefGoogle Scholar
  54. 54.
    U.S. Department of Health and Human Services, Physical Activity Guidelines for Americans. Washington, D.C.: U.S. Department of Health and Human Services; 2008:2008.Google Scholar
  55. 55.
    van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222,497 Australian adults. Arch Intern Med. 2012;172:494-500.PubMedCrossRefGoogle Scholar
  56. 56.
    Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey Questionnaire. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.Google Scholar
  57. 57.
    National Sleep Foundation. How much sleep do we really need? Retrieved September 6, 2012 from
  58. 58.
    Donovan JE, Jessor R, Costa FM. Adolescent health behavior and conventionality-unconventionality: an extension of problem-behavior therapy. Heal Psychol. 1991;10:52.CrossRefGoogle Scholar
  59. 59.
    Gallant MP, Connell CM. Neuroticism and depressive symptoms among spouse caregivers: do health behaviors mediate this relationship? Psychol Aging. 2003;18:587-592.PubMedCrossRefGoogle Scholar
  60. 60.
    Feldman P, Steptoe A. How neighborhoods and physical functioning are related: the roles of neighborhood socioeconomic status, perceived neighborhood strain, and individual health risk factors. Ann Behav Med. 2004;27:91-99.PubMedCrossRefGoogle Scholar
  61. 61.
    Helgeson VS, Novak SA, Lepore SJ, Eton DT. Spouse social control efforts: relations to health behavior and well-being among men with prostate cancer. J Soc Pers Relat. 2004;21:53-68.CrossRefGoogle Scholar
  62. 62.
    Kroenke K, Spitzer RL, Williams JBW. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50:613-621.PubMedGoogle Scholar
  63. 63.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;385–396.Google Scholar
  64. 64.
    Rubin DB. Multiple Imputation for Nonresponse in Surveys. Hoboken, NJ: Wiley; 1987.CrossRefGoogle Scholar
  65. 65.
    Schafer JL. Multiple imputation: A primer. Stat Methods Med Res. 1999;8(1):3–15Google Scholar
  66. 66.
    Graham JW, Olchowski AE, Gilreath TD. How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prev Sci. 2007;8:206-213.PubMedCrossRefGoogle Scholar
  67. 67.
    Honaker J, King G, Blackwell M. Amelia II: a program for missing data. J Stat Softw. 2011;45:1-47.Google Scholar
  68. 68.
    Muthén LK, Muthén BO. Mplus User’s Guide (6 ed.). Los Angeles, CA: Muthén & Muthén, 1998–2012.Google Scholar
  69. 69.
    Curran PJ. A latent curve framework for the study of developmental trajectories in adolescent substance use. In: Rose JS, Chassin L, Presson CC, Sherman SJ, eds. Multivariate Applications in Substance Use Research. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2000:1-42.Google Scholar
  70. 70.
    Reeves MJ, Rafferty AP. Healthy lifestyle characteristics among adults in the United States, 2000. Arch Intern Med. 2005;165:854-857.PubMedCrossRefGoogle Scholar
  71. 71.
    National Center for Health Statistics. Health, United States, 2011. Hyattsville, MD: National Center for Health Statistics; 2012.Google Scholar
  72. 72.
    Casagrande SS, Wang Y, Anderson C, Gary TL. Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002. Am J Prev Med. 2007;32:257-263.PubMedCrossRefGoogle Scholar
  73. 73.
    Kant AK, Graubard BI. Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 1971–1975 to NHANES 1999–2002. Am J Clin Nutr. 2006;84:1215-1223.PubMedGoogle Scholar
  74. 74.
    Lucan S, Mitra N. Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: findings from multi-level models. Int J Public Health. 2012;57:599-608.PubMedCrossRefGoogle Scholar
  75. 75.
    Seiffge-Krenke I, Klessinger N. Long-term effects of avoidant coping on adolescents’ depressive symptoms. J Youth Adolesc. 2000;29:617-630.CrossRefGoogle Scholar
  76. 76.
    Moneyham L, Hennessy M, Sowell R, et al. The effectiveness of coping strategies used by HIV-seropositive women. Res Nurs Heal. 1998;21:351-362.CrossRefGoogle Scholar
  77. 77.
    Stall R, Friedman M, Catania JA. Interacting epidemics and gay men’s health: a theory of syndemic production among urban gay men. In: Wolitski RJ, Stall R, Valdiserri RO, eds. Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. Oxford: Oxford University Press; 2008:251-274.Google Scholar
  78. 78.
    Singer MC, Erickson PI, Badiane L, et al. Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med. 2006;63:2010-2021.PubMedCrossRefGoogle Scholar
  79. 79.
    Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic. J Nat Med Assoc. 2010;102:614.Google Scholar
  80. 80.
    Ickovics JR. “Bundling” HIV prevention: integrating services to promote synergistic gain. Prev Med. 2008;46:222-225.PubMedCrossRefGoogle Scholar
  81. 81.
    Jackson JS, Knight KM, Rafferty JA. Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health. 2010; 100.Google Scholar
  82. 82.
    Mezuk B, Rafferty JA, Kershaw KN, et al. Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression. Am J Epidemiol. 2010;172:1238-1249.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2013

Authors and Affiliations

  • Jennifer L Walsh
    • 1
    • 2
  • Theresa E Senn
    • 1
    • 2
  • Michael P Carey
    • 1
    • 2
    • 3
  1. 1.Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceUSA
  2. 2.Department of Psychiatry and Human Behavior, Alpert Medical SchoolBrown UniversityProvidenceUSA
  3. 3.Department of Behavioral and Social Sciences, Program in Public Health, Brown UniversityProvidenceUSA

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