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Age-varying associations between lifestyle risk factors and major depressive disorder: a nationally representative cross-sectional study of adolescents

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Abstract

Purpose

Lifestyle risk factors, such as alcohol use, smoking, high body mass index, poor sleep, and sedentary behavior, represent major public health issues for adolescents. These factors have been associated with increased rates of major depressive disorder (MDD). The purpose of this paper is to investigate critical peaks in the prevalence of MDD at certain ages and to examine how these peaks might be amplified or attenuated by the presence of lifestyle risk factors.

Methods

A nationally representative sample of adolescents aged 11–17 years old (n = 2967) and time-varying effect models were used to investigate the associations between lifestyle risk factors and the prevalence of MDD by sex.

Results

The estimated prevalence of MDD significantly increased among adolescents from 4% (95% CI 3–6%) at 13 years of age to 19% (95% CI 15–24%) at 16 years of age. From the age of 13, males were significantly less likely to have a diagnosis of MDD than females with the maximum sex difference occurring at the age of 15 (OR 0.24, 95% CI 0.13–0.47). All lifestyle risk factors were at some point significantly associated with MDD, but these associations did not differ by sex, except for body mass index.

Discussion

These findings suggest that interventions designed to prevent the development of depression should be implemented in early adolescence, ideally before or at the age of 13 and particularly among young females given that the prevalence of MDD begins to rise and diverge from young males. Interventions should also simultaneously address lifestyle risk factors and symptoms of major depression.

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Notes

  1. Body mass index was used in the current study as a proxy measure for low physical activity and poor diet given the well-established correlation between poor physical activity, poor diet, and high BMI.

  2. Preliminary analysis examined the fit on linear versus non-linear models for the age-varying relationship between all covariates and MDD. On all occasions, the non-linear models provided superior fit based on AIC and BIC values and therefore justified the use of TVEMs in this study. The results are provided in Supplementary Table 1.

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Acknowledgements

†Health4Life Team: The Health4Life team comprises Katherine Mills (The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia), Leanne Hides (Centre for Youth Substance Abuse Research, School of Psychology, The University of Queensland, Brisbane, Australia), Lexine Stapinski (The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia), Emma L. Barrett (The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia), Louise Mewton (Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, Australia), Lauren A. Gardner (The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia).

Funding

Members of the current study were funded in part by the Paul Ramsay Foundation. The second Australian Child and Adolescent Survey of Mental Health and Wellbeing (Young Minds Matter) was funded by the Australian Government Department of Health.

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Authors and Affiliations

  1. The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), Sydney, NSW, 2006, Australia

    Matthew Sunderland, Katrina Champion, Tim Slade, Cath Chapman, Nicola Newton, Louise Thornton & Maree Teesson

  2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Katrina Champion

  3. Centre for Brain and Mental Health Priority Research Centre, The University of Newcastle, Newcastle, Australia

    Frances Kay-Lambkin

  4. National Drug Research Institute, Curtin University, Perth, Australia

    Nyanda McBride & Steve Allsop

  5. Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia

    Belinda Parmenter

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  1. Matthew Sunderland
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  2. Katrina Champion
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  3. Tim Slade
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Consortia

Health4Life Team

  • Katherine Mills
  • , Leanne Hides
  • , Lexine Stapinski
  • , Emma L. Barrett
  • , Louise Mewton
  •  & Lauren A. Gardner

Corresponding author

Correspondence to Matthew Sunderland.

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Conflict of interest

The authors wish to report no conflicts of interest.

Ethical approval

The survey data used in the current study received ethical approval from the Department of Health Departmental Ethics Committee (Project 17/2012) in accordance with the National Health and Medical Research Council (NHMRC) National Statement on Ethical Conduct in Human Research and the Federal Privacy Act 1988. Ethics approval to access the data was received from UNSW HREC no. 13073.

Informed consent

Participation in the survey was voluntary and written consent was required from all participants.

Additional information

The members of the Health4Life Team listed in acknowledgement section.

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Supplementary file1 (DOCX 1962 kb)

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Sunderland, M., Champion, K., Slade, T. et al. Age-varying associations between lifestyle risk factors and major depressive disorder: a nationally representative cross-sectional study of adolescents. Soc Psychiatry Psychiatr Epidemiol 56, 129–139 (2021). https://doi.org/10.1007/s00127-020-01888-8

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  • DOI: https://doi.org/10.1007/s00127-020-01888-8

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