Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: results from the National Survey of 4583 individuals

Abstract

BackgroundUnhealthy behaviors are associated with mental health problems and violence in adolescents, yet their combined association has been understudied. Using the Global School Health Survey, this study examined the association between combined unhealthy behaviors (including fast food, soft drink, smoking, other tobacco products and physical inactivity) and anxiety, suicidal ideation and involvement in physical fight among Pakistani adolescents.MethodsData were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school going adolescents aged 13 to 15 years. Association of combined unhealthy behaviors with anxiety, suicidal ideation and involvement in physical fight were studied through secondary analysis. We used univariate and multivariate logistic regression analysis by complex sample method, accounting for cluster sampling technique used for data collection.ResultsOf the total 4583 students, weighted percentage and unweighted count for one, two, three and four or more unhealthy behaviors was 39.4% (n = 1770), 22.1% (n = 963), 5.9% (n = 274) and 1.2% (n = 62) respectively. The weighted prevalence for anxiety, suicidal ideation and involvement in physical fight were 8.4%, 7.3% and 37.4% respectively. The results of multivariate logistic regression analysis after adjustment showed that students who had four or more unhealthy behaviors had higher odds of; being anxious (OR 2.45, 95%CI 1.31-4.59, p value 0.004), suicide ideation (OR 4.56, 95%CI 2.58-8.07, p value <0.001) and being involved in physical fight (OR 3.15, 95% CI 1.63–6.08, p value <0.001) as compared to those who had not adopted any unhealthy behaviors.ConclusionsThis study suggests that the co-occurrence of unhealthy behaviors is associated with anxiety, suicidal ideation and physical fight among adolescents. These findings should be considered when developing interventions to combat detrimental outcomes of unhealthy behaviors during adolescence.

Is there an association between diet and depression in children and adolescents? A systematic review

“…The total number of participants recruited across the twenty studies was 110 857, although two studies used participants from the same data set (The Western Australian Pregnancy Cohort (Raine) Study; with n 1324 and n 1598, respectively) (40,41) ; 109 533 unique individual participants were recruited in total to these studies. There were 51 834 males and 49 588 females, although some authors did not clearly state the number of boys and girls in their studies (42,43) . The age of participants ranged from 18 months to 18 years.…”

“…Using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, the quality of majority of studies was rated as 'fair' (n 16), with three studies classified as 'good' (43)(44)(45) and one rated as 'poor' (42) . The key methodological features of each study are outlined in Table 2.…”

“…Overall unhealthy diet. Six studies investigated the relationship between unhealthy diet and mental health (40,42,44,52,54) . An 'unhealthy' diet was broadly defined as one comprised of fast foods or take-aways, foods containing high fat and sugar levels, confectionery, sweetened beverages, snacking, Western dietary patterns and unhealthy food preferences.…”

“…Brooks et al (53) Cross-sectional Healthy diet negatively correlated with depression only in females: males d = 0•016, females d = 0•028* Fulkerson et al (54) Cross-sectional Health-promoting attitude negatively correlated with depression (52) Cross-sectional Healthy diet negatively correlated with depression d = 0•55* Unhealthy diet positively associated with depression: d = 0•39* Jacka et al (44) Cross (57) Cross-sectional Not enough information to calculate effect size. (47) Cross-sectional fish steamed grilled or tinned not associated with internalising symptoms Refined grains, processed meat, potato fried, crisps, soft drinks, cakes/biscuits, sauces/dressings and full fat dairy products not associated with internalising symptoms Oellingrath et al (51) Cross-sectional Not associated with problems: junk/convenient (d = 0•097), varied Norwegian (d = 0•053) and snacking (d = 0•025) Rao et al (42) Cross One study (43) used a longitudinal design, with dietary consumption measured by a parental report at 4•5 years and parent-reported mental health problems at the age of 7 years. Consumption of junk food at 4•5 years did not predict emotional problems at 7 years.…”

A pilot study of the relationship between diet and mental health in female university students enrolled in a training course for registered dietitians

“…It is well known that diet, physical activity, and mental health are important in preventing future lifestyle-related diseases in university students [1,2]. For example, improper dietary habits are linked closely to visceral fat accumulation and insulin resistance [3].…”