Association Between Comorbid Anxiety and Depression and Health Risk Behaviors Among Chinese Adolescents: Cross-Sectional Questionnaire Study

Authors：Meng Wang , Xingyue Mou , Tingting Li , Yi Zhang , Yang Xie , Shuman Tao, Yuhui Wan, Fangbiao Tao, Xiaoyan Wu

Source：JMIR Public Health Surveill. 2023 Jul 5;9:e46289.

DOI: 10.2196/46289.

Abstract：

Background: Comorbidity of psychiatric disorders such as depression and anxiety is very common among children and adolescents. Few studies have examined how comorbid anxiety and depression are associated with health risk behaviors (HRBs) in adolescents, which could inform preventative approaches for mental health.

Objective: We evaluated the association between HRBs and comorbid anxiety and depression in a large adolescent cohort.

Methods: We used data from 22,868 adolescents in the National Youth Cohort (China). Anxiety and depression symptoms were assessed using the 9-item Patient Health Questionnaire scale and the 7-item Generalized Anxiety Disorder scale, respectively. Comorbidity was determined by the coexistence of anxiety and depression. HRBs including poor diet, smoking, physical inactivity, and poor sleep, as well as the above HRB scores, were added to obtain the total HRB score (HRB risk index). Based on single and total HRB scores, we divided participants into low-, medium-, and high-risk groups. Potential confounders included gender, presence of siblings, regional economic level, educational status, self-rated health, parental education level, self-reported family income, number of friends, learning burden, and family history of psychosis. Correlation analysis was used to explore associations between single risk behaviors. Binary logistic regression estimated the association between HRBs and anxiety-depression comorbidity before and after adjusting for potential confounders.

Results: The comorbidity rate of anxiety and depression among Chinese adolescents was 31.6% (7236/22,868). There was a statistically significant association between each HRB (P<.05), and HRBs were positively associated with comorbid anxiety and depression in the above population. For single HRBs, adolescents with poor diet, smoking, and poor sleep (medium-risk) were more prone to anxiety-depression comorbidity after adjusting for confounders compared to low-risk adolescents. However, adolescents with all high-risk HRBs were more likely to have comorbid anxiety and depression after adjusting for confounders (poor diet odds ratio [OR] 1.50, 95% CI 1.39-1.62; smoking OR 2.17, 95% CI 1.67-2.81; physical inactivity OR 1.16, 95% CI 1.06-1.28; poor sleep OR 1.84, 95% CI 1.70-2.01). Moreover, in both unadjusted (medium risk OR 1.79, 95% CI 1.56-2.05; high risk OR 3.09, 95% CI 2.72-3.52) and adjusted (medium risk OR 1.57, 95% CI 1.37-1.80; high risk OR 2.33, 95% CI 2.03-2.68) models, HRB risk index, like clustered HRBs, was positively associated with anxiety-depression comorbidity, and the strength of the association was stronger than for any single HRB. In addition, we found that compared to girls, the association between clustered HRBs and anxiety-depression comorbidity was stronger in boys after adjustment.

Conclusions: We provide evidence that HRBs are related to comorbid anxiety and depression. Interventions that decrease HRBs may support mental health development in adolescence, with the potential to improve health and well-being through to adulthood.

摘要：

背景：在儿童和青少年中，抑郁症和焦虑症等精神疾病的合并症非常常见。很少有研究探讨青少年合并焦虑症和抑郁症与健康风险行为（HRBs）之间的关系，而这些研究可为心理健康预防方法提供参考。

目的：我们在一个大型青少年队列中评估了健康风险行为与合并焦虑症和抑郁症之间的关联。

方法：我们使用了全国青少年队列（中国）中22868名青少年的数据。焦虑和抑郁症状分别使用9项患者健康问卷量表和7项广泛性焦虑症量表进行评估。焦虑和抑郁同时存在时，即为合并症。不良饮食、吸烟、缺乏运动和睡眠不足等HRB因素与上述HRB得分相加，得出HRB总分（HRB风险指数）。根据单项和总的 HRB 分数，我们将参与者分为低、中、高风险组。潜在的混杂因素包括性别、是否有兄弟姐妹、地区经济水平、教育状况、自我健康评价、父母教育水平、自我报告的家庭收入、朋友数量、学习负担和家族精神病史。相关分析用于探讨单一风险行为之间的关联。二元逻辑回归估算了调整潜在混杂因素前后，危险行为与焦虑抑郁合并症之间的关联。

结果：中国青少年的焦虑和抑郁合并率为31.6%（7236/22868）。在上述人群中，每种HRB之间均有统计学意义（P<0.05），且HRB与合并焦虑和抑郁呈正相关。就单个 HRB 而言，与低风险青少年相比，在调整了混杂因素后，饮食不健康、吸烟和睡眠不佳的青少年（中度风险）更容易合并焦虑-抑郁。然而，在对混杂因素进行调整后，具有所有高风险HRB的青少年更有可能合并焦虑和抑郁（饮食不良的风险比[OR]为1.50，95% CI为1.39-1.62；吸烟的OR为2.17，95% CI为1.67-2.81；缺乏运动的OR为1.16，95% CI为1.06-1.28；睡眠不佳的OR为1.84，95% CI为1.70-2.01）。此外，在未调整模型（中度风险 OR 1.79，95% CI 1.56-2.05；高度风险 OR 3.09，95% CI 2.72-3.52）和调整模型（中度风险 OR 1.57，95% CI 1.37-1.80；高度风险 OR 2.33，95% CI 2.03-2.68）中，HRB 风险指数与聚类 HRB 一样，与焦虑抑郁合并症呈正相关，且相关性强于任何单一 HRB。此外，我们还发现，与女孩相比，经过调整后，男孩的聚类 HRB 与焦虑抑郁合并症之间的关联性更强。

结论：我们提供的证据表明，HRBs 与合并焦虑和抑郁有关。减少HRBs的干预措施可支持青少年时期的心理健康发展，并有可能改善他们成年后的健康和福祉。