ASSOCIATION BETWEEN UNHEALTHY BEHAVIORS AND MENTAL HEALTH AMONG ADOLESCENTS IN TAIWAN

Introduction
Mental health issue in adolescents is a rising public health challenge in Taiwan. Among adolescents, how eating behavior, physical and sedentary activity reciprocally relate to mental health issue remains unclear. Therefore, our first study determined how clustering of unhealthy behaviors including frequent sugar-sweetened beverage consumption, screen-based sedentary behaviors, and insufficient physical activity associate with depression symptom. The second study investigated the association between emotional eating and frequent unhealthy food consumption.
Material and methods
Data was retrieved from the baseline survey of Taiwan Adolescent to Adult Survey (TAALS), a longitudinal nationwide school-based surveillance in comprehensive health-related issues in Taiwanese adolescents from 2015 to 2020. We characterized the participants on individual factors, social determinants, unhealthy behaviors and depressive symptoms.
In study I, probability of depressive symptom occurrences were predicted, given exhibiting clustering of unhealthy behaviors by multiple logistic regression models. In study II, multiple logistic regression analyses were conducted to assess the association between emotional eating and frequent unhealthy food consumption as well as to reveal the associated effect modifiers.
Results
The first study showed that, among the 18,509 participants (48.5% male and 51.5% female), depressive symptom were common (31.4%), particularly in female and older adolescents. After adjustments for covariats including sex, school type, other lifestyle factors and social determinants, individuals exhibiting clustering of unhealthy behaviors were more likely (aOR = 1.56, 95% CI: 1.43-1.70) to exhibit depressive symptoms than those who have no or only one unhealthy behavior. Stratified results indicated the modified effects of sex on the association between unhealthy behaviors and depressive symptoms. Insufficient physical activity significantly predicted depressive symptom among male, while screen based sedentary behavior was a crucial factor for depressive symptom among female.
The second study demonstrated that males were more likely than females to report frequent consumption of fast food (19.2% vs. 12.9%, p < 0.001), high-fat snacks (28.8% vs. 24.3%, p < 0.001), processed meat products (35.5% vs. 24.5%, p < 0.001), and SSBs (64.7% vs. 55.8%, p < 0.001). Those exhibiting emotional eating were more likely to consume fast food (Odds ratio (OR) = 2.40, 95% Confidence interval (CI): 2.18–2.64), high-fat snacks (OR = 2.30, 95% CI: 2.12–2.49), processed meat products (OR = 1.92, 95% CI: 1.78–2.08), dessert foods (OR = 2.49, 95% CI: 2.31–2.69), and sugar-sweetened beverages (OR = 1.83, 95% CI: 1.70–1.98). Factors that were positively associated with unhealthy food consumption included eating while doing other activities, binge drinking, smoking, and sedentary lifestyle. Among all the covariates, nutrition label reading was the only factor that was inversely associated with frequent unhealthy food consumption. Sex and school type may moderate the effect of emotional eating on the frequent consumption of specific unhealthy food groups.
Conclusion
The first study demonstrated that clustering of unhealthy behaviors were commonly occurred in adolescents, and were positively associated with depressive symptom. The findings highlight the importance of strengthening public health interventions to improve physical activity and decrease sedentary behavior.
The second study indicated a positive association between emotional eating and unhealthy food consumption among adolescents. Eating while doing other activities and living a sedentary lifestyle were the two factors significantly associated with increased unhealthy food consumption across all five unhealthy food groups, while nutrition label reading may decrease the consumption of unhealthy food.