Frontiers in public health · 2026
Co-occurring health behaviors and mental health outcomes among a large, aging US population.
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Chiang Kathryn E, Rees-Punia Erika, Chantaprasopsuk Sicha, Patel Alpa V, Bates-Fraser Lauren C, Shams-White Marissa M, Callands Tamora A, Muilenburg Jessica L, Padilla Heather M
Аннотация
INTRODUCTION: This study aimed to examine longitudinal associations of alignment to the American Cancer Society (ACS) Guidelines for Cancer Prevention in 2015 and self-reported anxiety and depression in 2021.
METHODS: Participants included 88,643 women (79%) and 23,373 men (21%) with a mean (SD) age of 53 (10) in the Cancer Prevention Study-3. The ACS Guideline Score captures alignment to guidelines for co-occurring health behaviors including body mass index, physical activity, diet quality, and alcohol consumption, on a range from 0-to-8; with higher scores indicating greater alignment. Self-reported anxiety and depression symptoms were measured via the Patient Health Questionnaire-4 (PHQ-4). Multivariable logistic regression models were used to calculate odds ratios and 95% confidence intervals. Further sensitivity analyses included: (1) excluding participants with prevalent depression and/or anxiety and those taking medications for depression and/or anxiety at baseline (n = 66,594); and (2) stratifying by level of change in PHQ-4 during the COVID-19 pandemic.
RESULTS: Among 112,016 participants, 32% reported both depression and anxiety symptoms, 10% reported anxiety symptoms, and 7% had symptoms of depression at follow-up. Participants with higher ACS Guideline Scores in 2015 were less likely to experience symptoms of depression and/or anxiety in 2021 compared to individuals with lower scores (OR = 0.60; 95% CI: 0.57-0.63). Analyses restricted to those without anxiety or depression in 2015 resulted in attenuated, though still statistically significant findings.
CONCLUSION: These findings suggest lifestyles aligned with the ACS Guidelines for Cancer Prevention are associated with a lower likelihood of future symptoms of depression and anxiety.
METHODS: Participants included 88,643 women (79%) and 23,373 men (21%) with a mean (SD) age of 53 (10) in the Cancer Prevention Study-3. The ACS Guideline Score captures alignment to guidelines for co-occurring health behaviors including body mass index, physical activity, diet quality, and alcohol consumption, on a range from 0-to-8; with higher scores indicating greater alignment. Self-reported anxiety and depression symptoms were measured via the Patient Health Questionnaire-4 (PHQ-4). Multivariable logistic regression models were used to calculate odds ratios and 95% confidence intervals. Further sensitivity analyses included: (1) excluding participants with prevalent depression and/or anxiety and those taking medications for depression and/or anxiety at baseline (n = 66,594); and (2) stratifying by level of change in PHQ-4 during the COVID-19 pandemic.
RESULTS: Among 112,016 participants, 32% reported both depression and anxiety symptoms, 10% reported anxiety symptoms, and 7% had symptoms of depression at follow-up. Participants with higher ACS Guideline Scores in 2015 were less likely to experience symptoms of depression and/or anxiety in 2021 compared to individuals with lower scores (OR = 0.60; 95% CI: 0.57-0.63). Analyses restricted to those without anxiety or depression in 2015 resulted in attenuated, though still statistically significant findings.
CONCLUSION: These findings suggest lifestyles aligned with the ACS Guidelines for Cancer Prevention are associated with a lower likelihood of future symptoms of depression and anxiety.