Abstract
ObjectivesSmoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with psychological distress. We also examined differences by age and birth cohort.MethodsData were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997–2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6).ResultsPsychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s.ConclusionsThe strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.
Highlights
Mental disorders are associated with poor physical health and reduced life expectancy [1]
Using multiple cross-sectional surveys from the U.S National Health Interview Surveys (NHIS) between 1997 and 2016, we examined whether the associations between psychological distress and four unhealthy behaviors changed during this time period, and whether there were age differences in these associations
Previous studies have shown that the relative risk of smoking associated with psychological distress has become stronger in the last 20 years, because the prevalence of smoking has declined more rapidly among those without psychological distress than among those with psychological distress [10,11,12,13,14] The current results suggest that other health behavior correlates of psychological distress have changed during the last 10–20 years in the United States: psychological distress has become more strongly associated with physical inactivity and short sleep duration, but less strongly related with heavy alcohol consumption
Summary
Mental disorders are associated with poor physical health and reduced life expectancy [1]. This is partially due to poor health behaviors; mentally distressed individuals are more likely to engage in unhealthy behaviors, such as smoking [2], risky alcohol consumption [3, 4], physical inactivity [5], and short sleep duration [6, 7]. During the last 10–20 years, smoking rates have declined among those without mental disorders but have remained the same, or declined at a slower pace, among those with mental disorders [10, 14] These trends suggest that health policies aimed at reducing smoking have not been effective for psychologically distressed individuals, which has led to an increasingly widening health disparity between those with and without mental disorders [10]
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