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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Lifestyle choices and mental health: a longitudinal survey with German and Chinese students

Authors: Julia Velten, Angela Bieda, Saskia Scholten, André Wannemüller, Jürgen Margraf

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

A healthy lifestyle can be beneficial for one’s mental health. Thus, identifying healthy lifestyle choices that promote psychological well-being and reduce mental problems is useful to prevent mental disorders. The aim of this longitudinal study was to evaluate the predictive values of a broad range of lifestyle choices for positive mental health (PMH) and mental health problems (MHP) in German and Chinese students.

Method

Data were assessed at baseline and at 1-year follow-up. Samples included 2991 German (Mage = 21.69, SD = 4.07) and 12,405 Chinese (Mage = 20.59, SD = 1.58) university students. Lifestyle choices were body mass index, frequency of physical and mental activities, frequency of alcohol consumption, smoking, vegetarian diet, and social rhythm irregularity. PMH and MHP were measured with the Positive Mental Health Scale and a 21-item version of the Depression Anxiety and Stress Scale. The predictive values of lifestyle choices for PMH and MHP at baseline and follow-up were assessed with single-group and multi-group path analyses.

Results

Better mental health (higher PMH and fewer MHP) at baseline was predicted by a lower body mass index, a higher frequency of physical and mental activities, non-smoking, a non-vegetarian diet, and a more regular social rhythm. When controlling for baseline mental health, age, and gender, physical activity was a positive predictor of PMH, smoking was a positive predictor of MHP, and a more irregular social rhythm was a positive predictor of PMH and a negative predictor of MHP at follow-up. The good fit of a multi-group model indicated that most lifestyle choices predict mental health comparably across samples. Some country-specific effects emerged: frequency of alcohol consumption, for example, predicted better mental health in German and poorer mental health in Chinese students.

Conclusions

Our findings underline the importance of healthy lifestyle choices for improved psychological well-being and fewer mental health difficulties. Effects of lifestyle on mental health are comparable in German and Chinese students. Some healthy lifestyle choices (i.e., more frequent physical activity, non-smoking, regular social rhythm) are related to improvements in mental health over a 1-year period.
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Literature
1.
Herrman H, Saxena S, Moodie R. Promoting mental health: concepts, emerging evidence, practice: a report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne: World Health Organization; 2005.
2.
Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21:655–79.CrossRefPubMed
3.
World Health Organization. Mental health: strengthening our response. Fact sheet Nr. 220. Geneva: World Health Organization; 2014.
4.
Keyes CLM. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73:539–48.CrossRefPubMed
5.
6.
Schönfeld P, Brailovskaia J, Bieda A, Zhang XC, Margraf J. The effects of daily stress on positive and negative mental health: mediation through self-efficacy. Int J Clin Heal. 2016;16:1–10.CrossRef
7.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th revision ed. Washington, DC; 2013.
8.
World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization; 1993.
9.
Keyes CLM. Social well-being. Soc Psychol. 1998:121–40.
10.
Waterman AS. Two conceptions of happiness: contrasts of personal expressiveness (eudaimonia) and hedonic enjoyment. J Pers Soc Psychol. 1993;64:678–91.CrossRef
11.
Keyes CLM, Shmotkin D, Ryff CD. Optimizing well-being: the empirical encounter of two traditions. J Pers Soc Psychol. 2002;82:1007–22.CrossRefPubMed
12.
Lukat J, Margraf J, Lutz R, van der Veld WM, Becker ES. Psychometric properties of the positive mental health scale (PMH-scale). BMCPsychol. 2016;4:8.
13.
14.
Fogelholm M. Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review. Obes Rev. 2010;11:202–21.CrossRefPubMed
15.
Bygren LO, Weissglas G, Wikström B-M, Konlaan BB, Grjibovski A, Karlsson A-B, et al. Cultural participation and health: a randomized controlled trial among medical care staff. Psychosom Med. 2009;71:469–73.CrossRefPubMed
16.
Bygren LO, Konlaan BB, Johansson S. Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions. BMJ Br Med J. 1996;313:1577–80.CrossRef
17.
18.
Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ Br Med J. 2011;342:d671.CrossRef
19.
Harriss DJ, Atkinson G, George K, Tim Cable N, Reilly T, Haboubi N, et al. Lifestyle factors and colorectal cancer risk (1): systematic review and meta-analysis of associations with body mass index. Color Dis. 2009;11:547–63.CrossRef
20.
Scarborough P, Nnoaham KE, Clarke D, Capewell S, Rayner M. Modelling the impact of a healthy diet on cardiovascular disease and cancer mortality. J Epidemiol Community Heal. 2012;66:420–6.CrossRef
21.
Harriss DJ, Atkinson G, Batterham A, George K, Tim Cable N, Reilly T, et al. Lifestyle factors and colorectal cancer risk (2): a systematic review and meta-analysis of associations with leisure-time physical activity. Color Dis. 2009;11:689–701.CrossRef
22.
Sattelmair J, Pertman J, Ding EL, Kohl HW, Haskell W, Lee I-M. Dose response between physical activity and risk of coronary heart disease a meta-analysis. Circulation. 2011;124:789–95.CrossRefPubMedPubMedCentral
23.
He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. 2006;367:320–6.CrossRefPubMed
24.
Jonsdottir IH, Rödjer L, Hadzibajramovic E, Börjesson M, Ahlborg G. A prospective study of leisure-time physical activity and mental health in Swedish health care workers and social insurance officers. Prev Med. 2010;51:373–7.CrossRefPubMed
25.
Xu Q, Courtney M, Anderson D, Courtney M. A longitudinal study of the relationship between lifestyle and mental health among midlife and older women in Australia: findings from the healthy aging of women study. Health Care Women Int. 2010;31:1082–96.CrossRefPubMed
26.
Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, de Girolamo G, et al. Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes. 2008;32:192–200.
27.
Headey B, Muffels R, Wagner GG. Choices which change life satisfaction: similar results for Australia, Britain and Germany. Soc Indic Res. 2013;112:725–48.CrossRef
28.
Chaney EH, Chaney JD, Wang MQ, Eddy JM. Lifestyle behaviors and mental health of American adults. Psychol Rep. 2007;100:294–302.CrossRefPubMed
29.
Hamer M, Stamatakis E, Steptoe A. Dose-response relationship between physical activity and mental health: the Scottish health survey. Br J Sport Med. 2009;43:1111–4.CrossRef
30.
Rohrer JE, Pierce JR Jr, Blackburn C, et al. Lifestyle and mental health. Prev Med. 2005;40:438–43.CrossRefPubMed
31.
Margraf J, Lavallee KL, Zhang XC, Schneider S. Social rhythm and mental health: a cross-cultural comparison. PLoS One. 2016;11:e0150312.
32.
Cai D, Zhu M, Lin M, Zhang XC, Margraf J. The bidirectional relationship between positive mental health and social rhythm in college students: a three-year longitudinal study. Front Psychol. 2017;8:1–7.
33.
Velten J, Lavallee KL, Scholten S, Meyer AH, Zhang XC, Schneider S, et al. Lifestyle choices and mental health: a representative population survey in Germany. BMC Psychol. 2014;2:2.
34.
World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; 2000.
35.
36.
McCallum J. The SF-36 in an Australian sample: validating a new, generic health status measure. Aust N Z J Public Health. 1995;19:160–6.CrossRef
37.
Pavot W, Diener E. Review of the satisfaction with life scale. Psychol Assess. 1993;5:164–72.CrossRef
38.
Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression. Arch Gen Psychiatry. 2010;67:220–9.CrossRefPubMed
39.
Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45:649–57.CrossRefPubMed
40.
Herring MP, O’Connor PJ, Dishman RK. The effect of exercise training on anxiety symptoms among patients: a systematic review. Arch Intern Med. 2010;170:321–31.CrossRefPubMed
41.
Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000;62:633–8.CrossRefPubMed
42.
Netz Y, Wu M-J, Becker BJ, Tenenbaum G. Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. Psychol Aging. 2005;20:272–84.CrossRefPubMed
43.
Cuypers K, Krokstad S, Lingaas Holmen T, Skjei Knudtsen M, Bygren LO, Holmen J. Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway. J Epidemiol Community Heal. 2012;66:698–703.CrossRef
44.
Takeda F, Noguchi H, Monma T, Tamiya N. How possibly do leisure and social activities impact mental health of middle-Aged adults in Japan? An evidence from a national longitudinal survey. PLoS One. 2015;10:e0139777.CrossRefPubMedPubMedCentral
45.
Kötter T, Tautphäus Y, Obst KU, Voltmer E, Scherer M. Health-promoting factors in the freshman year of medical school: a longitudinal study. Med Educ. 2016;50:646–56.CrossRefPubMed
46.
Rodgers B, Korten AE, Jorm AF, Christensen H, Henderson S, Jacomb PA. Risk factors for depression and anxiety in abstainers, moderate drinkers and heavy drinkers. Addiction. 2000;95:1833–45.CrossRefPubMed
47.
Skogen JC, Harvey SB, Henderson M, Stordal E, Mykletun A. Anxiety and depression among abstainers and low-level alcohol consumers. The Nord-Trøndelag health study. Addiction. 2009;104:1519–29.CrossRefPubMed
48.
Massin S, Kopp P. Is life satisfaction hump-shaped with alcohol consumption? Evidence from Russian panel data. Addict Behav. 2014;39:803–10.CrossRefPubMed
49.
Kinnunen T, Haukkala A, Korhonen T, Quiles ZN, Spiro A, Garvey AJ. Depression and smoking across 25 years of the normative aging study. Int J Psychiatry Med. 2006;36:413–26.CrossRefPubMed
50.
Lien L, Satatun Å, Heyerdahl S, Søgaard AJ, Bjertness E. Is the relationship between smoking and mental health influenced by other unhealthy lifestyle factors? Results from a 3-year follow-up study among adolescents in Oslo, Norway. J Adolesc Health. 2009;45:609–17.
51.
Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:g1151.CrossRefPubMedPubMedCentral
52.
Weinhold D, Chaloupka FJ. Smoking status and subjective well-being. Tob Control. 2017;26:195–201.CrossRefPubMed
53.
Tjora T, Hetland J, Aaroe LE, Wold B, Wiium N, Oeverland S. The association between smoking and depression from adolescence to adulthood. Addiction. 2014;109:1022–30.CrossRefPubMed
54.
McKenzie M, Olsson CA, Jorm AF, Romaniuk H, Patton GC. Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood: findings from a 10-year longitudinal study. Addiction. 2010;105:1652–9.CrossRefPubMed
55.
Baines S, Powers J, Brown WJ. How does the health and well-being of young Australian vegetarian and semi-vegetarian women compare with non-vegetarians? Public Health Nutr. 2007;10:436–42.CrossRefPubMed
56.
Michalak J, Zhang XC, Jacobi F. Vegetarian diet and mental disorders: results from a representative community survey. Int J Behav Nutr Phys Act. 2012;9:67.
57.
Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Örning L, et al. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr. 2001;74:233–41.CrossRefPubMed
58.
Jagannath A, Peirson SN, Foster RG. Sleep and circadian rhythm disruption in neuropsychiatric illness. Curr Opin Neurobiol. 2013;23:888–94.CrossRefPubMed
59.
60.
61.
Lieverse R, de Vries R, Hoogendoorn AW, Smit JH, Hoogendijk WJG. Social support and social rhythm regularity in elderly patients with major depressive disorder. Am J Geriatr Psychiatry. 2013;21:1144–53.CrossRefPubMed
62.
Sutherland C. Introduction: German politics and society from a cosmopolitan perspective. Ger Polit Soc. 2011;29:1–19.CrossRef
63.
Markus HR, Kitayama S. Culture and the self: implications for cognition, emotion, and motivation. Psychol Rev. 1991;98:224–53.CrossRef
64.
Gorber, SC, Tremblay, M, Moher, D, & Gorber, B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007;8(4):307–26.
65.
Jin S, Zheng J, Xin Z. The structure and characteristics of contemporary Chinese values. Acta Psychol Sin. 2009;41:1000–14.
66.
Brislin RW. Back-translation for cross-cultural research. J Cross-Cult Psychol. 1970;1:185–216.CrossRef
67.
Milton K, Bull FC, Bauman A. Reliability and validity testing of a single-item physical activity measure. Br J Sport Med. 2011;45:203–8.CrossRef
68.
Wanner M, Probst-Hensch N, Kriemler S, Meier F, Bauman A, Martin BW. What physical activity surveillance needs: validity of a single-item questionnaire. Br J Sports Med. 2014;48:1570–6.CrossRefPubMed
69.
Gmel G, Rehm J. Measuring alcohol consumption. Contemp Drug Probl. 2004;31:467.CrossRef
70.
Skogen JC, Knudsen AK, Hysing M, Wold B, Sivertsen B. Trajectories of alcohol use and association with symptoms of depression from early to late adolescence: the Norwegian longitudinal health behaviour study. Drug Alcohol Rev. 2016;35:307–16.CrossRefPubMed
71.
Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44:227–39.CrossRefPubMed
72.
Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav Res Ther. 1995;33:335–43.CrossRefPubMed
73.
74.
IBM. IBM SPSS statistics for Macintosh. Armonk, NY: IBM Corp; 2012.
75.
Muthén LK, Muthén BO. Mplus User’s Guide. 8th ed. Muthén & Muthén: Los Angeles; 1988-2017.
76.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.
77.
Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1–55.CrossRef
78.
RC MC, Browne MW, Sugawara HM. Power analysis and determination of sample size for covariance structure modeling. Psychol Methods. 1996, 1:130.
79.
Hu L, Bentler PM. Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychol Meth. 1998;3:424–53.CrossRef
80.
NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2016;390:2627–42.
81.
Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640–9.CrossRefPubMed
82.
World Health Organization. Global status report on alcohol and health, 2014. Geneva: World Health Organization; 2014.
83.
Cochrane J, Chen H, Conigrave KM, Hao W. Alcohol use in China. Alcohol. 2003;38:537–42.CrossRef
84.
Du S, Mroz TA, Zhai F, Popkin BM. Rapid income growth adversely affects diet quality in China - particularly for the poor! Soc Sci Med. 2004;59:1505–15.CrossRefPubMed
85.
Appleby L, Warner R, Whitton A, Faragher B. A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ. 1997;314:932.CrossRefPubMedPubMedCentral
86.
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Prevalence of mental disorders in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand. 2004;109:21–7.CrossRef
87.
Twenge JM, Gentile B, DeWall CN, Ma D, Lacefield K, Schurtz DR. Birth cohort increases in psychopathology among young Americans, 1938-2007: a cross-temporal meta-analysis of the MMPI. Clin Psychol Rev. 2010;30:145–54.CrossRefPubMed
88.
Norton Norton PJ. Depression anxiety and stress scales (DASS-21): psychometric analysis across four racial groups. Anxiety Stress Coping. 2007;20:253–65.CrossRefPubMed
89.
Zhang XC, Kuchinke L, Woud ML, Velten J, Margraf J. Survey method matters: online/offline questionnaires and face-to-face or telephone interviews differ. Comput Human Behav. 2017;71:172–80.CrossRef
90.
Costa PT, McCrae RR. Influence of extraversion and neuroticism on subjective well-being: happy and unhappy people. J Pers Soc Psychol. 1980;38:668–78.
91.
Brailovskaia J, Schönfeld P, Zhang XC, Bieda A, Kochetkov Y, Margraf J. A cross-cultural study in Germany, Russia, and China: are resilient and social supported students protected against depression, anxiety, and stress? Psychol Rep. 2017:1–19.
92.
Berking M, Wupperman P. Emotion regulation and mental health. Curr Opin Psychiatry. 2012;25:128–34.CrossRefPubMed
93.
Zawadzki MJ. Rumination is independently associated with poor psychological health: comparing emotion regulation strategies. Psychol Health. 2015;30:1146–63.CrossRefPubMed
94.
Molarius A, Berglund K, Eriksson C, Eriksson HG, Linden-Bostrom M, Nordstrom E, et al. Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population-based study in Sweden. BMC Public Health. 2009;9:302.CrossRefPubMedPubMedCentral
95.
Stathopoulou G, Powers MB, Berry AC, JAJ S, Otto MW. Exercise interventions for mental health: a quantitative and qualitative review. Clin Psychol Sci Pract. 2006;13:179–93.CrossRef
96.
Hutton HE, Wilson LM, Apelberg BJ, Tang EA, Odelola O, Bass EB, et al. A systematic review of randomized controlled trials: web-based interventions for smoking cessation among adolescents, college students, and adults. Nicotine Tob Res. 2011;13:227–38.CrossRefPubMed
97.
Grandin LD, Alloy LB, Abramson LY. The social zeitgeber theory, circadian rhythms, and mood disorders: review and evaluation. Clin Psychol Rev. 2006;26:679–94.CrossRefPubMed
98.
Ehlers CL, Kupfer DJ, Frank E, Monk TH. Biological rhythms and depression: the role of zeitgebers and zeitstorers. Depression. 1993;1:285–93.CrossRef
99.
Monk TH, Kupfer DJ, Frank E, Ritenour AM. The social rhythm metric (SRM): measuring daily social rhythms over 12 weeks. Psychiatry Res. 1991;36:195–207.CrossRefPubMed
100.
Blanco C, Okuda M, Wright C, Hasin DS, Grant BF, Liu S-M, et al. Mental health of college students and their non–college-attending peers. Arch Gen Psych. 2008;65:1429–37.CrossRef
101.
Hunt J, Eisenberg D. Mental health problems and help-seeking behavior among college students. J Adolesc Health. 2010;46:3–10.CrossRefPubMed
102.
Metadata
Title
Lifestyle choices and mental health: a longitudinal survey with German and Chinese students
Authors
Julia Velten
Angela Bieda
Saskia Scholten
André Wannemüller
Jürgen Margraf
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5526-2

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