Associations of childhood household dysfunction and healthy lifestyle with depressive symptoms in adolescents

Objective

Limited understanding exists regarding the cumulative impact of childhood household dysfunction (CHD) on adolescent depressive symptoms in developing countries, as well as the role of lifestyles in this association. This study aims to explore the associations of individual and cumulative CHD indicators with depressive symptoms among Chinese adolescents. Additionally, we investigate potential interactions and joint associations of CHD and lifestyles on depressive symptoms.

Methods

In the second phase of the Longitudinal Study of Adolescents’ Mental and Behavioral Well-being Research, data on depressive symptoms, CHD indicators, lifestyle factors, and other covariates were collected from 3106 students (mean [SD] age, 15.16 [1.52] years). Linear and logistic mixed-effects models were employed, with both stratified and joint analyses conducted.

Results

Except for parental death, each CHD indicator was associated with an increased risk of depressive symptoms. The accumulation of CHD indicators exhibited a positive, graded association with depressive symptoms scores (β = 3.22, 95% CI: 2.48 to 3.97 for one CHD indicator; β = 5.45, 95% CI: 4.41 to 6.49 for two or more CHD indicators, all P < 0.01). A significant interaction was found between the number of CHD indicators and the healthy lifestyle score (interaction β = −0.40, 95% CI: −0.78 to −0.03, P < 0.05), indicating that healthy lifestyles may mitigate the risk of depressive symptoms in individuals experiencing CHD. For example, the OR for having depressive symptoms among adolescents with favourable lifestyles compared with those with unfavourable lifestyles was 0.21 (95% CI: 0.10 to 0.45, P < 0.01) among those experiencing CHD. Moreover, adolescents with two or more CHD indicators and unfavourable lifestyles faced the highest risk of having depressive symptoms (OR = 8.03, 95% CI: 4.83 to 13.34, P < 0.01) compared with those with no CHD indicator and favourable lifestyles.

Conclusions

These findings underscore the importance of promoting comprehensive healthy lifestyles and reducing CHD exposure for the prevention of depressive symptoms in adolescents.