Co-occurring health behaviors and mental health outcomes among a large, aging US population

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.