A cross-sectional study on healthy lifestyle and the risk of anxiety and depression among adults undergoing health examinations.
10.11817/j.issn.1672-7347.2025.250243
- Author:
Yangyiyi YU
1
,
2
;
Jiale LIU
1
;
Pu PENG
3
;
Ting YUAN
4
;
Jinrong ZENG
1
,
5
;
Jianyun LU
1
,
6
Author Information
1. Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha
2. yiyi1998@csu.edu.cn.
3. Department of Mental Health, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou
4. Health Management Medical Center, Third Xiangya Hospital, Central South University, Changsha 410013, China.
5. zengjinrong1989@csu.edu.cn.
6. xiaoyun3@csu.edu.cn.
- Publication Type:Journal Article
- Keywords:
Life’s Simple 7;
anxiety;
cardiometabolic-psychiatric comorbidity;
depression;
lifestyle medicine;
mental disorders
- MeSH:
Humans;
Cross-Sectional Studies;
Depression/epidemiology*;
Anxiety/epidemiology*;
Adult;
Male;
Female;
Middle Aged;
Healthy Lifestyle;
Risk Factors;
Anxiety Disorders/epidemiology*;
Exercise;
Physical Examination;
Aged
- From:
Journal of Central South University(Medical Sciences)
2025;50(8):1428-1442
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVES:Depressive and anxiety disorders are among the most common mental disorders worldwide and are associated with unhealthy lifestyle behaviors. The Life's Simple 7 (LS7) guideline proposed by the American Heart Association aims to reduce cardiovascular risk by improving behaviors such as diet and physical activity, but its impact on mental health is not yet fully clear. This study examined the association between LS7 scores and symptoms of anxiety and depression in adults undergoing routine health examinations.
METHODS:Data were collected from individuals who underwent health examinations from May 2015 to December 2024 at the Health Management Center of the Third Xiangya Hospital. All participants completed the LS7 assessments, the Self-Rating Depression Scale (SDS), and the Self-Rating Anxiety Scale (SAS). Participants were categorized into 4 LS7 score groups: Low (≤7), average (8-9), good (10), and excellent (11-14). Those with SDS or SAS≥50 were classified as having mental disorder symptoms; with this group, SAS≥50 indicated anxiety, SDS≥50 indicated depression, and SDS and SAS≥50 indicated comorbid anxiety-depression. Binary logistic regression was used to assess associations between LS7 score and mental symptoms, calculating odds ratio (OR) and 95% confidence interval (CI). A restricted cubic spline (RCS) regression model was used to analyze the dose-response relationship between LS7 score (continuous variable) and the risk of mental symptoms. Nodes were set at the 5th, 35th, 65th, and 95th percentiles of the LS7 score, with the 5th percentile as the reference point. All models were adjusted for covariates such as gender, age, living alone, drinking status, education level, and sleep quality. Logistic regression framework was used to fit and calculate the adjusted OR (aOR) and 95% CI. Nonlinear relationship tests were also conducted. Subgroup analysis was performed to explore the interaction between gender, age, drinking habits, education level, and other factors and the LS7 score in influencing the risk of mental symptoms.
RESULTS:A total of 5 449 participants were included; 1 363 (25.01%) had depressive symptoms, 398 (7.30%) had anxiety symptoms, and 259 (4.75%) had comorbid anxiety-depression. The prevalence of mental symptoms decreased significantly as LS7 scores increased. Univariate and multivariate Logistic regression indicated that LS7 score≥8 was protective against mental symptoms. Multivariate Logistic regression demonstrated moderate discriminative ability (AUC=0.672). Among individuals with anxiety, depression, or comorbid symptoms, LS7 score distributions showed a graded decrease from poor to excellent groups. After adjustment, an excellent LS7 score was associated with a 39% lower risk of depression (aOR=0.61, 95% CI 0.47 to 0.78, P<0.001), a 63% lower risk of anxiety (aOR=0.37, 95% CI 0.22 to 0.59, P<0.001), and a 66% lower risk of comorbid anxiety-depression (aOR=0.34, 95% CI 0.17 to 0.62, P=0.001). The AUC values of the anxiety model, depression model, and comorbid anxiety and depression model were 0.632, 0.672, and 0.619, respectively. All models demonstrated moderate discriminatory ability, which was statistically significant, but their capacity to distinguish cases from non-cases was limited. RCS analysis confirmed a linear inverse relationship between LS7 score and mental symptom risk. Not smoking and regular physical activity were the strongest protective behaviors. Subgroup analysis suggested stronger protective effects in men, younger adults (≤60), non-drinkers, and those with higher education levels, and revealed a significant interaction between alcohol use and LS7 score (P for interaction=0.021), indicating that alcohol consumption may weaken the protective effect of LS7.
CONCLUSIONS:Ideal healthy lifestyle behaviors, as reflected by higher LS7 scores, are associated with lower risks of anxiety and depression in adults. Promoting LS7-based lifestyle practices may serve as a practical and effective strategy for the prevention and management of anxiety and depression in both clinical and daily life settings.
