Global study reveals link between psychological distress and unhealthy eating in adolescents

A recent Scientific Reports journal study estimates the prevalence of unhealthy eating and psychological distress across sexes.

Study: The burden of psychological distress and unhealthy dietary behaviours among 222,401 school-going adolescents from 61 countries. Image Credit: Inside Creative House / Shutterstock.com

Background

Mental health disorders adversely affect academic performance, physical health, and quality of life. Among adolescents, psychological distress is often a sign of mental health disorders and, if not identified and treated early, may have severe consequences, such as personality disorders or even suicide.

In adolescents, psychological distress is correlated with a number of factors, such as tobacco use, physical inactivity, and an unhealthy diet. These relationships can be bi-directional in nature and complex to understand.

Current research on the relationship between psychological distress and unhealthy diet among adolescents has some limitations, including the unaccountability for sex differences and the fact that most evidence comes from high-income countries. Comprehensive epidemiological studies based on representative data could overcome some of these limitations. 

About the study

The Global School-Based Health Survey (GSHS) data from 61 countries between 2009 and 2018 was used for the analysis. GSHS obtains detailed information on protective, lifestyle, psychosocial, and sociodemographic factors. 

To measure psychological distress, suicide ideation, loneliness, suicide planning, anxiety, and suicide attempts were considered. An individual with two or more of these characteristics was considered psychologically distressed.

Daily consumption of soft drinks, inadequate fruit intake, weekly fast-food consumption, and inadequate vegetable intake were four factors to gauge unhealthy dietary behaviors.

A random-effects meta-analysis was used to understand the overall and regional pooled prevalence. Mixed-effect multilevel logistic regressions were estimated to analyze the adjusted odds ratios (aORs) of unhealthy diet in relation to psychological distress. 

Key findings

More than one in six adolescents experienced some form of psychological distress, with boys reporting a lower prevalence of distress than girls. Unhealthy dietary patterns were also reported, often involving low fruit and vegetable consumption and high consumption of fast food and soft drinks.

Across geographical regions, notable heterogeneity in the prevalence of unhealthy dietary behaviors and psychological distress was observed. The four unhealthy dietary behaviors were significantly associated with psychological distress. Factors like region, age, and socioeconomic status also affected the associations. 

In line with prior research, there was a significantly high prevalence of psychological distress across the studied regions. However, direct comparability was difficult due to differences in definitions and age distributions across studies.

The African region was associated with the most significant prevalence of psychological distress, which could have been accelerated by other problems in this region, such as the high prevalence of malaria and human immunodeficiency virus (HIV), as well as the relatively larger number of human rights violations.

In terms of heterogeneities concerning sex, a higher prevalence of psychological distress was observed in girls as compared to boys. Similar differences among sexes were noted while analyzing anxiety, loneliness, suicide planning, suicidal ideation, and suicide attempts separately. The higher rates of sexual abuse, domestic violence, and internalizing problems in girls could explain this.

A significant proportion of adolescents engaged in unhealthy dietary habits; however, no significant sex differences were observed. Fruit consumption was particularly low, and fast food and soft drinks consumption rates were high in all regions.

These findings suggest that adolescents with psychological distress are likely more inclined to have unhealthy dietary behaviors. Although causality was not established, low mood could have led to an increased intake of unhealthy food. In the future, more research is needed to determine the causal mechanism underlying these associations. 

Conclusions

The current study highlights the significant burden of unhealthy dietary behaviors and psychological distress among adolescents across regions. Individuals with psychological distress were more likely to engage in unhealthy dietary behaviors.

A key strength of the study was the inclusion of many adolescents from representative samples across 61 countries, which aids in the generalizability of the findings. The use of consistent definitions for both exposure and outcome variables and accounting for confounders were also notable strengths of this study.

The use of self-reported data to assess psychological distress differed from many previous studies, thus making comparability difficult. Variations in the data could have affected the accuracy of comparing trends across the countries. Although multiple covariates were accounted for, residual confounding could still affect the results.