Depressive symptoms in childhood and adolescence were associated with poorer sleep patterns, lower fruit and vegetable consumption, and greater social media use in adolescence, according to a study published in JAMA Network Open.

Investigators extracted data from the fourth and sixth waves of the Millennium Cohort Study, a population-based longitudinal study of young people in the United Kingdom who were born between 2000 and 2001. Wave 4 (2012-2013) included data from when participants were 7 years of age, while wave 6 (2015-2016) contained data from when participants were 14 years of age. The primary outcomes were health behaviors at the age of 14 years, assessed by self-report. Health behaviors of interest included fruit, vegetable, and soft drink consumption; social media use; and the number of hours of sleep per night.

The primary exposures were parent-reported mental health problems at the age of 7 years and self-reported mental health problems at 14 years of age. Parent-reported symptoms were captured using the 25-item Strengths and Difficulties Questionnaire, while self-reported symptoms were captured with the Short Mood and Feelings Questionnaire. Linear and logistic regression models were used to assess the impact of mental health status in childhood and adolescence on health behaviors in adolescence. Models were adjusted for participants’ sex and household income.

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The study cohort comprised 9369 adolescents, among whom 4665 (48.1%) were girls. A total of 6106 (65.2%) had no reported mental health problems at either time point; 693 (7.4%) had parent-reported problems at age 7 only; 2197 (23.4%) had self-reported problems at age 14 only; and 373 (4.0%) had parent- and self-reported problems at both time points. Compared to participants with no mental health problems at either time point, participants with symptoms at 14 years of age only were less likely to sleep 9 hours or more per night (odds ratio [OR], 0.39; 95% CI, 0.34-0.45), less likely to consume fruit (OR, 0.55; 95% CI, 0.46-0.65) and vegetables (OR, 0.66; 95% CI, 0.52-0.83), and used more social media (β = 0.62; 95% CI, 0.49-0.75). The same trends were observed for participants who reported problems at both ages: less sleep (OR, 0.68; 95% CI, 0.51-0.90), less fruit (OR, 0.39; 95% CI, 0.26-0.58) and vegetable consumption (OR, 0.57; 95% CI, 0.35-0.91), and more social media use (β = 0.63; 95% CI, 0.34-0.91). Participants with parent-reported mental health problems at 7 years of age did not have significantly different behavioral outcomes from participants with no problems at either time point.

Depressive symptoms at 7 and 14 years of age had a substantial impact on health-related behaviors in adolescence. Concerning study limitations, investigators noted that parent- and self-reporting of mental health problems may not have captured all potential psychiatric symptoms in participants. Additionally, data on certain potential confounders were unavailable, including adverse childhood experiences and family history of mental illness. Further study is necessary to better clarify the relationship between childhood mental health symptoms and health behaviors in adolescence.

“These findings are particularly important given that independent health behaviors can deteriorate and become habitual during adolescence, and adolescence is a known time for the first emergence of mental health problems that continue into adulthood,” the investigators wrote.


Hoare E, Werneck AO, Stubbs B, et al. Association of child and adolescent mental health with adolescent health behaviors in the UK Millennium Cohort [published August 10, 2020]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.11381