Body mass index and depressive symptoms in adolescents in Taiwan: testing mediation effects of peer victimization and sleep problems

Bullying and depression among adolescents in East Asia: a scoping review on prevalence rates, risk and protective factors

Introduction

Bullying and victimization in adolescence is associated with mental health problems including depression. Depression in East Asian adolescents presents similarities and differences from that in Western adolescents. This review reports on the prevalence and psychosocial associations of bullying and depression in East Asian adolescents.

Methods

Electronic databases (Medline, and Embase) were searched for English language articles on bullying and its associations for a span of 10 years (1st January 2013 to 19th January 2024). Searches were limited to studies conducted in East Asia involving adolescents 10-19 years of age.

Results

Out of 1,231 articles initially identified, 65 full-text articles (consisting of 44 cross-sectional and 21 cohort studies) met the inclusion criteria and were included for qualitative synthesis & analysis. Prevalence rates of bullying ranged from 6.1% - 61.3% in traditional bullying victimization and 3.3% to 74.6% in cyberbullying victimization with higher rates in at-risk groups (e.g., adolescents with internet addiction). Psychosocial associations of bullying and depression which were similarly found in Western cultures include individual factors of coping style and gender; family factors of functioning and sibling relationships; and community factors of friendship and school-connectedness. In contrast, unique East Asian risk factors included being different (i.e., sexual minority status) and teachers as bullies.

Conclusion

Findings of this scoping review suggest that strong relationships within families, peers and the school community coupled with adolescents' positive coping style are protective against the negative effects of bullying. Conversely, poor parent-child attachment in the midst of family dysfunction, poor engagement with peers and the school community together with low self-esteem predispose East Asian adolescents to depressive symptoms as a result of victimization. Similar to Western cultures, adolescents who are bully-victims and poly-victims are most vulnerable to depression. As a significant proportion of bullying occurred in school, future research could focus on a whole-school intervention approach to counter bullying.

The role of victimisation and sleep quality in self-harm and depression among sexual minority adolescents. A prospective cohort study

Sexual minority adolescents (SMA) have a disproportionately high prevalence of victimisation, self-harm, and depressed mood, relative to the general population. Yet, the contributing and mechanistic factors are unclear. We aim to explore the directional relationship between victimisation and self-harm and depressed mood, with poor sleep quality as a possible mediator. A secondary data analysis was conducted using a nationally representative birth cohort in the United Kingdom, where participants self-identified as sexual minority (N = 1922, aged 11-13, 67.1% female) and their parents completed questionnaires and interviews when the participants were aged 11, 14 and 17. Logistic and linear regression were used to test whether victimisation prospectively predicted self-harm and depressed mood with mediation analyses conducted to assess if sleep onset latency and nocturnal awakening mediated their relationships. After adjusting for demographic factors and baseline self-harm and depressed mood, victimisation at age 11 significantly predicted self-harm (OR = 1.40, p < .01) and depressed mood (B = 0.024, SE = 0.01, p < .05) at age 17. In the mediation analyses, frequent nocturnal awakening at age 14, but not sleep onset latency, significantly mediated the effect of victimisation at age 11 on self-harm (indirect effect B = 0.008, SE = 0.004, 95%CI = 0.001-0.017) and depressed mood (indirect effect B = 0.005, SE = 0.002 95%CI = 0.001-0.010) at age 17. Our findings supported that victimisation contributed to negative mental health among SMA. Poor sleep quality could be an indicator of maladjustment with victimisation, which further increased vulnerability to negative mental health. Victimisation and sleep quality could be important assessment targets in mental health campaign among sexual minority adolescents.

Association between Body Mass Index and Externalizing and Internalizing Symptoms among Chinese Adolescents: Mediating Role of Traditional Bullying and Cyberbullying Victimization

BACKGROUND

Externalizing problems, internalizing problems, and obesity are among the greatest challenges to adolescent health. However, the moderating and mediating mechanisms that underlie this association remain predominantly unexplored.

OBJECTIVES

In this study, we examined the association between body mass index (BMI) and externalizing and internalizing scores in adolescents, tested whether traditional bullying and cyberbullying mediated the association, and explored the moderated role of sex.

METHODS

The data came from 1486 adolescents from grade 7, 8, and 10 living in Shantou, China. Information on BMI, traditional bullying, and cyberbullying victimization was obtained through a self-administered questionnaire. The students' externalizing and internalizing scores were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Furthermore, we built two parallel mediation models with sex as a moderating variable.

RESULTS

Compared to their peers with normal weight, adolescents with increased BMI reported higher externalizing and internalizing scores. Traditional bullying and cyberbullying were both significant mediators in the two relationships. Sex moderated the pathway from BMI to cyberbullying. But sex did not moderate the relationship between BMI and traditional bullying.

CONCLUSIONS

The results highlight that it is imperative for educators to identify students who are subjected to weight-based bullying and provide them with recommendations for effective coping strategies. Meanwhile, both victims of traditional bullying and those affected by cyberbullying should be the focus of prevention and intervention efforts when developing a strategy to improve levels of internalizing and externalizing symptoms among adolescents with increased BMI.

Potential biopsychosocial factors mediating/moderating the relationship between depressive symptoms and body size among children and adolescents: A systematic review

The prevalence of depression and obesity in the pediatric population has increased along with multiple adverse health outcomes in later life. However, the mechanisms underlying the bidirectional relationship between obesity and depression have not yet been clarified. We aim to systematically summarize the literature reporting on mediational or moderational biopsychosocial factors in the relationship between depression and body size among children and adolescents. Four electronic databases (PubMed, Web of Science, PsycINFO, and PsychArticles) were systematically searched from inception until December 23, 2021, and subsequently updated until June 9, 2023. The study protocol was registered with PROSPERO (CRD42022301475). A total of 36 unique records reporting 152,513 children and adolescents meeting the inclusion criteria were identified. The results indicate that disparate psychological variables (e.g., body image, victimization and bullying, eating disorders, and sleep problems) may mediate the bidirectional relationship between depressive symptoms and body size. Moreover, the mediational/moderational effect of biological factors has not been well established. The moderational effect of social factors was inconsistently reported. Future research should aim to identify and characterize factors that may impact the bidirectional relationship between depression and obesity to inform prevention intervention strategies for affected children and adolescents.

Longitudinal relationship between adolescents' mental health, energy balance-related behavior, and anthropometric changes

Energy balance-related behaviors (EBRBs) are considered the immediate causes of adolescents' body weight increases, but adolescents have identified mental health as a contributor. Cross-sectional studies have reported associations between adolescents' mental health and obesity, but causal relationships and the role of EBRBs within this can only be established using longitudinal studies. This systematic review summarizes the findings of longitudinal studies investigating this relationship, in addition to the role of EBRB in the relationship. Multiple electronic databases were searched for longitudinal studies using keywords related to the adolescent population, mental health, EBRB, and body weight. In total, 1216 references were identified and screened based on previously defined eligibility criteria. Sixteen articles met the inclusion criteria. Most studies indicated that mental health-related measures like depression, anxiety, and body dissatisfaction were related to an increase in body weight later. As this review is focused on behavioral mediators, six studies reported associations between mental health-anthropometry dyad and EBRBs such as eating habits, screen time, physical activity, and sleep-as well as stressors like peer victimization. Future studies may focus on streamlining mental health measures and body weight outcomes to assess this relationship. Furthermore, more longitudinal investigations are needed to provide insight into the role of EBRBs in the mental health-body weight relationship during adolescence.

Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study

Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing-doubling on average for boys and girls and decreasing obesity prevalence by over 4%.

Longitudinal association between cardiovascular risk factors and depression in young people: a systematic review and meta-analysis of cohort studies

BACKGROUND

Depression is a common and serious mental illness that begins early in life. An association between cardiovascular disease (CVD) and subsequent depression is clear in adults. We examined associations between individual CVD risk factors and depression in young people.

METHODS

We searched MEDLINE, EMBASE, and PsycINFO databases from inception to 1 January 2020. We extracted data from cohort studies assessing the longitudinal association between CVD risk factors [body mass index (BMI), smoking, systolic blood pressure (SBP), total cholesterol, high-density lipoprotein] and depression, measured using a validated tool in individuals with mean age of 24 years or younger. Random effect meta-analysis was used to combine effect estimates from individual studies, including odds ratio (OR) for depression and standardised mean difference for depressive symptoms.

RESULTS

Based on meta-analysis of seven studies, comprising 15 753 participants, high BMI was associated with subsequent depression [pooled OR 1.61; 95% confidence interval (CI) 1.21-2.14; I2 = 31%]. Based on meta-analysis of eight studies, comprising 30 539 participants, smoking was associated with subsequent depression (pooled OR 1.73; 95% CI 1.36-2.20; I2 = 74%). Low, but not high, SBP was associated with an increased risk of depression (pooled OR 3.32; 95% CI 1.68-6.55; I2 = 0%), although this was based on a small pooled high-risk sample of 893 participants. Generalisability may be limited as most studies were based in North America or Europe.

CONCLUSIONS

Targeting childhood/adolescent smoking and obesity may be important for the prevention of both CVD and depression across the lifespan. Further research on other CVD risk factors including blood pressure and cholesterol in young people is required.

Testing Bidirectional, Longitudinal Associations Between Disturbed Sleep and Depressive Symptoms in Children and Adolescents Using Cross-Lagged Models

IMPORTANCE

Understanding the longitudinal, bidirectional associations between disturbed sleep and depression in childhood and adolescence is crucial for the development of prevention and intervention programs.

OBJECTIVE

To test for bidirectional associations and cascade processes between disturbed sleep and depressive symptoms covering both childhood and adolescence and to test for the moderating processes of sex and pubertal status in adolescence.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study using the Québec Longitudinal Study of Child Development (QLSCD; 1997-ongoing). QLSCD's objective is to identify early childhood factors associated with long-term psychosocial and academic adjustment. Data were collected across 8 waves between ages 5 years (2003) and 17 years (2015). Associations were tested through cross-lagged models in childhood (5, 7, and 8 years), and in adolescence (10, 12, 13, 15, and 17 years). Data were analyzed from February to October 2021.

MAIN OUTCOMES AND MEASURES

Primary outcomes were disturbed sleep and depressive symptoms. Disturbed sleep was parent-reported and included sleep duration, time awake in bed, daytime sleepiness, sleep talking, sleepwalking, night terrors, and nightmares. Depressive symptoms were parent-reported in childhood (Child Behavior Checklist and Revised Ontario Child Health Study Scales), and self-reported in adolescence (Mental Health and Social Inadaptation Assessment for Adolescents).

RESULTS

Data on 1689 children (852 female [50.4%]) and 1113 adolescents (595 female [53.5%]) were included in the analyses. In childhood, significant bidirectional associations between depressive symptoms and disturbed sleep at all time points were found, indicating cascade processes (range β = 0.07; 95% CI, 0.02-012 to β = 0.15; 95% CI, 0.10-0.19). In adolescence, significant bidirectional associations from depressive symptoms to disturbed sleep (β = 0.09; 95% CI, 0.04-0.14) and vice versa (β = 0.10; 95% CI, 0.04-0.16) between 10 and 12 years were found. Between 12 and 13 years, depressive symptoms were modestly associated with disturbed sleep (β = 0.05; 95% CI, 0.001-0.10) but the reverse association was not significant. Cross-lagged estimates were nonsignificant after 13 years. The associations did not vary as a function of either sex or puberty-by-sex.

CONCLUSIONS AND RELEVANCE

These findings suggest that disturbed sleep is associated with the consolidation of depressive symptoms starting in childhood, which, in turn, is associated with ongoing sleep problems. It is possible that timely and appropriate interventions for incipient disturbed sleep and depression prevent spiraling effects on both domains.

Association Between Disturbed Sleep and Depression in Children and Youths: A Systematic Review and Meta-analysis of Cohort Studies

IMPORTANCE

Disturbed sleep represents a potentially modifiable risk factor for depression in children and youths that can be targeted in prevention programs.

OBJECTIVE

To evaluate the association between disturbed sleep and depression in children and youths using meta-analytic methods.

DATA SOURCES

Embase, MEDLINE, PsycINFO, Scopus, Web of Science, and ProQuest Dissertations & Theses Global were searched for articles published from 1980 to August 2019.

STUDY SELECTION

Prospective cohort studies reporting estimates, adjusted for baseline depression, of the association between disturbed sleep and depression in 5- to 24-year-old participants from community and clinical-based samples with any comorbid diagnosis. Case series and reports, systematic reviews, meta-analyses, and treatment, theoretical, and position studies were excluded. A total of 8700 studies met the selection criteria. This study adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-analyses and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statements.

DATA EXTRACTION AND SYNTHESIS

Study screening and data extraction were conducted by 2 authors at all stages. To pool effect estimates, a fixed-effect model was used if I2 < 50%; otherwise, a random-effects model was used. The I2 statistic was used to assess heterogeneity. The risk of bias was assessed using the Research Triangle Institute Item Bank tool. Metaregression analyses were used to explore the heterogeneity associated with type of ascertainment, type of and assessment tool for disturbed sleep and depression, follow-up duration, disturbed sleep at follow-up, and age at baseline.

MAIN OUTCOME AND MEASURES

Disturbed sleep included sleep disturbances or insomnia. Depression included depressive disorders or dimensional constructs of depression. Covariates included age, sex, and sociodemographic variables.

RESULTS

A total of 22 studies (including 28 895 patients) were included in the study, of which 16 (including 27 073 patients) were included in the meta-analysis. The pooled β coefficient of the association between disturbed sleep and depression was 0.11 (95% CI, 0.06-0.15; P < .001; n = 14 067; I2 = 50.8%), and the pooled odds ratio of depression in those with vs without disturbed sleep was 1.50 (95% CI, 1.13-2.00; P = .005; n = 13 006; I2 = 87.7%). Metaregression and sensitivity analyses showed no evidence that pooled estimates differed across any covariate. Substantial publication bias was found.

CONCLUSIONS AND RELEVANCE

This meta-analysis found a small but statistically significant effect size indicating an association between sleep disruption and depressive symptoms in children and youths. The high prevalence of disturbed sleep implies a large cohort of vulnerable children and youths who could develop depression. Disrupted sleep should be included in multifaceted prevention programs starting in childhood.

Is the Effect of Body Dissatisfaction on Depressive Symptoms Dependent on Weight Status? A Study with Early-to-Middle Adolescents

Depression is a recognized mental health problem in adolescence and body dissatisfaction is an important risk factor. The main goal of this study is to examine the relationship between body dissatisfaction and depressive symptoms, and whether it depends on adolescents' weight status, an issue that remains understudied. Two hundred and fourteen adolescents (12-16 years) completed self-report measures of depressive symptoms, body dissatisfaction and weight status (i.e., current body weight and height, to compute body mass index z-scores, BMIz). Hierarchical multiple regression and moderation analyses were conducted, accounting for gender and age effects on depressive symptoms. Body dissatisfaction was found to be a predictor of depressive symptoms for the low and median BMIz adolescents, but not for those with high BMIz. In addition, this interaction of body dissatisfaction and BMIz improved the ability of the regression model to explain depressive symptoms´ variance beyond the effect of gender and age. The high-BMIz adolescents presented higher body dissatisfaction but similar levels of depressive symptoms, compared to the lower BMIz adolescents. These findings suggest the influence of body dissatisfaction in the emergence of depressive symptoms in the first half of adolescence, and the importance of weight status throughout this path.

Association of Sedentary Behavior With Anxiety, Depression, and Suicide Ideation in College Students

Objectives: To investigate the association of sedentary behavior with anxiety, depression, and suicide ideation in multi-centered college students in China. Methods: This was a cross-sectional study of the first-year college student population. The students underwent a questionnaire survey inquiring about sedentary behavior (hours per day) and physical activity (minutes per week) during the past year. Anxiety, depression, and sleep quality were measured by the Generalized Anxiety Disorder Scale (GAD-2), the Patient Health Questionnaire (PHQ-2), and the Pittsburgh Sleep Quality Index (PSQI), respectively. Mixed models were used to estimate the associations, and adjusted odds ratios (AORs) were presented as the effect size. Mediation effect analysis was conducted to test the mediation effect of PSQI. Results: A total of 28,298 participants (response rate: 82%) completed the survey and were included in the final analyses. Crude and adjusted estimates consistently showed that both sedentary behavior and physical activity were significantly associated with mental illnesses. Sedentary behavior was positively associated with anxiety, depression, and suicidal behavior in a dose-response manner (AOR: 0.54-0.24; ≥7 h/day as reference), independent from the effect of physical activity (AOR: 0.78-0.41; no physical activity as reference). The association of sedentary behavior with mental health was partly mediated by sleep quality (25-71%). Conclusions: There is an independent dose-response association of sedentary behavior with mental well-being among college students in China, and this association may be partially attributable to impaired sleep quality. Attention should be drawn and actions should be taken by college educators and mental health providers.

Interaction Between Depression, Obesity, and Type 2 Diabetes: A Complex Picture

Depression plays an important role in the pathogenesis and treatment of obesity and type 2 diabetes (T2D). However, its relevance is frequently unrecognized by clinicians and researchers. The purpose of this review is to present a critical analysis of the evidence linking depression and metabolic disorders and to highlight the practical implications of this complex relationship. Evidence obtained from epidemiological, basic, clinical and controlled studies demonstrate that the association goes beyond a random phenomenon. Epidemiological studies have rendered controversial results due to the lack of control of the confounding variables and the bidirectional relationship that exists between the outcomes and the conditions that modulate the association (i.e. socioeconomic status). Animal and human studies have been useful to define the anatomic substrates and physiologic processes that participate in the association, but, the evidence is preliminary in many areas (i.e gene × environmental interactions). Controlled studies have shown the strong impact that treatment of depression has on body weight and the large effect that has the correction of excess body weight on the depression-related symptoms. Practical implications of the depression-obesity duet include the training of the health providers to assess and treat these conditions in a concomitant manner, the need for translational medicine projects and the application the systems biology approach to fill the existing gaps of knowledge.

Normal diet Vs High fat diet - A comparative study: Behavioral and neuroimmunological changes in adolescent male mice

Recent evidence has established that consumption of High-fat diet (HFD)-induced obesity is associated with deficits in hippocampus-dependent memory/learning and mood states. Nevertheless the link between obesity and emotional disorders still remains to be elucidated. This issue is of particular interest during adolescence, which is important period for shaping learning/memory and mood regulation that can be sensitive to the detrimental effects of HFD. Our present study is focused to investigate behavioral and metabolic influences of short-term HFD intake in adolescent C57BL/6 mice. HFD caused weight gain, impaired glucose tolerance (IGT) and depression-like behavior as early as after 3 weeks which was clearly proved by a decrease in number of groomings in the open field test (OFT) and an increase in immobility time in the tail suspension test (TST). In the 4th week HFD induced obese model was fully developed and above behavioral symptoms were more dominant (decrease in number of crossings and groomings and increase in immobility time in both FST and TST). At the end of 6th week hippocampal analysis revealed the differences in morphology (reduced Nissl positive neurons and decreased the 5-HT_1A receptor expression), neuronal survival (increased cleaved caspase-3 expression), synaptic plasticity (down regulation of p-CREB and BDNF), and inflammatory responses (increase in expression of pro-inflammatory cytokines and decrease in expression of anti-inflammatory cyokines) in HFD mice. Our results demonstrate that, high-fat feeding of adolescent mice could provoke "depression-like" behavior as early as 3 weeks and modulate structure, neuron survival and neuroinflammation in hippocampus as early as 6 weeks proving that adolescent age is much prone to adverse effects of HFD, which causes obesity, behavioral differences, memory and learning deficiencies.