Cross-sectional and prospective associations of lifestyle risk behaviors clustering with elevated depressive symptoms among middle-aged and older adults

Objectives: To investigate the cross-sectional and prospective associations of lifestyle risk behaviors clustering with elevated depressive symptoms and to explore synergic prospective associations of different combinations of lifestyle risk behaviors with subsequent depressive symptoms. Study design: Prospective cohort study. Data on 31,190 middle-aged and older adults from waves 4 (2011) and 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Main outcome measures: Elevated depressive symptoms were estimated using the EURO-D 12-item scale. Lifestyle risk behaviors composing the cluster included physical inactivity, inadequate consumption of fruit and/or vegetables, binge drinking, and tobacco smoking. Gender, age group, education, place of residence, country, number of chronic diseases and body mass index were considered as confounders. Results: With the exception of binge drinking, all lifestyle risk behaviors were associated with higher odds of elevated depressive symptoms in cross-sectional and prospective analyses. The clustering of unhealthy lifestyle behaviors was cross-sectionally associated with elevated depressive symptoms and the clustering of two [odds ratio [OR]: 1.39; 95%CI: 1.28–1.51) and three or four (OR: 1.60; 95%CI: 1.38–1.85) were prospectively associated with elevated depressive symptoms. There were no interactions between the pairs of behaviors in the association with later elevated depressive symptoms. Conclusions: Our findings support the need for interventions integrating multiple health behaviors to prevent elevated depressive symptoms among middle-aged and older adults.