title: Depressive symptoms are associated with excess weight and unhealthier lifestyle behaviors in urban adolescents.
abstract: BACKGROUND
  Adolescence is a critical period for the development of depressive symptoms and obesity. This study examined the association of depressive symptoms with standardized BMI (BMI z-score), lifestyle behaviors, and self-efficacy measures in a sample of urban adolescents.
  
  
  METHODS
  A school-based study was conducted among adolescents (N=1508) enrolled from 11 public schools. Depressive symptoms were assessed with Kandel's depressive symptoms scale for adolescents. Fruit and vegetable intake and intake of energy-dense foods were assessed by a short food frequency questionnaire. Sedentary behavior and physical activity (PA) were obtained by self-report. Height and weight were measured directly and BMI z-scores were calculated. Mixed-effects models were used to examine the association of depressive symptoms with BMI z-score and lifestyle behaviors, accounting for clustering at school level and adjusting for confounders. Self-efficacy measures were evaluated as potential mediators.
  
  
  RESULTS
  The sample was 53% female, 75% Hispanic, and 82% US born, with a mean age of 13.9 years. Higher depressive symptoms were associated with higher BMI z-score (β=0.02; p=0.02), intake of energy-dense foods (β=0.42; p<0.001), and sedentary behavior (β=0.48; p<0.001), but lower PA (β=-0.03; p=0.01). There was an interaction by gender in the association of depressive symptoms and PA. Self-efficacy mediated the association of depressive symptoms and PA.
  
  
  CONCLUSIONS
  Obesity prevention and treatment programs should consider addressing the role of negative emotions as part of their preventive strategies.
authors.affiliation: 1 Ross University School of Medicine , Roseau, Commonwealth of Dominica .
authors.forename: Fiorella
authors.initials: F
authors.lastname: Castillo
authors.forename: Lori
authors.initials: L
authors.lastname: Francis
authors.forename: Judith
authors.initials: J
authors.lastname: Wylie-Rosett
authors.forename: Carmen R
authors.initials: CR
authors.lastname: Isasi
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D015992:Body Mass Index; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D015444:Exercise / Q000523:psychology; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D012572:School Health Services; D057185:Sedentary Behavior; D020377:Self Efficacy; D014505:Urban Population