title: Clustering of health risk behaviours and the relationship with mental disorders.
abstract: BACKGROUND
  Health risk behaviours tend to co-occur and are found to be related to mental health symptoms. This is the first study to identify health behaviour clusters in relation to mental disorders.
  
  
  METHODS
  Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a nationally representative sample of adults (n=5303). Latent class analysis was performed to identify clusters based on four health risk behaviours (smoking, heavy drinking, physical inactivity, and unhealthy diet). Concurrently, we examined the relationship between the identified clusters and a range of DSM-IV diagnoses, assessed with the Composite International Diagnostic Interview 3.0.
  
  
  RESULTS
  Four distinct health behaviour clusters were identified: most healthy (mainly non-smokers, moderate drinkers, active, healthy diet; class 1: 79.3%); smokers, moderate drinkers, inactive, unhealthy diet (class 2: 13.2%); smokers, heavy episodic drinkers, active, unhealthy diet (class 3: 3.8%); Smokers, frequent heavy drinkers, active, low fruit (class 4: 3.6%). Despite their different lifestyles, individuals in all three unhealthy clusters had double the risk of depression. Unhealthy behaviour clusters were strongly associated with drug dependence (classes 2 and 3), alcohol abuse and dependence (classes 3 and 4), and social phobia (class 4).
  
  
  CONCLUSIONS
  Due to the cross-sectional design, no conclusions about the causality of the relationship between HRB clusters and mental disorders can be drawn from the current study.
  
  
  CONCLUSIONS
  Health behaviour clusters are strongly associated with mental disorders. This co-existence of behaviours and disorders emphasises the importance of an integrative approach in the prevention of mental illnesses.
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands. Electronic address: evermeulen@trimbos.nl.
authors.forename: E
authors.initials: E
authors.lastname: Vermeulen-Smit
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Van Laar
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: De Graaf
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D016000:Cluster Analysis; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004032:Diet / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D009043:Motor Activity; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
keywords: Health risk behaviour clusters; Latent class analysis; Mental disorders