Prospective Changes in Healthy Lifestyle Among Midlife Women: When Psychological Symptoms Get in the Way.
Anxiety and depression are linked to increased risk of cardiometabolic disease and mortality, and unhealthy behaviors may be the key mechanisms underlying these associations. Although higher levels of psychological symptoms are associated with individual unhealthy behaviors (e.g., physical activity, smoking), their roles in overall lifestyle remain understudied.



Midlife women (n=55,395) from the cohort Nurses' Health Study reported anxiety and depression symptoms in 1988 and 1992, respectively. Health behaviors (i.e., physical inactivity, BMI, diet, and alcohol and tobacco consumption) were measured in self-administered questionnaires in 1988 or 1992, and every 4 years until the last assessment available (2010; follow-up, 18-22 years). Data were analyzed in 2014-2015. Women were categorized according to initial level of psychological symptoms (e.g., lower versus higher anxiety symptoms).



Despite slight improvements in healthy lifestyle over time among women with higher versus lower anxiety (βinteraction=0.002, 95% CI=0.001, 0.003), those experiencing more severe symptoms had a consistently less healthy lifestyle over time (p<0.0001). Each SD increase in anxiety symptoms was related to a decrease in healthy lifestyle score throughout follow-up (βpooled=-0.09, 95% CI=-0.09, -0.08). Women with higher versus lower anxiety symptoms also had decreased odds of having a healthy lifestyle in 2010 (AOR=0.78, 95% CI=0.75, 0.81), particularly among women with an initially unhealthy lifestyle (pinteraction≤0.0001). Comparable patterns were observed with depression symptoms.



Among midlife women, anxiety and depression symptoms were associated with unhealthier lifestyle throughout follow-up and reduced odds of having a healthy lifestyle 20 years later. Treating psychological symptoms may promote healthier lifestyles.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Electronic address: ctrudel@hsph.harvard.edu.
Claudia
C
Trudel-Fitzgerald
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts;; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Shelley S
SS
Tworoger
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts;
Elizabeth M
EM
Poole
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
David R
DR
Williams
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Laura D
LD
Kubzansky
D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D000072001:Diet, Healthy; D015444:Exercise; D005260:Female; D015438:Health Behavior; D000070497:Healthy Lifestyle / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires