Objective: To analyze the association between severe mental illnesses and health behaviors among Brazilian adults. Methods: We used data from the Brazilian National Health Survey, a large nationally representative cross-sectional study conducted in 2013 among 60,202 adults (≥ 18 years). Clinical diagnoses (major depressive disorder, bipolar disorder and schizophrenia), lifestyle behaviors (leisure-time physical activity, TV viewing, tobacco use and the consumption of alcohol, sweets, and soft drinks) and potential confounders (chronological age, race, educational and employment status) were self-reported. Logistic regression models were used to examine the associations between severe mental illness and lifestyle behaviors, adjusting for confounders. Results: Schizophrenia (n=41) was associated with lower odds of physical activity (OR 0.08 [95%CI 0.01-0.58]). Major depressive disorder (n=4,014) was associated with higher odds of TV viewing (OR 1.34 [95%CI 1.12-1.61]), tobacco use (OR 1.37 (95%CI 1.18-1.58]), consumption of sweets (OR 1.34 (95%CI 1.15-1.55]) and consumption of soft drinks (OR 1.24 (95%CI 1.06-1.45]). There were no significant associations between bipolar disorder (n=47) and any lifestyle behaviors. Conclusions: Schizophrenia was associated with lower physical activity, while major depressive disorder was associated with increased TV viewing, tobacco use, and consumption of sweets and soft drinks. These findings reinforce the need for prevention and treatment interventions that focus on people with severe mental illness in Brazil.
Objective: To evaluate the associations of moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA), moderate physical activity (MPA), and sedentary behavior (SB) with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) during the COVID-19 pandemic in Brazil.Methods: Cross-sectional online survey in self-isolating people. Self-reported MVPA, VPA, MPA, and SB (exposures), and depressive and anxiety symptoms (Beck Depression and Anxiety Inventories [BDI and BAI]) were collected. Associations of MVPA, VPA, MPA, and SB with prevalent depressive (BDI>9), anxiety (BAI>7), and D&A (BDI>9+BAI>7) symptoms were investigated using logistic regressions, presented as odds ratio (OR) and 95% confidence interval (95%CI). Linear regressions were performed testing associations with symptom severity. Models were adjusted for confounding factors. Results: Participants (n=937, females=72.3%) performing ≥30min/day MVPA or ≥15min/day VPA had lower odds of prevalent depressive (ORMVPA=0.71, 95%CI=0.53-0.96; ORVPA=0.60, 95%CI=0.43-0.82), anxiety (ORMVPA=0.71, 95%CI=0.54-0.96; ORVPA=0.70, 95%CI=0.51-0.96), and co-occurring D&A symptoms (ORMVPA=0.71, 95%CI=0.52-0.96; ORVPA=0.59, 95%CI=0.41-0.83). People spending ≥10h/day sedentary were more likely to have depressive symptoms (OR=1.39,95%CI=1.02-1.90). Each hour spent sedentary corresponded to 0.22 (95%CI=0.10-0.33) points and 0.16 (95%CI=0.02-0.31) points higher on the BDI and BAI, respectively.Conclusion: Higher MVPA and VPA levels are associated with lower odds of depressive, anxiety and D&A symptoms. Higher SB is associated with higher odds of depressive symptoms.
Objective: Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association. Methods: We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses. Results: The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association. Conclusion: Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.
Objective: To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data. Methods: We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (≥ 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted. Results: Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities. Conclusion: Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.