Poor Mental Health Leads to Unhealthy Behaviors Among Low-income Adults, Say Miriam Hospital Researchers

Posted Monday, February 04, 2013

Study says binge drinking, smoking, and illegal drug use may be used to cope with depression and anxiety

Poor mental health leads to unhealthy behaviors in low-income adults – not the other way around, according to a new study by researchers from The Miriam Hospital’s Centers for Behavioral and Preventive Medicine.

They report stress, depression and anxiety predict potentially harmful behaviors, such as smoking, binge drinking, illegal drug use, unprotected sex and unhealthy diets. Lead author Jennifer Walsh, PhD, says one possible explanation for these findings is that these behaviors may be used as coping mechanisms to manage the effects of stress, depression and anxiety.

“Although there are established relationships between physical and mental health, few studies have explored the relationship between health behaviors and mental health over time, particularly in the context of socioeconomic disadvantage,” says Walsh, a researcher with The Miriam Hospital’s Centers for Behavioral and Preventive Medicine. “Our goal was to determine whether mental health problems lead to subsequent unhealthy behaviors, or if unhealthy behaviors contribute to poor mental health.”

The study is published online in the journal Translational Behavioral Medicine.

A total of 482 adults receiving care at a sexually transmitted infection clinic took part in the study. They were asked to complete an online interview at the start of the study and then every three months over a one- year period. The researchers assessed a number of behaviors, including substance use (binge drinking, smoking and illegal drug use), exercise, and sexual, dietary and sleep behaviors. They also measured levels of anxiety, depression and perceived stress.

Health-compromising behaviors, including substance use, unprotected sex, poor diet and insufficient or excessive sleep, were common among patients attending the clinic. Participants with very low incomes (annual income of less than $15,000) reported a higher number of health-compromising behaviors, as well as more symptoms of depression and anxiety and higher levels of stress, compared to those participants with higher incomes.

The authors found that symptoms of depression and anxiety, as well as perceived stress, predicted later levels of unhealthy behaviors, when both socioeconomic status and earlier behaviors were taken into account. In contrast, unhealthy behaviors did not predict later mental health. These results show that unhealthy behaviors follow depression, anxiety and stress, rather than giving rise to them.

Walsh suggests that targeting mental health may offer a way to promote improvements across health behaviors.

“Clinicians and practitioners should recognize that there may be high rates of depression, anxiety and stress, as well as health-compromising behaviors, in low-income populations, and they should assess mental health as well as health behaviors,” she says. “Referring patients for mental health counseling or stress reduction techniques may help to improve their health behaviors.”

Research reported in this publication was supported by the National Institute of Mental Health under award number R01-MH068171. Study co-authors include Michael P. Carey, PhD, director of The Miriam Hospital’s Centers for Behavioral and Preventive Medicine, and Theresa E. Senn, PhD, also of The Miriam Hospital’s Centers for Behavioral and Preventive Medicine.

The principal affiliation of Jennifer Walsh, PhD, is The Miriam Hospital (a member hospital of the Lifespan health system in Rhode Island), and direct financial and infrastructure support for this project was received through the Lifespan Office of Research Administration. Walsh, Senn and Carey are also on the faculty at The Warren Alpert Medical School of Brown University.

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