Association between lifestyle behaviors and depression in 90.846 Brazilian adults: A cluster analysis

Background and aims: A lifestyle that includes high screen time, unhealthy eating behaviors, physical inactivity, and tobacco use has been associated with an increased risk of developing depressive disorders. However, lifestyles often encompass a combination of both positive and negative behaviors. This study aimed to investigate the association between clusters of lifestyle behaviors and depression in Brazilians. Methods: A secondary analysis was conducted using the data from the Brazilian National Health Survey. Brazilians aged >= 15 years participated in this study. Lifestyle evaluations included eating behavior, physical activity, screen time, tobacco use, and alcohol consumption. Clinical diagnoses of depression were self-reported. Two-step cluster analysis was used to identify the lifestyle profiles. We used a multivariate logistic regression model to examine the association between the lifestyle cluster profiles and depression. Results: A total of 90,846 Brazilians were analyzed, revealing three lifestyle clusters. The "At Risk" cluster, characterized by the least healthy behaviors represented 12.5% of the sample and had a depression prevalence of 10.9%. The results demonstrated that participants in the "active with alcohol consumption" cluster had approximately 35% (ORadjusted = 0.65; 95%CI = 0.57, 0.74) and the "healthier" cluster had 27% (ORadjusted = 0.73; 95%CI = 0.65, 0.85) lower odds of reporting depression than those in the at-risk cluster. Conclusion: Participants in clusters that combine multiple detrimental health behaviors showed an association with depression. Synergies between lifestyle behaviors may be key to understanding mental health issues.