Associations between Health Behaviors Index and Mental Health in Brazilian Adolescents: Insights from the 2019 National School Health Survey

Previous studies have shown associations between individual health behaviors and mental health outcomes. However, the impact of the accumulation of such behaviors on mental health remains unclear. This study aimed to examine the association between an index of accumulated health behaviors and mental health in adolescents, using data from the Brazilian National School Health Survey (PeNSE), which included 4,361 schools and a sample of 124,898 students. Health behaviors were assessed across five domains: healthy diet, alcohol consumption, smoking, physical activity, and sedentary behavior, with scores ranging from 0 to 5. Mental health outcomes (anxiety, sadness, social isolation, stress, and depression) and self-rated health were evaluated based on students' responses about their feelings over the previous 30 days. Regression models were applied, adjusting for key sociodemographic variables. The majority of participants were female, aged 13-15 years, and from the Southeast region. The results showed that a higher accumulation of healthy behaviors was associated with better mental health and more favorable self-rated health. These associations remained consistent after controlling for potential confounders. The findings underscore the importance of promoting multiple healthy behaviors to support mental well-being and self-perceived health among Brazilian adolescents.