Poor mental health leads to unhealthy behaviors among low-income adults

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 study¹ by Dr. Jennifer Walsh and colleagues from the Centers for Behavioral and Preventive Medicine at The Miriam Hospital in the US. In this study, stress and anxiety predicted subsequent health-compromising behaviors, such as smoking, binge drinking, illegal drug use, unprotected sex and unhealthy diets. One possible explanation for these findings is that health compromising behaviors may be used as coping mechanisms to manage the effects of stress and anxiety. The study is published online in the Springer journal, Translational Behavioral Medicine², and is part of an issue focusing on multiple health behavior change.

Dr. Walsh and her team explored the relationship between health-compromising behaviors and mental health in the context of socioeconomic disadvantage to determine whether mental health problems lead to subsequent unhealthy behaviors, or whether these behaviors lead to mental health problems.

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 three, six, nine and twelve months later. The researchers assessed a number of behaviors: substance use (binge drinking, smoking, illegal drug use), exercise, as well as 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 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.

The authors suggest 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 these behaviors." Referring patients for mental health counselling or stress reduction techniques may help to improve their health behaviors.