Health care reform includes a strong focus on population health, a strategy that seeks to proactively encourage healthy behavior change across the board, including the historically underserved.
New research supports this approach, as investigators have found that poor mental health leads to unhealthy behaviors in low-income adults.
In the study, Dr. Jennifer Walsh and colleagues discovered stress and anxiety predicted subsequent health-compromising behaviors, such as smoking, binge drinking, illegal drug use, unprotected sex and unhealthy diets. And it may be 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 Medicine, and is part of an issue focusing on multiple health behavior change.
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 12 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.
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, suggesting that unhealthy behaviors follow depression, anxiety and stress, rather than giving rise to them.
In response to these findings, study 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.”
Thus, referring patients for mental health counseling or stress reduction techniques may help to improve their health behaviors.