Relationship between sedentary behavior and depression: A mediation analysis of influential factors across the lifespan among 42,469 people in low- and middle-income countries

• Published in: Journal of affective disorders 2018-03, Vol.229, p.231-238
• Main Authors: Stubbs, Brendon, Vancampfort, Davy, Firth, Joseph, Schuch, Felipe B., Hallgren, Mats, Smith, Lee, Gardner, Benjamin, Kahl, Kai.G., Veronese, Nicola, Solmi, Marco, Carvalho, André F., Koyanagi, Ai
• Format: Article
• Language: English
• Subjects: Adult; Aged; Body Mass Index; Cross-Sectional Studies; Depression; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Developing Countries - statistics & numerical data; Exercise - psychology; Female; Humans; Logistic Models; Low- and middle-income countries; Male; Middle Aged; Physical activity; Prevalence; Sedentary Behavior; Sitting; Young Adult
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2017.12.104

Sedentary behavior (SB) is associated with diabetes, cardiovascular disease and low mood. There is a paucity of multi-national research investigating SB and depression, particularly among low- and middle-income countries. This study investigated the association between SB and depression, and factors which influence this. Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Depression was based on the Composite International Diagnostic Interview. The association between depression and SB (self-report) was estimated by multivariable linear and logistic regression analyses. Mediation analysis was used to identify influential factors. A total of 42,469 individuals (50.1% female, mean 43.8 years) were included. People with depression spent 25.6 (95%CI8.5–42.7) more daily minutes in SB than non-depressed participants. This discrepancy was most notable in adults aged ≥ 65y (35.6min more in those with depression). Overall, adjusting for socio-demographics and country, depression was associated with a 1.94 (95%CI1.31–2.85) times higher odds for high SB (i.e., ≥ 8h/day). The largest proportion of the SB-depression relationship was explained by mobility limitations (49.9%), followed by impairments in sleep/energy (43.4%), pain/discomfort (31.1%), anxiety (30.0%), disability (25.6%), cognition (16.1%), and problems with vision (11.0%). Other health behaviors (physical activity, alcohol consumption, smoking), body mass index, and social cohesion did not influence the SB-depression relationship. People with depression are at increased risk of engaging in high levels of SB. This first multi-national study offers potentially valuable insight for a number of hypotheses which may influence this relationship, although testing with longitudinal studies is needed. •This is the first multinational study investigating the association between sedentary behavior and depression.•People with depression spent 25.6 (95%CI 8.5–42.7) more minutes per day in SB than non-depressed participants.•The relationship between SB and depression was most notable in older people.•Factors influencing the SB and depression relationship included mobility limitations (49.9%), followed by impairments in sleep/energy (43.4%), pain/discomfort (31.1%), anxiety (30.0%), disability (25.6%).