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Body mass index and depressive symptoms in adolescents in Taiwan: testing mediation effects of peer victimization and sleep problems

Abstract

Background:

Despite recognition of the link between body mass index (BMI) and depression in adolescence, the underlying mechanisms behind this association remain understudied. This study aims to examine three mediational pathways from BMI to depressive symptoms through peer victimization and sleep problems. Sex differences in the mediating effects were also explored.

Methods:

Data came from 1893 adolescents participating in a multi-wave longitudinal study from grade 9 to 12 in northern Taiwan were analyzed. Measures included BMI in 2009, peer victimization in 2010, sleep problems in 2011, depressive symptoms in 2012 and other covariates (sex, age, parental education, family structure, family economic stress, stressful life events, pubertal development and previous scores of focal study variables). A series of multiple regression models were conducted to test mediation hypotheses. A bootstrapping approach was applied to obtain confidence intervals for determining the significance of indirect effects.

Results:

The association between BMI and depressive symptoms was significantly mediated by peer victimization and sleep problems. Higher BMI predicted more peer victimization and sleep problems, each of which led to higher levels of depressive symptoms. Our results further showed that higher BMI was associated with more peer victimization, which led to greater sleep problems and in turn resulted in increased depressive symptoms. No sex differences was found for the indirect effects of BMI on depressive symptoms through either peer victimization or sleep problems.

Conclusions:

Peer victimization and sleep problems partly explain the link between BMI and depressive symptoms. Interventions to prevent or manage depressive symptoms may yield better results if they consider the effects of these two psychosocial factors rather than targeting BMI alone.

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References

  1. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA . Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015; 56: 345–365.

    Article  Google Scholar 

  2. Sullivan SA, Lewis G, Gunnell D, Cannon M, Mars B, Zammit S . The longitudinal association between psychotic experiences, depression and suicidal behaviour in a population sample of adolescents. Soc Psychiatry Psychiatr Epidemiol 2015; 50: 1809–1817.

    Article  Google Scholar 

  3. Measelle JR, Stice E, Hogansen JM . Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents. J Abnorm Psychol 2006; 115: 524–538.

    Article  Google Scholar 

  4. Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Läksy K et al. Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes (Lond) 2006; 30: 520–527.

    Article  CAS  Google Scholar 

  5. Pryor L, Brendgen M, Boivin M, Dubois L, Japel C, Falissard B et al. Overweight during childhood and internalizing symptoms in early adolescence: the mediating role of peer victimization and the desire to be thinner. J Affect Disord 2016; 202: 203–209.

    Article  Google Scholar 

  6. Anderson SE, Cohen P, Naumova EN, Jacques PF, Must A . Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosom Med 2007; 69: 740–747.

    Article  Google Scholar 

  7. Stunkard AJ, Faith MS, Allison KC . Depression and obesity. Biol Psychiatry 2003; 54: 330–337.

    Article  Google Scholar 

  8. Puhl RM, Luedicke J, Heuer C . Weight-based victimization toward overweight adolescents: observations and reactions of peers. J Sch Health 2011; 81: 696–703.

    Article  Google Scholar 

  9. Griffiths LJ, Wolke D, Page AS, Horwood JP . Obesity and bullying: different effects for boys and girls. Arch Dis Child 2006; 91: 121–125.

    Article  CAS  Google Scholar 

  10. Hamilton JL, Potter CM, Olino TM, Abramson LY, Heimberg RG, Alloy LB . The temporal sequence of social anxiety and depressive symptoms following interpersonal stressors during adolescence. J Abnorm Child Psychol 2016; 44: 495–509.

    Article  Google Scholar 

  11. Yen CF, Liu TL, Ko CH, Wu YY, Cheng CP . Mediating effects of bullying involvement on the relationship of body mass index with social phobia, depression, suicidality, and self-esteem and sex differences in adolescents in Taiwan. Child Abuse Negl 2014; 38: 517–526.

    Article  Google Scholar 

  12. Lucassen EA, Cizza G . The hypothalamic-pituitary-adrenal axis, obesity, and chronic stress exposure: sleep and the HPA axis in obesity. Curr Obes Rep 2012; 1: 208–215.

    Article  Google Scholar 

  13. Dahl RE . The regulation of sleep and arousal: development and psychopathology. Dev Psychopathol 1996; 8: 3–27.

    Article  Google Scholar 

  14. Buckley TM, Schatzberg AF . On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders. J Clin Endocrinol Metab 2005; 90: 3106–3114.

    Article  CAS  Google Scholar 

  15. Killgore WD, Kahn-Greene ET, Lipizzi EL, Newman RA, Kamimori GH, Balkin TJ . Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Med 2008; 9: 517–526.

    Article  Google Scholar 

  16. Hayes AF . Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Press: New York, USA, 2013.

    Google Scholar 

  17. Kliewer W, Lepore SJ, Oskin D, Johnson PD . The role of social and cognitive processes in children's adjustment to community violence. J Consult Clin Psychol 1998; 66: 199–209.

    Article  CAS  Google Scholar 

  18. van Geel M, Goemans A, Vedder PH . The relation between peer victimization and sleeping problems: a meta-analysis. Sleep Med Rev 2016; 27: 89–95.

    Article  Google Scholar 

  19. Chang LY, Wu WC, Wu CC, Lin LN, Yen LL, Chang HY . The role of sleep problems in the relationship between peer victimization and antisocial behavior: a five-year longitudinal study. Soc Sci Med 2017; 173: 126–133.

    Article  Google Scholar 

  20. Sosnowski DW, Kliewer W, Lepore SJ . The role of sleep in the relationship between victimization and externalizing problems in adolescents. J Youth Adolesc 2016; 45: 1744–1754.

    Article  Google Scholar 

  21. Needham BL, Crosnoe R . Overweight status and depressive symptoms during adolescence. J Adolesc Health 2005; 36: 48–55.

    Article  Google Scholar 

  22. St-Onge MP, Perumean-Chaney S, Desmond R, Lewis CE, Yan LL, Person SD et al. Gender differences in the association between sleep duration and body composition: The Cardia Study. Int J Endocrinol 2010; 2010: 726071.

    Article  Google Scholar 

  23. Knutson KL . Sex differences in the association between sleep and body mass index in adolescents. J Pediatr 2005; 147: 830–834.

    Article  Google Scholar 

  24. Shi ZM, Taylor AW, Gill TK, Tuckerman J, Adams R, Martin J . Short sleep duration and obesity among Australian children. BMC Public Health 2010; 10: 609.

    Article  Google Scholar 

  25. Peach H, Gaultney JF, Reeve CL . Sleep characteristics, body mass index, and risk for hypertension in young adolescents. J Youth Adolesc 2015; 44: 271–284.

    Article  Google Scholar 

  26. Xie B, Chou CP, Spruijt-Metz D, Liu C, Xia J, Gong J et al. Effects of perceived peer isolation and social support availability on the relationship between body mass index and depressive symptoms. Int J Obes (Lond) 2005; 29: 1137–1143.

    Article  CAS  Google Scholar 

  27. Yen LL, Chen L, Lee SH, Hsiao C, Pan LY . Child and adolescent behaviour in long-term evolution (CABLE): a school-based health lifestyle study. Promot Educ 2002; 9 (Suppl 1): 33–40.

    Article  Google Scholar 

  28. Centers for Disease Control and Prevention. A SAS Program for the 2000 CDC Growth Charts (ages 0 to <20 years) [Web page]. Available at: http://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm#reference (accessed 10 August 2016).

  29. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  30. Crick NR, Grotpeter JK . Children's treatment by peers: victims of relational and overt aggression. Dev Psychopathol 1996; 8: 367–380.

    Article  Google Scholar 

  31. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193–213.

    Article  CAS  Google Scholar 

  32. Pallant J . Checking the reliability of a scale. In: Pallant J (ed). SPSS Survival Manual: A Step by Step Guide to Data Analysis Using IBM SPSS, 6th edn. Open University Press: England, 2016, pp 101–105.

    Google Scholar 

  33. Briggs SR, Cheek JM . The role of factor analysis in the development and evaluation of personality scales. J Pers 1986; 54: 106–148.

    Article  Google Scholar 

  34. Faulstich ME, Carey MP, Ruggiero L, Enyart P, Gresham F . Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Am J Psychiatry 1986; 143: 1024–1027.

    Article  CAS  Google Scholar 

  35. Holmes TH, Rahe RH . The Social Readjustment Rating Scale. J Psychosom Res 1967; 11: 213–218.

    Article  CAS  Google Scholar 

  36. Petersen AC, Crockett L, Richards M, Boxer A . A self-report measure of pubertal status: reliability, validity, and initial norms. J Youth Adolesc 1988; 17: 117–133.

    Article  CAS  Google Scholar 

  37. Hayes AF . An index and test of linear moderated mediation. Multivariate Behav Res 2015; 50: 1–22.

    Article  Google Scholar 

  38. Hayes AF . Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr 2009; 76: 408–420.

    Article  Google Scholar 

  39. Rucker DD, Preacher KJ, Tormala ZL, Petty RE . Mediation analysis in social psychology: current practices and new recommendations. Soc Personal Psychol Compass 2011; 5: 359–371.

    Article  Google Scholar 

  40. Cramer P, Steinwert T . Thin is good, fat is bad: how early does it begin? J Appl Dev Psychol 1998; 19: 429–451.

    Article  Google Scholar 

  41. Haines J, Neumark-Sztainer D, Hannan PJ, van den Berg P, Eisenberg ME . Longitudinal and secular trends in weight-related teasing during adolescence. Obesity (Silver Spring) 2008; 16: S18–S23.

    Article  Google Scholar 

  42. Gardner M, Steinberg L . Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Dev Psychol 2005; 41: 625–635.

    Article  Google Scholar 

  43. Adams RE, Bukowski WM . Peer victimization as a predictor of depression and body mass index in obese and non-obese adolescents. J Child Psychol Psychiatry 2008; 49: 858–866.

    Article  Google Scholar 

  44. Newman RS, Murray BJ . How students and teachers view the seriousness of peer harassment: when is it appropriate to seek help? J Educ Psychol 2005; 97: 347–365.

    Article  Google Scholar 

  45. Yu J, Fei K, Fox A, Negron R, Horowitz C . Stress eating and sleep disturbance as mediators in the relationship between depression and obesity in low-income, minority women. Obes Res Clin Pract 2016; 10: 283–290.

    Article  Google Scholar 

  46. Gregory AM, Van der Ende J, Willis TA, Verhulst FC . Parent-reported sleep problems during development and self-reported anxiety/depression, attention problems, and aggressive behavior later in life. Arch Pediatr Adolesc Med 2008; 162: 330–335.

    Article  Google Scholar 

  47. Butte NF, Puyau MR, Adolph AL, Vohra FA, Zakeri I . Physical activity in nonoverweight and overweight Hispanic children and adolescents. Med Sci Sports Exerc 2007; 39: 1257–1266.

    Article  Google Scholar 

  48. Wang H, Fu J, Lu Q, Tao F, Hao J . Physical activity, body mass index and mental health in Chinese adolescents: a population based study. J Sports Med Phys Fitness 2014; 54: 518–525.

    CAS  PubMed  Google Scholar 

  49. Libbey HP, Story MT, Neumark-Sztainer DR, Boutelle KN . Teasing, disordered eating behaviors, and psychological morbidities among overweight adolescents. Obesity (Silver Spring) 2008; 16: S24–S29.

    Article  Google Scholar 

  50. Doyle AC, le Grange D, Goldschmidt A, Wilfley DE . Psychosocial and physical impairment in overweight adolescents at high risk for eating disorders. Obesity (Silver Spring) 2007; 15: 145–154.

    Article  Google Scholar 

  51. Jeffers AJ, Cotter EW, Snipes DJ, Benotsch EG . BMI and depressive symptoms: the role of media pressures. Eat Behav 2013; 14: 468–471.

    Article  Google Scholar 

  52. Xie B, Unger JB, Gallaher P, Johnson CA, Wu Q, Chou CP . Overweight, body image, and depression in Asian and Hispanic adolescents. Am J Health Behav 2010; 34: 476–488.

    Article  Google Scholar 

  53. Revah-Levy A, Speranza M, Barry C, Hassler C, Gasquet I, Moro MR et al. Association between body mass index and depression: the "fat and jolly" hypothesis for adolescents girls. BMC Public Health 2011; 11: 649.

    Article  Google Scholar 

  54. Eisenberg ME, Neumark-Sztainer D, Story M . Associations of weight-based teasing and emotional well-being among adolescents. Arch Pediatr Adolesc Med. 2003; 157: 733–738.

    Article  Google Scholar 

  55. Wardle J, Cooke L . The impact of obesity on psychological well-being. Best Pract Res Clin Endocrinol Metab 2005; 19: 421–440.

    Article  Google Scholar 

  56. Vaughan CA, Halpern CT . Gender differences in depressive symptoms during adolescence: the contributions of weight-related concerns and behaviors. J Res Adolesc 2010; 20: 389–419.

    Article  Google Scholar 

  57. Goodman E, Hinden BR, Khandelwal S . Accuracy of teen and parental reports of obesity and body mass index. Pediatrics 2000; 106: 52–58.

    Article  CAS  Google Scholar 

  58. Perez A, Gabriel K, Nehme EK, Mandell DJ, Hoelscher DM . Measuring the bias, precision, accuracy, and validity of self-reported height and weight in assessing overweight and obesity status among adolescents using a surveillance system. Int J Behav Nutr Phys Act 2015; 12: S2.

    Article  Google Scholar 

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Acknowledgements

We thank the Child and Adolescent Behaviors in Long-term Evolution project (HP-090-SG-03) for providing data for this study. This study was funded by the Ministry of Science and Technology (MOST 105-3011-F-400-001 and MOST 103-2314-B-400-003-MY3).

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Correspondence to H-Y Chang.

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Chang, LY., Chang, HY., Wu, WC. et al. Body mass index and depressive symptoms in adolescents in Taiwan: testing mediation effects of peer victimization and sleep problems. Int J Obes 41, 1510–1517 (2017). https://doi.org/10.1038/ijo.2017.111

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