Clustering of Lifestyle Habits and Association with Depressive Symptoms and Suicidal Behaviors in Adolescents: A Systematic Review and Meta-Analysis

Unhealthy lifestyle choices have long been linked with various health problems. Existing literature indicates that modifiable lifestyle factors such as physical activity, sedentary behavior, dietary habits, and alcohol and tobacco consumption, are associated with depressive symptoms and suicidal behaviors. However, comprehensive reviews examining how these behaviors cluster and collectively contribute to depressive symptoms and suicidal behaviors are lacking. This systematic review and meta-analysis aimed to investigate the impact of the clustering of these modifiable lifestyle factors on depressive symptoms and suicidal behaviors such as suicidal ideation, plans, and attempts in adolescents aged between 10 to 19 years. A comprehensive search of seven databases namely, Medline, Scopus, Embase, Emcare, Web of Science, PsycINFO, and CINAHL was conducted using an extensive list of search terms. A total of sixteen eligible studies, comprising data from 433,207 adolescents, were included. A random effect meta-analysis revealed a significant association between unhealthy clusters of lifestyle behaviors and increased odds of depressive symptoms and suicidal ideation. A dose-response association was also observed between the number of lifestyle factors and both depressive symptoms and suicidal ideation. However, no significant association was found between unhealthy clusters and suicidal plans or attempts. This review suggests that adolescents engaging in multiple unhealthy lifestyle behaviors have synergistically higher odds of experiencing depressive symptoms and suicidal ideation.