The European Journal of Public Health Advance Access published online on April 29, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp057
Is depression associated with health risk-related behaviour clusters in adults?
Pierre Verger1,2,3, Caroline Lions1,2,3 and Bruno Ventelou1,2,3,4
1 INSERM, U912 (SE4S), Marseille, France
2 Université Aix Marseille, IRD, UMR-S912, Marseille, France
3 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
4 GREQAM CNRS, Marseille, France
Correspondence: Pierre Verger, Observatoire régional de la santé PACA, 23 rue Stanislas Torrents, 13006 Marseille, France, tel: +04 91 59 89 01, fax: +04 91 59 89 18, e-mail: verger{at}marseille.inserm.fr
Received January 8, 2009 , accepted March 30, 2009
Background: Depressive disorders have been linked to health risk-related behaviours (HRBs) considered separately. Our objective was to study whether depression is associated with the co-occurrence of HRBs in adults. Methods: A sample of 17 355 subjects aged 
18 years, derived from the 2002–03 cross-sectional Decennial Health Survey; probable depression was assessed with the CES-D scale. A cluster analysis of various HRBs (tobacco use, alcohol use, binge drinking, physical inactivity, certain eating habits) was used to study their co-occurrence. Multiple regressions adjusted on demographic and socio-economic characteristics, Body Mass Index and chronic illnesses were performed to study associations between probable depression and the HRBs clusters obtained. Results: Five clusters were observed evidencing a gradient of cumulative exposure to HRBs: ‘healthy lifestyles (Cluster 1), ‘non-daily-consumers-fruit-and-green-vegetables’ (Cluster 2), ‘regular alcohol users’ (Cluster 3), ‘daily smokers’ (Cluster 4) and ‘cumulate risk takers’ (Cluster 5). Compared with Cluster 1, positive associations were found between probable depression and Clusters 2, 4 and 5: OR 1.49 (95% CI 1.26–1.76) for Cluster 2; OR 1.81 (95% CI 1.54–2.12) for Cluster 4; OR 2.05 (95% CI 1.68–2.51) for Cluster 5. For Cluster 3, no association was found: OR 1.01 (95% CI 0.84–1.21). Conclusions: HRBs tend to co-occur in the general population, more frequently in case of probable depression. Further research is necessary to disentangle the direction of the links between depression and HRB clusters. Nonetheless, these results question the classic design of education campaigns considering HRBs separately. Moreover, screening for depression should be systematic during prevention consultations and various HRBs should be monitored when treating depressive patients.
Keywords: cluster analysis, depressive disorder, health behaviours, general French population