Mental Health Status Among Overweight Or Obese Adolescents: A Cross-sectional Study

Objectives To describe the incidences of indices as satisfaction of life, depression, trait anxiety and self concept of overweight or obese adolescents. Then to examine the gender difference of the relationships between overweight, obesity and mental health status. And to explore the associations between overweight, obesity and unhealthy psycho-behaviors related to weight control in adolescents.Methods The survey was conducted among 1 818 participants of grade 1 and grade 2 of one junior high school in Hefei city. The students completed the anonymous questionnaire including the demographic characteristics of adolescents and parents, self-reported weight status, adolescents'psycho-behaviors related to weight control, Multidimensional Students' Life Satisfaction Scale (MSLSS), Center for Epidemiologic Studies Depression Scale (CES-D), Trait Anxiety Inventory (T-AI), and Piers-Harris Children's Self Concept Scale (PHSCS). Anthropometric measures were taken together with the calculation of body mass index (BMI). The students were divided into obesity, overweight and control group by BMI separate criteria and by self reporting respectively. We analyzed the associations between the group separating results of the two methods and its gender diffenence. Then, the distribution characters of the scores of MSLSS, CES-D, T-AI, PHSCS and the incidences of psycho-behaviors related to weight control were described. The group difference of mental health status and the incidences of psycho-behaviors related to weight control at different weight status assessed by BMI and by self reporting were estimated.Results The incidences of overweight and obesity assessed by self reporting (15.9% and 3.2%) were lower than those assessed by BMI (21.5% and 7.7%) among boys with significant difference (P﹤0.01). The overweight incidence assessed by self reporting (13.0%) was significantly higher than that assessed by BMI (8.0%) among girls (P﹤0.01). And the obesity incidence assessed by self reporting (2.2%) was lower than that assessed by BMI (2.8%) among girls (P﹤0.01). The Spearman correlation coefficient between the two results evaluated by the two methods in boys was 0.60. And that in girls was 0.52. Among boys, the consistencies of obesity and overweight assessed by BMI with those assessed by self reporting (55.9% and 41.4%) were higher than those among girls (36.6%and 36.8%).The Cronbachαcoefficient of MSLSS, CES-D, T-AI, and PHSCS were 0.90, 0.91, 0.81 and 0.89 respectively. The internal consistencies of all the 4 scales were well.As classifyed by BMI criteria or by self reporting, both MSLSS scores and PHSCS scores of overweight and obesity in boys were higher than those in girls and having statistically significant difference (P﹤0.05). CES-D scores and T-AI scores of overweight and obesity in girls were all higher than those in boys (P﹤0.05). And MSLSS scores of control groups in girls were also higher than those in boys (P﹤0.05).As classifyed by BMI criteria, there was no statistically group difference in MSLSS, CES-D, T-AI, and PHSCS scores among the obesity, overweight and control group in boys (P>0.05). Among girls, the CES-D and T-AI scores of obese were higher than those in control group (P﹤0.05). And the PHSCS score of obese girls was lower than that in control group (P﹤0.05). CES-D score of overweight girls was higher than that in control group too (P﹤0.05).As classifyed by self reporting, PHSCS score of overweight in boys was lower than that in control group (P﹤0.05). Moreover, MSLSS and PHSCS scores of obese girls were all lower than those in control group (P﹤0.01). Both CES-D score and T-AI score of obese girls were higher than those in control group (P﹤0.01). And PHSCS score of obese girls was lower than that in overweight girls (P﹤0.05). CES-D score of overweight girls were higher than that in control group as well as T-AI scores (P﹤0.01). MSLSS and PHSCS scores of overweight girls were lower than those in control group (P﹤0.05).There was no statistically significant correlation between boys BMI and the scores of these 4 scales (P>0.05). And the correlation between weight status assessed by self reporting and the 4 scales'scores wasn't found (P>0.05). Nevertheless, BMI showed a positive association with CES-D scores in girls (r=0.12, P﹤0.05). There was a negative correlation between BMI and PHSCS score in girls (r=-0.11, P﹤0.05). And these associations of girls did not decrease when some factors such as grade, age, performance record and family income were controlled. However, when weight status assessed by self reporting was included in the partial correlation analytical model, these associations reduced significantly among girls (P>0.05).By using multinomial logistic regression model, it showed that overweight assessed by BMI was among the risk factors of higher CES-D status (P﹤0.05). We found that obesity and overweight assessed by self reporting were more likely to have lower PHSCS status. And overweight assessed by self reporting was more likely to has higher CES-D status and higher T-AI status (P﹤0.05). The Cronbachαcoefficient of the adolescents psycho-behaviors questionnaire related to weight control was 0.64. The Cronbachαcoefficient of the adolescents psychology questionnaire related to weight control was 0.70, and the Cronbachαcoefficient of the adolescents behaviors questionnaire related to weight control was 0.44. The Spearman correlation coefficients of the psychology questionnaire related to weight control ranged from 0.14 to 0.65 (P﹤0.01). The Spearman correlation coefficients of the behaviors questionnaire related to weight control ranged from 0.03 to 0.34.Among all the students, 17.4% reported having unhealthy psychology related to weight control, 3.8% reported having unhealthy behaviors related to weight control, 19.1% reported having unhealthy psycho-behaviors related to weight control. And the incidences of unhealthy psychology, unhealthy behaviors and total unhealthy psycho-behaviors related to weight control among girls (20.6%, 4.3%, 22.6%) were all higher than those among boys (14.5%, 3.3%, 15.8%) (P﹤0.05). The incidences of unhealthy psychology, unhealthy behaviors and total unhealthy psycho-behaviors related to weight control in obese both assessed by BMI and assessed by self reporting were the highest (P﹤0.05).By using binary logistic regression logistic model, it showed that obesity and overweight assessed both by BMI separate criteria and by self reporting all have positive correlations with the incidences of unhealthy psycho-behaviors related to weight control (P﹤0.01). In addition, the OR between obesity assessed by the two methods and unhealthy psycho-behaviors related to weight control were all higher than those between overweight assessed by the two methods and unhealthy psycho-behaviors related to weight control. Moreover,the relationship between obesity or overweight assessed by the two methods and unhealthy psycho-behaviors related to weight control did not alter by other factors.Conclusions Among boys, the consistencies of overweight or obesity assessed by BMI with those assessed by self reporting were higher than those among girls. Mental health status of overweight and obesity assessed by the two methods in boys were all better than those in girls. Associations between mental health status and overweight, obesity assessed by self reporting were stronger compared with those between mental health status and overweight, obesity assessed by BMI. Weight status assessed by self reporting may be an important mediator factor in the relationship between obesity and mental health. Incidences of unhealthy psycho-behaviors related to weight control of girls were higher than boys. And there was little influence of other factors on the relationships between obesity, overweight and unhealthy psycho-behaviors related to weight control.