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HOME > J Korean Acad Community Health Nurs > Volume 27(2); 2016 > Article
Original Article
Gender Differences in the Association between Eating Behavior and Depression of Adolescents: Evidence from a National Korean Cross-sectional Survey
Hye Sun Hyun
Journal of Korean Academy of Community Health Nursing 2016;27(2):106-113.
DOI: https://doi.org/10.12799/jkachn.2016.27.2.106
Published online: June 12, 2016

Department of Nursing, Sangmyung University, Cheonan, Korea

Corresponding author: Hyun, Hye Sun Department of Nursing, Sangmyung University, 13 Sangmyungdae-gil, Dongnam-gu, Cheonan 31066, Korea. Tel: +82-41-550-5380, Fax: +82-41-550-5545, E-mail: hshyun@smu.ac.kr / hshyun76@gmail.com
• Received: January 11, 2016   • Revised: April 21, 2016   • Accepted: May 3, 2016

Copyright © 2016 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to determine the relationship between unhealthy eating behavior and depression in adolescents, with confounding variables adjusted.
  • Methods
    This study is a secondary analysis of the data collected from the 2013 Korean Youth Risk Behavior Web-based Survey (KYRBWS). The analysis included 72,435 participants (36,655 male and 35,780 female). The data were analyzed by x2 test, t-test, and logistic regression analysis using SPSS Version 21 by complex samples analysis.
  • Results
    Compared with male adolescents with healthy eating behavior, those who with unhealthy eating behavior were more likely to suffer depression with other factors controlled (OR=1.37, 1.07~1.75). On the other hand, female adolescents with unhealthy eating behavior were less likely to feel depressed compared with female adolescents with unhealthy eating behavior and with other factors controlled (OR=0.98, 0.64~1.50). However, it was not statistically significant.
  • Conclusion
    Our findings suggest that healthy eating behavior may be a protective factor against depression in male adolescents, but not in female adolescents. Furthermore, our results suggest that the longitudinal associations between mental health and healthy eating behavior and other lifestyle factors are complex.
Table 1.
Comparison of Characteristics between Boys and Girls (% [SE] or M±SE)
Characteristics Categories All subjects Girls Boys x2 or t p
Depression No 69.1(0.24) 62.9(0.31) 74.8(0.30) 1,201.07 <.001
Yes 30.9(0.24) 37.1(0.31) 25.2(0.30)
Living withfamily No 3.9(0.17) 3.5(0.23) 4.3(0.24) 26.29 .028
Yes 96.1(0.17) 96.5(0.23) 95.7(0.24)
Economic level Very rich 7.5(0.16) 5.1(0.18) 9.7(0.24) 695.36 <.001
Rich 24.9(0.24) 23.7(0.36) 25.9(0.32)
Medium 47.4(0.23) 50.4(0.33) 44.7(0.32)
Poor 15.8(0.21) 16.5(0.31) 15.1(0.29)
Very poor 4.5(0.10) 4.2(0.14) 4.7(0.14)
School performance Very high 10.9(0.14) 9.4(0.18) 12.3(0.21) 223.49 <.001
High 23.7(0.18) 24.4(0.26) 23.1(0.26)
Medium 28.1(0.18) 28.8(0.27) 27.4(0.23)
Low 24.9(0.19) 25.8(0.25) 24.1(0.27)
Very low 12.4(0.15) 11.6(0.20) 13.1(0.22)
Smoke Non-smoke 54.4(0.61) 62.7(1.01) 51.3(0.73) 163.60 <.001
Smoke 45.6(0.61) 37.3(1.01) 48.7(0.73)
Drink No 42.2(0.59) 50.1(0.86) 37.4(0.76) 184.49 <.001
Yes 57.8(0.59) 49.9(0.86) 62.6(0.76)
Moderate physical activities (day) Never 34.9(0.29) 43.1(0.38) 27.3(0.31) 3,873.11 <.001
1 17.5(0.17) 19.7(0.24) 15.4(0.24)
2 15.6(0.18) 15.0(0.23) 16.1(0.26)
3 12.9(0.15) 10.8(0.19) 14.8(0.21)
4 6.7(0.12) 4.6(0.13) 8.6(0.16)
≥5 12.6(0.18) 6.9(0.16) 17.8(0.26)
Vigorous Never 23.8(0.31) 34.2(0.44) 14.2(0.26) 6,663.08 <.001
physical 1 20.8(0.20) 23.9(0.29) 18.0(0.25)
activities 2 19.5(0.20) 18.4(0.26) 20.5(0.30)
(day) 3 15.3(0.17) 12.1(0.24) 18.2(0.22)
4 7.0(0.12) 4.6(0.14) 9.3(0.16)
≥5 13.6(0.20) 6.7(0.16) 19.8(0.310)
Sleep <4 1.8(0.07) 1.9(0.10) 1.6(0.09) 1,138.88 <.001
duration 4 8.0(0.20) 9.2(0.29) 6.9(0.28)
(hour/day) 5 19.3(0.32) 20.8(0.44) 17.8(0.47)
6 26.2(0.23) 26.8(0.31) 25.6(0.35)
7 25.4(0.31) 24.3(0.41) 26.5(0.47)
≥8 19.3(0.36) 17.0(0.47) 21.5(0.54)
BMI Underweight 5.6(0.13) 6.9(0.20) 4.5(0.16) 6,280.57 <.001
(percentile) Normal 80.0(0.26) 89.5(0.20) 71.3(0.31)
Overweight 9.1(0.18) 3.3(0.10) 14.4(0.25)
Obese 5.3(0.15) 0.3(0.03) 9.8(0.22)
Perceived Underweight 27.6(0.20) 19.7(0.22) 34.7(0.24) 2,123.36 <.001
weight status Normal 33.7(0.19) 35.9(0.28) 31.8(0.25)
Overweight 38.7(0.20) 44.4(0.28) 33.5(0.25)
Healthy eating No 81.9(0.22) 81.7(0.32) 82.0(0.29) 1.31 .409
behavior Yes 18.1(0.22) 18.3(0.32) 18.0(0.29)    

BMI=body mass index; SE=standard error; Values are presented as weighted % (SE) or Mean±SE unless otherwise indicated.

Table 2.
Characteristics of the Study Sample according to Depression by Gender (% [SE] or Mean±SE)
Characteristics Categories Boys
Girls
Normal Depression x2 or t p Normal Depression x2 or t p
Depression 14.9±0.04 15.2±0.04 −1.03 .303 14.88±0.04 15.05±0.04 −1.68 .093
Living withfamily No 67.8 (1.31) 32.3 (1.31) 43.58 <.001 56.3 (1.60) 43.7 (1.60) 24.89 <.001
Yes 75.1 (0.30) 24.9 (0.30) 63.2 (0.32) 36.9 (0.32)
Economic level Very rich 75.7 (0.71) 24.3 (0.71) 374.11 <.001 64.3 (1.17) 35.7 (1.17) 483.62 <.001
Rich 77.4 (0.50) 22.6 (0.50) 66.5 (0.56) 33.5 (0.56)
Medium 76.7 (0.39) 23.3 (0.39) 65.2 (0.42) 34.9 (0.42)
Poor 68.7 (0.73) 31.3 (0.73) 55.6 (0.65) 44.4 (0.65)
Very poor 60.1 (1.16) 39.9 (1.16) 42.9 (1.27) 57.2 (1.27)
School performance Very high 79.6 (0.63) 20.4 (0.63) 231.88 <.001 70.4 (0.79) 29.6 (0.79) 586.80 <.001
High 77.3 (0.51) 22.7 (0.51) 67.9 (0.52) 32.1 (0.52)
Medium 76.0 (0.46) 24.0 (0.46) 65.5 (0.52) 34.6 (0.52)
Low 72.2 (0.55) 27.8 (0.55) 58.6 (0.56) 41.4 (0.56)
Very low 68.3 (0.69) 31.7 (0.69) 49.7 (0.81) 50.3 (0.81)
Smoke Non-smoke 69.9 (0.65) 30.1 (0.65) 98.35 <.001 49.3 (1.01) 50.7 (1.01) 100.71 <.001
Smoke 60.9 (0.69) 39.1 (0.69) 34.1 (1.10) 65.9 (1.10)
Drink No 69.8 (0.92) 30.2 (0.92) 63.20 <.001 49.6 (1.07) 50.4 (1.07) 32.14 <.001
Yes 60.4 (0.76) 39.6 (0.76) 41.5 (1.01) 58.5 (1.01)
Moderate physical activities (day) Never 78.9 (0.44) 21.0 (0.44) 136.45 <.001 65.8 (0.43) 34.3 (0.43) 105.22 <.001
1 73.6 (0.65) 26.4 (0.65) 61.7 (0.61) 38.3 (0.61)
2 73.7 (0.67) 26.3 (0.67) 61.1 (0.76) 38.9 (0.76)
3 73.8 (0.63) 26.2 (0.63) 60.7 (0.88) 39.3 (0.88)
4 73.9 (0.75) 26.1 (0.75) 58.2 (1.18) 41.8 (1.18)
≥5 71.8 (0.59) 28.3 (0.59) 59.0 (0.95) 41.0 (0.95)
Vigorous physical activities (day) Never 77.5 (0.59) 22.5 (0.59) 48.63 <.001 64.0 (0.45) 36.0 (0.45) 25.60 <.001
1 76.2 (0.52) 23.8 (0.52) 63.7 (0.57) 36.4 (0.57)
2 75.1 (0.57) 24.9 (0.57) 62.3 (0.62) 37.7 (0.62)
3 74.0 (0.61) 26.1 (0.61) 62.0 (0.82) 38.0 (0.82)
4 73.0 (0.83) 27.0 (0.83) 61.2 (1.24) 38.8 (1.24)
≥5 72.9 (0.53) 27.1 (0.53) 59.4 (1.00) 40.6 (1.00)
Sleep duration (hour/day) <4 56.8 (2.47) 43.2 (2.47) 373.92 <.001 43.7 (1.79) 56.3 (1.79) 381.76 <.001
4 66.4 (1.11) 33.6 (1.11) 54.8 (0.94) 45.2 (0.94)
5 70.8 (0.74) 29.2 (0.74) 59.6 (0.67) 40.4 (0.67)
6 75.1 (0.55) 24.9 (0.55) 63.6 (0.56) 36.4 (0.56)
7 78.3 (0.49) 21.7 (0.49) 66.7 (0.61) 33.3 (0.61)
≥8 81.2 (0.56) 19.0 (0.56) 71.4 (0.72) 28.6 (0.72)
BMI (percentile) Underweight 80.7 (1.05) 19.3 (1.05) 40.40 <.001 65.0 (1.03) 35.0 (1.03) 7.71 .054
Normal 75.3 (0.34) 24.7 (0.34) 63.1 (0.32) 36.9 (0.32)
Overweight 73.4 (0.62) 26.6 (0.62) 61.4 (1.47) 38.6 (1.47)
Obese 73.5 (0.76) 26.5 (0.76) 55.7 (4.53) 44.3 (4.53)
Perceived weight status Underweight 73.8 (0.44) 26.2 (0.44) 17.87 <.001 62.8 (0.62) 37.2 (0.62) 72.12 <.001
Normal 76.2 (0.43) 23.9 (0.43) 65.6 (0.43) 34.4 (0.43)
Overweight 74.6 (0.41) 25.4 (0.41) 60.8 (0.46) 39.2 (0.46)
Healthy eating behavior No 74.9 (0.34) 25.1 (0.34) 42.04 <.001 62.0 (0.33) 38.0 (0.33) 67.33 <.001
Yes 76.2 (0.63) 23.8 (0.63) 67.9 (0.65) 32.1 (0.65)

BMI=body mass index; SE=standard error; a Values are presented as weighted % (SE) or M±SE unless otherwise indicated.

Table 3.
Association between Healthy Eating Behavior and Depression
Characteristics Categories Boys
Girls
OR 95% CI p OR 95% CI p
Eating behavior Non-healthy eating behavior 1.37 1.07~1.75 .013 0.98 0.64~1.50 .933
Healthy eating behavior 1.00 1.00

BMI=body mass index OR=odds ratio; CI=confidence interval;

Calculated by complex sample multi-logistic regression analysis, adjusted for family live together, economic status, academic performance, smoking, alcohol use, exercise habits, sleep duration, perceived weight status, BMI;

Calculated by complex sample multi- logistic regression analysis, adjusted for family live together, economic status, academic performance, smoking, alcohol use, exercise habits, sleep duration, perceived weight status.

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      Gender Differences in the Association between Eating Behavior and Depression of Adolescents: Evidence from a National Korean Cross-sectional Survey
      Gender Differences in the Association between Eating Behavior and Depression of Adolescents: Evidence from a National Korean Cross-sectional Survey
      Characteristics Categories All subjects Girls Boys x2 or t p
      Depression No 69.1(0.24) 62.9(0.31) 74.8(0.30) 1,201.07 <.001
      Yes 30.9(0.24) 37.1(0.31) 25.2(0.30)
      Living withfamily No 3.9(0.17) 3.5(0.23) 4.3(0.24) 26.29 .028
      Yes 96.1(0.17) 96.5(0.23) 95.7(0.24)
      Economic level Very rich 7.5(0.16) 5.1(0.18) 9.7(0.24) 695.36 <.001
      Rich 24.9(0.24) 23.7(0.36) 25.9(0.32)
      Medium 47.4(0.23) 50.4(0.33) 44.7(0.32)
      Poor 15.8(0.21) 16.5(0.31) 15.1(0.29)
      Very poor 4.5(0.10) 4.2(0.14) 4.7(0.14)
      School performance Very high 10.9(0.14) 9.4(0.18) 12.3(0.21) 223.49 <.001
      High 23.7(0.18) 24.4(0.26) 23.1(0.26)
      Medium 28.1(0.18) 28.8(0.27) 27.4(0.23)
      Low 24.9(0.19) 25.8(0.25) 24.1(0.27)
      Very low 12.4(0.15) 11.6(0.20) 13.1(0.22)
      Smoke Non-smoke 54.4(0.61) 62.7(1.01) 51.3(0.73) 163.60 <.001
      Smoke 45.6(0.61) 37.3(1.01) 48.7(0.73)
      Drink No 42.2(0.59) 50.1(0.86) 37.4(0.76) 184.49 <.001
      Yes 57.8(0.59) 49.9(0.86) 62.6(0.76)
      Moderate physical activities (day) Never 34.9(0.29) 43.1(0.38) 27.3(0.31) 3,873.11 <.001
      1 17.5(0.17) 19.7(0.24) 15.4(0.24)
      2 15.6(0.18) 15.0(0.23) 16.1(0.26)
      3 12.9(0.15) 10.8(0.19) 14.8(0.21)
      4 6.7(0.12) 4.6(0.13) 8.6(0.16)
      ≥5 12.6(0.18) 6.9(0.16) 17.8(0.26)
      Vigorous Never 23.8(0.31) 34.2(0.44) 14.2(0.26) 6,663.08 <.001
      physical 1 20.8(0.20) 23.9(0.29) 18.0(0.25)
      activities 2 19.5(0.20) 18.4(0.26) 20.5(0.30)
      (day) 3 15.3(0.17) 12.1(0.24) 18.2(0.22)
      4 7.0(0.12) 4.6(0.14) 9.3(0.16)
      ≥5 13.6(0.20) 6.7(0.16) 19.8(0.310)
      Sleep <4 1.8(0.07) 1.9(0.10) 1.6(0.09) 1,138.88 <.001
      duration 4 8.0(0.20) 9.2(0.29) 6.9(0.28)
      (hour/day) 5 19.3(0.32) 20.8(0.44) 17.8(0.47)
      6 26.2(0.23) 26.8(0.31) 25.6(0.35)
      7 25.4(0.31) 24.3(0.41) 26.5(0.47)
      ≥8 19.3(0.36) 17.0(0.47) 21.5(0.54)
      BMI Underweight 5.6(0.13) 6.9(0.20) 4.5(0.16) 6,280.57 <.001
      (percentile) Normal 80.0(0.26) 89.5(0.20) 71.3(0.31)
      Overweight 9.1(0.18) 3.3(0.10) 14.4(0.25)
      Obese 5.3(0.15) 0.3(0.03) 9.8(0.22)
      Perceived Underweight 27.6(0.20) 19.7(0.22) 34.7(0.24) 2,123.36 <.001
      weight status Normal 33.7(0.19) 35.9(0.28) 31.8(0.25)
      Overweight 38.7(0.20) 44.4(0.28) 33.5(0.25)
      Healthy eating No 81.9(0.22) 81.7(0.32) 82.0(0.29) 1.31 .409
      behavior Yes 18.1(0.22) 18.3(0.32) 18.0(0.29)    
      Characteristics Categories Boys
      Girls
      Normal Depression x2 or t p Normal Depression x2 or t p
      Depression 14.9±0.04 15.2±0.04 −1.03 .303 14.88±0.04 15.05±0.04 −1.68 .093
      Living withfamily No 67.8 (1.31) 32.3 (1.31) 43.58 <.001 56.3 (1.60) 43.7 (1.60) 24.89 <.001
      Yes 75.1 (0.30) 24.9 (0.30) 63.2 (0.32) 36.9 (0.32)
      Economic level Very rich 75.7 (0.71) 24.3 (0.71) 374.11 <.001 64.3 (1.17) 35.7 (1.17) 483.62 <.001
      Rich 77.4 (0.50) 22.6 (0.50) 66.5 (0.56) 33.5 (0.56)
      Medium 76.7 (0.39) 23.3 (0.39) 65.2 (0.42) 34.9 (0.42)
      Poor 68.7 (0.73) 31.3 (0.73) 55.6 (0.65) 44.4 (0.65)
      Very poor 60.1 (1.16) 39.9 (1.16) 42.9 (1.27) 57.2 (1.27)
      School performance Very high 79.6 (0.63) 20.4 (0.63) 231.88 <.001 70.4 (0.79) 29.6 (0.79) 586.80 <.001
      High 77.3 (0.51) 22.7 (0.51) 67.9 (0.52) 32.1 (0.52)
      Medium 76.0 (0.46) 24.0 (0.46) 65.5 (0.52) 34.6 (0.52)
      Low 72.2 (0.55) 27.8 (0.55) 58.6 (0.56) 41.4 (0.56)
      Very low 68.3 (0.69) 31.7 (0.69) 49.7 (0.81) 50.3 (0.81)
      Smoke Non-smoke 69.9 (0.65) 30.1 (0.65) 98.35 <.001 49.3 (1.01) 50.7 (1.01) 100.71 <.001
      Smoke 60.9 (0.69) 39.1 (0.69) 34.1 (1.10) 65.9 (1.10)
      Drink No 69.8 (0.92) 30.2 (0.92) 63.20 <.001 49.6 (1.07) 50.4 (1.07) 32.14 <.001
      Yes 60.4 (0.76) 39.6 (0.76) 41.5 (1.01) 58.5 (1.01)
      Moderate physical activities (day) Never 78.9 (0.44) 21.0 (0.44) 136.45 <.001 65.8 (0.43) 34.3 (0.43) 105.22 <.001
      1 73.6 (0.65) 26.4 (0.65) 61.7 (0.61) 38.3 (0.61)
      2 73.7 (0.67) 26.3 (0.67) 61.1 (0.76) 38.9 (0.76)
      3 73.8 (0.63) 26.2 (0.63) 60.7 (0.88) 39.3 (0.88)
      4 73.9 (0.75) 26.1 (0.75) 58.2 (1.18) 41.8 (1.18)
      ≥5 71.8 (0.59) 28.3 (0.59) 59.0 (0.95) 41.0 (0.95)
      Vigorous physical activities (day) Never 77.5 (0.59) 22.5 (0.59) 48.63 <.001 64.0 (0.45) 36.0 (0.45) 25.60 <.001
      1 76.2 (0.52) 23.8 (0.52) 63.7 (0.57) 36.4 (0.57)
      2 75.1 (0.57) 24.9 (0.57) 62.3 (0.62) 37.7 (0.62)
      3 74.0 (0.61) 26.1 (0.61) 62.0 (0.82) 38.0 (0.82)
      4 73.0 (0.83) 27.0 (0.83) 61.2 (1.24) 38.8 (1.24)
      ≥5 72.9 (0.53) 27.1 (0.53) 59.4 (1.00) 40.6 (1.00)
      Sleep duration (hour/day) <4 56.8 (2.47) 43.2 (2.47) 373.92 <.001 43.7 (1.79) 56.3 (1.79) 381.76 <.001
      4 66.4 (1.11) 33.6 (1.11) 54.8 (0.94) 45.2 (0.94)
      5 70.8 (0.74) 29.2 (0.74) 59.6 (0.67) 40.4 (0.67)
      6 75.1 (0.55) 24.9 (0.55) 63.6 (0.56) 36.4 (0.56)
      7 78.3 (0.49) 21.7 (0.49) 66.7 (0.61) 33.3 (0.61)
      ≥8 81.2 (0.56) 19.0 (0.56) 71.4 (0.72) 28.6 (0.72)
      BMI (percentile) Underweight 80.7 (1.05) 19.3 (1.05) 40.40 <.001 65.0 (1.03) 35.0 (1.03) 7.71 .054
      Normal 75.3 (0.34) 24.7 (0.34) 63.1 (0.32) 36.9 (0.32)
      Overweight 73.4 (0.62) 26.6 (0.62) 61.4 (1.47) 38.6 (1.47)
      Obese 73.5 (0.76) 26.5 (0.76) 55.7 (4.53) 44.3 (4.53)
      Perceived weight status Underweight 73.8 (0.44) 26.2 (0.44) 17.87 <.001 62.8 (0.62) 37.2 (0.62) 72.12 <.001
      Normal 76.2 (0.43) 23.9 (0.43) 65.6 (0.43) 34.4 (0.43)
      Overweight 74.6 (0.41) 25.4 (0.41) 60.8 (0.46) 39.2 (0.46)
      Healthy eating behavior No 74.9 (0.34) 25.1 (0.34) 42.04 <.001 62.0 (0.33) 38.0 (0.33) 67.33 <.001
      Yes 76.2 (0.63) 23.8 (0.63) 67.9 (0.65) 32.1 (0.65)
      Characteristics Categories Boys
      Girls
      OR 95% CI p OR 95% CI p
      Eating behavior Non-healthy eating behavior 1.37 1.07~1.75 .013 0.98 0.64~1.50 .933
      Healthy eating behavior 1.00 1.00
      Table 1. Comparison of Characteristics between Boys and Girls (% [SE] or M±SE†)

      BMI=body mass index; SE=standard error; Values are presented as weighted % (SE) or Mean±SE unless otherwise indicated.

      Table 2. Characteristics of the Study Sample according to Depression by Gender (% [SE] or Mean±SE†)

      BMI=body mass index; SE=standard error; a Values are presented as weighted % (SE) or M±SE unless otherwise indicated.

      Table 3. Association between Healthy Eating Behavior and Depression

      BMI=body mass index OR=odds ratio; CI=confidence interval;

      Calculated by complex sample multi-logistic regression analysis, adjusted for family live together, economic status, academic performance, smoking, alcohol use, exercise habits, sleep duration, perceived weight status, BMI;

      Calculated by complex sample multi- logistic regression analysis, adjusted for family live together, economic status, academic performance, smoking, alcohol use, exercise habits, sleep duration, perceived weight status.


      RCPHN : Research in Community and Public Health Nursing
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