Background
Psychosocial stress and health behavior
Smoking
Obesity and eating behavior
Physical inactivity
Aims and hypothesis
Method
Procedure and study sample
Measures
Health Behaviors
Patient Health Questionnaire - stress scale
Statistical Analyses
Results
Demographic variables & health behavior
Total | Women | Men | p-value | |
---|---|---|---|---|
Age Mean (SD; range) | 39.5 (14.1; 18-93) | 40.4 (14.2; 18-93) | 38.3 (13.9; 18-83) |
<0.001
|
Sex (%; n) | 56.6 (1316) | 43.4 (1010) | ||
Marital status (%; n) |
<0.001
| |||
single | 50,3 (1133) | 46.3 (589) | 55.6 (544) | |
married | 33,1 (745) | 33.9 (431) | 32,1 (314) | |
separate living | 3,8 (86) | 4.4 (56) | 3.1 (30) | |
divorced | 10,4 (234) | 11.9 (152) | 8.4 (82) | |
widowed | 2,2 (49) | 3.1 (40) | 0.9(9) | |
School degree (%; n) | n.s. | |||
in school | 1.2 (27) | 0.9 (11) | 1.6 (16) | |
no or special school degree | 1.9 (43) | 1.8 (23) | 2.0 (20) | |
basic school (“Hauptschule”) | 24.3 (548) | 22.8 (292) | 26.2 (256) | |
secondary school (“Realschule”) | 29.0 (654) | 32.4 (415) | 24.4 (239) | |
grammar school (“Abitur”) | 41.7 (941) | 40.3 (515) | 43.6 (426) | |
Vocational degree (%; n) |
<0.001
| |||
no vocational degree | 15.3 (329) | 12.3 (149) | 19.2 (180) | |
still in vocational training | 10.2 (218) | 10.1 (122) | 10.2 (96) | |
apprenticeship | 39.3 (844) | 43.6 (526) | 33.9 (318) | |
master craftsman | 3.4 (72) | 1.7 (20) | 5.5 (52) | |
university degree | 21.0 (451) | 20.5 (248) | 21.6 (203) | |
others | 10.8 (232) | 11.8 (142) | 9.6 (90) | |
Vocational position (%; n) |
<0.001
| |||
employed full time | 33.4 (743) | 26.4 (333) | 42.4 (410) | |
employed part time | 16.3 (363) | 23.4 (295) | 7.0 (68) | |
not employed (e.g. housewife) | 5.8 (130) | 9.5 (120) | 1.0 (10) | |
vocational training | 8.6 (191) | 7.9 (100) | 9.4 (91) | |
unemployed | 14.1 (315) | 10.8 (136) | 18.5 (179) | |
retired | 9.7 (217) | 10.6 (133) | 8.7 (84) | |
others | 12.0 (268) | 11.3 (143) | 12.9 (125) | |
Diagnoses ICD-10 (%; n) | ||||
depression (F32, F33, F34) (%) |
<0.001
| |||
no depressive disorder / other | 50.0 (1162) | 46.4 (610) | 54.7 (552) | |
mild depressive disorder | 8.0 (185) | 8.5 (112) | 7.2 (73) | |
moderate depressive disorder | 34.6 (804) | 37.1 (488) | 31.3 (316) | |
severe depressive disorder | 7.5 (175) | 8.1 (106) | 6.8 (69) | |
anxiety disorder (F40. F41) (%) | 27.3 (634) | 29.0 (382) | 25.0 (252) |
<0.05
|
somatoform disorder (F45) (%) | 18.2 (423) | 20.7 (272) | 15.0 (151) |
<0.001
|
number of F-diagnoses/patient | 2.0 (2326) | 2.0 (1316) | 2.0 (1010) | |
Health behavior | ||||
smoking (% yes; n) | 38.4 (851) | 34.0% (424) | 44.0% (427) |
<0.001
|
number of cig./day (M; SD) | 11.4 (15.7) | 10.5 (16.5) | 12.4 (14.9) |
<0.05
|
BMI (M; SD) | 25.5 (5.8) | 24.9 (6.3) | 26.2 (5.1) |
<0.001
|
obesity (BMI ≥ 30.0) (%; n) | 18.5 (377) | 19.3 (218) | 17.4 (159) | |
uncontrolled eating (% yes; n) | 24.9 (552) | 27.3 (341) | 21.7 (211) |
<0.001
|
physical inactivity (< 2) | 61.9 (1345) | 62.3 (762) | 61.3 (583) |
PHQ-stress
PHQ-stress scale (M; SD) | M | SD | p-value | |||||
Total | 8.08 | 4.26 |
<0.001
| |||||
Women | 8.70 | 4.29 | ||||||
Men | 7.34 | 4.11 | ||||||
PHQ-stress items (M; n) | ||||||||
not bothered | bothered a little | bothered a lot | ||||||
Worries about health | 15.1 | (335) | 27.8 | (619) | 57.1 | (1269) |
<0.001
| |
Women | 12.2 | (152) | 26.0 | (325) | 61.8 | (772) | [1] | |
Men | 18.8 | (183) | 30.2 | (294) | 51.0 | (497) | [1] | |
Stress at work or at school | 43.7 | (933) | 22.0 | (470) | 34.3 | (732) |
<0.01
| |
Women | 41.9 | (501) | 20.5 | (245) | 37.6 | (449) | [3] | |
Men | 46.0 | (432) | 23.9 | (225) | 30.1 | (283) | [3] | |
Worries about weight or look | 31.9 | (710) | 36.0 | (802) | 32.1 | (716) |
<0.001
| |
Women | 27.3 | (343) | 33.0 | (415) | 39.6 | (498) | [2] | |
Men | 37.8 | (367) | 39.8 | (387) | 22.4 | (218) | [6] | |
Financial problems or worries | 39.6 | (877) | 30.1 | (667) | 30.2 | (669) | n.s. | |
Women | 41.7 | (519) | 29.0 | (361) | 29.4 | (366) | [5] | |
Men | 37.0 | (358) | 31.6 | (306) | 31.3 | (303) | [2] | |
Little or no sexual desire | 46.4 | (1004) | 26.7 | (577) | 26.9 | (582) |
<0.01
| |
Women | 45.1 | (543) | 24.8 | (299) | 30.1 | (363) | [4] | |
Men | 48.1 | (461) | 29.0 | (278) | 22.9 | (219) | [5] | |
Difficulties with partner | 49.7 | (1066) | 25.5 | (546) | 24.8 | (532) | n.s. | |
Women | 48.7 | (584) | 25.1 | (301) | 26.1 | (313) | [7] | |
Men | 51.0 | (482) | 25.9 | (245) | 23.2 | (219) | [4] | |
Thinking / dreaming about something terrible that happened | 56.2 | (1236) | 18.9 | (416) | 24.8 | (546) |
<0.001
| |
Women | 49.1 | (606) | 21.6 | (266) | 29.3 | (361) | [6] | |
Men | 65.3 | (630) | 15.5 | (150) | 19.2 | (185) | [8] | |
Having no one to turn to with problems | 47.2 | (1041) | 29.8 | (657) | 23.0 | (507) |
<0.05
| |
Women | 45.0 | (558) | 30.4 | (377) | 24.7 | (306) | [8] | |
Men | 50.1 | (483) | 29.0 | (280) | 20.9 | (201) | [7] | |
Something bad that happened recently | 64.4 | (1391) | 14.7 | (317) | 20.9 | (452) |
<0.001
| |
Women | 60.8 | (736) | 15.2 | (184) | 24.0 | (291) | [9] | |
Men | 69.0 | (655) | 14.0 | (133) | 17.0 | (161) | [9] | |
Stress of care taking | 61.5 | (1336) | 20.5 | (446) | 18.0 | (392) |
<0.001
| |
Women | 57.3 | (700) | 21.6 | (264) | 21.0 | (257) | [10] | |
Men | 66.7 | (636) | 19.1 | (182) | 14.2 | (135) | [10] |
Associations between PHQ-stress and health behaviors
BMI and obesity
BMI | Obesity (BMI ≥ 30) | Uncontrolled eating | Smoking | Cig / day | Physical inactivity | |||||||||||||||||
no | yes | no | yes | no | yes | no | yes | |||||||||||||||
PHQ-stress scale (0-20) | r=0.09*** | M=7.92 | M=8.94 | *** | M=7.43 | M=10.16 | *** | M=7.85 | M=8.47 | ** | r=0.08** | M=7.40 | M=8.52 | *** | ||||||||
SD=4.22 | SD=4.33 | SD=4.13 | SD=3.98 | SD=4.13 | SD=4.37 | SD=4.06 | SD=4.28 | |||||||||||||||
BMI (M, SD) | Obesity (% BMI ≥ 30) | Uncontrolled eating (% yes) | Smoking (% yes) | Cig / day (M, SD) | Physical inactivity (% inactive) | |||||||||||||||||
PHQ-stress items (dichotomous) | not/a little bothered | bothered a lot | not/a little bothered | bothered a lot | not/a little bothered | bothered a lot | not/a little bothered | bothered a lot | not/a little bothered | bothered a lot | not/a little bothered | bothered a lot | ||||||||||
dCohen | Cramérs V | Cramérs V | Cramérs V | dCohen | Cramérs V | |||||||||||||||||
Worries about health | 25.3 | (5.4) | 25.6 | (6.1) |
16.2
|
19.9
|
0.05*
|
22.3
|
26.8
|
0.05*
|
43.4
|
34.9
|
0.09***
| 11.2 | (12.6) | 10.7 | (15.5) |
58.5
|
64.5
|
0.06**
| ||
Stress at work or at school | 25.3 | (5.8) | 25.6 | (5.9) |
16.6
|
20.6
|
0.05*
|
20.8
|
31.9
|
0.12***
| 40.1 | 35.8 |
11.5
|
(15.3)
|
9.7
|
(12.9)
|
0.12*
| 61.7 | 62.4 | |||
Worries about weight or look |
25.1
|
(4.9)
|
26.4
|
(7.3)
|
0.23***
|
14.3
|
28.0
|
0.16***
|
15.2
|
45.6
|
0.33***
| 38.7 | 38.4 | 10.8 | (13.3) | 11.5 | (16.5) | 60.7 | 64.5 | |||
Financial problems or worries |
25.1
|
(5.8)
|
26.3
|
(6.0)
|
0.21***
|
16.0
|
24.3
|
0.10***
|
20.7
|
34.4
|
0.15***
|
32.8
|
51.3
|
0.18***
|
9.8
|
(14.7)
|
13.3
|
(13.7)
|
0.24***
|
59.0
|
68.0
|
0.09***
|
Little or no sexual desire | 25.4 | (5.7) | 25.6 | (6.1) | 18.6 | 17.9 |
22.8
|
29.6
|
0.07**
| 39.2 | 37.3 | 10.9 | (14.7) | 11.5 | (14.1) | 60.8 | 65.5 | |||||
Difficulties with partner | 25.5 | (5.8) | 25.3 | (5.8) | 18.7 | 16.5 |
22.4
|
30.4
|
0.08***
|
36.8
|
44.4
|
0.07**
| 10.9 | (15.4) | 11.4 | (11.7) | 61.0 | 65.3 | ||||
Thinking / dreaming about sth terrible |
25.2
|
(5.5)
|
26.4
|
(6.7)
|
0.21***
|
17.0
|
22.7
|
0.06**
|
21.0
|
36.6
|
0.16***
| 37.4 | 40.7 | 10.5 | (13.1) | 11.8 | (16.0) | 60.9 | 64.7 | |||
Having no one to turn to with problems | 25.3 | (5.7) | 25.9 | (6.3) |
17.3
|
22.1
|
0.05*
|
21.9
|
34.8
|
0.13***
| 37.7 | 40.6 | 10.7 | (14.5) | 11.7 | (14.3) |
58.7
|
72.0
|
0.12***
| |||
Something bad that happened recently | 25.4 | (6.0) | 25.7 | (5.2) | 17.9 | 19.6 | 24.7 | 25.7 | 37.9 | 40.6 | 10.7 | (13.8) | 11.9 | (16.7) |
60.4
|
66.9
|
0.06*
| |||||
Stress of care taking |
25.3
|
(5.7)
|
26.3
|
(6.6)
|
0.17**
|
17.3
|
23.2
|
0.06**
|
22.7
|
34.3
|
0.10***
| 37.9 | 42.8 | 10.7 | (14.7) | 12.4 | (13.5) |
60.8
|
68.0
|
0.06**
|
Obesity | Uncontrolled eating | Smoking | Cig/day | Physical inactivity | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PHQ-stress - Women | OR | 95% CI | Nagelk. R2 | OR | 95% CI | Nagelk. R2 | OR | 95% CI | Nagelk. R2 | stand. ß | adj. R2 | OR | 95% CI | Nagelk. R2 |
PHQ-stress scale (0-20) (unadj.) |
1.07**
|
1.03-1.11
|
2.0
|
1.18***
|
1.14-1.23
|
13.1
|
1.05**
|
1.02-1.08
|
1.3
| n.s. |
1.06***
|
1.03-1.09
|
1.9
| |
PHQ-stress scale (0-20) (adjusted) |
1.07**
|
1.03-1.11
|
11.7
|
1.17***
|
1.12-1.22
|
18.5
| 1.03 | 1.00-1.07 | n.s. | n.s. |
1.05*
|
1.01-1.08
|
5.5
| |
PHQ-stress items (dichotomous) | ||||||||||||||
Worries about health (unadj.) | n.s. | n.s. |
0.77*
|
0.59-0.83
|
0.5
| n.s. | n.s. | |||||||
adjusted | n.s. | n.s. | 0.77 | 0.57-1.03 | n.s. | n.s. | n.s. | |||||||
Stress at work or at school (unadj.) | n.s. |
1.75***
|
1.35-2.27
|
2.2
| n.s. | n.s. | n.s. | |||||||
adjusted | n.s. |
1.69***
|
1.26-2.27
|
10.4
| n.s. | n.s. | n.s. | |||||||
Worries about weight or look (unadj.) |
2.03***
|
1.51-2.74
|
3.0
|
4.86***
|
3.72-6.36
|
15.9
| n.s. | n.s. | n.s. | |||||
adjusted |
2.02***
|
1.46-2.79
|
12.6
|
4.49***
|
3.38-5.97
|
21.7
| n.s. | n.s. | n.s. | |||||
Financial problems or worries (unadj.) |
1.78***
|
1.30-2.43
|
1.9
|
2.15***
|
1.65-2.79
|
3.7
|
1.85***
|
1.43-2.38
|
2.5
|
0.10**
|
0.9
|
1.48***
|
1.22-1.80
|
1.0
|
adjusted |
1.64**
|
1.18-2.31
|
11.3
|
1.79***
|
1.34-2.38
|
11.0
|
1.45*
|
1.08-1.93
|
14.1
|
0.09*
|
1.9
|
1.34*
|
1.01-1.77
|
4.1
|
Little or no sexual desire (unadj.) | n.s. |
1.39*
|
1.06-1.82
|
0.7
| n.s. | n.s. | n.s. | |||||||
adjusted | n.s. | 1.30 | 0.97-1.74 | n.s. | n.s. | n.s. | n.s. | |||||||
Difficulties with partner (unadj.) | n.s. |
1.59**
|
1.20-2.10
|
1.2
|
1.44**
|
1.10-1.89
|
0.8
| n.s. |
1.40*
|
1.06-1.85
|
0.7
| |||
adjusted | n.s. | 1.36 | 0.99-1.87 | n.s. |
1.47*
|
1.08-1.99
|
14.3
| n.s. | 1.30 | 0.97-1.76 | n.s. | |||
Thinking/dreaming about sth terrible that happened (unadj.) |
1.46*
|
1.06-2.00
|
0.8
|
1.98***
|
1.52-2.59
|
2.9
|
1.56***
|
1.20-2.01
|
1.3
|
0.12**
|
1.2
| n.s. | ||
adjusted | 1.37 | 0.98-1.92 | n.s. |
1.78***
|
1.34-2.37
|
10.9
|
1.52**
|
1.14-2.03
|
15.0
|
0.10**
|
2.7
| n.s. | ||
Having no one to turn to with problems (unadj.) |
1.71**
|
1.24-2.37
|
1.5
|
1.96***
|
1.49-2.59
|
2.6
| n.s. | n.s. |
1.67***
|
1.26-2.23
|
1.5
| |||
adjusted |
1.55*
|
1.10-2.19
|
10.9
|
1.58**
|
1.17-2.15
|
10.1
| n.s. | n.s. |
1.50**
|
1.10-2.05
|
4.9
| |||
Something bad that happened recently (unadj.) | n.s. | n.s. |
1.39*
|
1.06-1.83
|
0.6
| n.s. |
1.33*
|
1.06-1.66
|
0.9
| |||||
adjusted | n.s. | 1.26 | 0.91-1.74 | n.s. | n.s. |
1.40*
|
1.04-1.89
|
4.5
| ||||||
Stress of care taking (unadj.) |
1.46*
|
1.03-2.07
|
0.6
|
1.58**
|
1.17-2.13
|
1.0
| n.s. | n.s. | n.s. | |||||
adjusted | 1.41 | 0.97-2.06 | n.s. |
1.57**
|
1.13-2.18
|
9.9
| n.s. | n.s. | n.s. | |||||
PHQ-stress - Men | OR | 95% CI | Nagelk. R2 | OR | 95% CI | Nagelk. R2 | OR | 95% CI | Nagelk. R2 | stand. ß | adj. R2 | OR | 95% CI | Nagelk. R2 |
PHQ-stress scale (0-20) (unadj.) | 1.03 | 0.99-1.08 | n.s. |
1.13***
|
1.09-1.18
|
6.7
|
1.04*
|
1.00-1.07
|
0.7
|
0.12**
|
1.2
|
1.07***
|
1.04-1.11
|
2.6
|
PHQ-stress scale (0-20) (adj.) | 1.02 | 0.98-1.07 | n.s. |
1.14***
|
1.09-1.19
|
9.3
|
1.06**
|
1.02-1.10
|
19.8
|
0.10*
|
5.7
|
1.06**
|
1.02-1.10
|
5.2
|
PHQ-stress items (dichotomous) | ||||||||||||||
Worries about health (unadj.) | n.s. | n.s. |
0.69**
|
0.53-0.89
|
1.2
|
1.45**
|
1.11-1.89
|
1.1
| ||||||
adjusted | n.s. | n.s. |
0.73*
|
0.55-0.98
|
19.3
|
1.33*
|
1.01-1.75
|
4.4
| ||||||
Stress at work or at school (unadj.) | n.s. |
1.72**
|
1.24-2.39
|
1.7
| n.s. | n.s. | n.s. | |||||||
adjusted | n.s. |
1.57**
|
1.11-2.21
|
3.9
| n.s. | n.s. | n.s. | |||||||
Worries about weight or look (unadj.) |
2.89***
|
1.99-4.18
|
5.4
|
4.27***
|
3.05-5.97
|
10.9
| n.s. | n.s. | ||||||
adjusted |
3.18***
|
2.15-4.71
|
13.8
|
4.05***
|
2.88-5.68
|
12.8
| n.s. | n.s. | ||||||
Financial problems or worries (unadj.) |
1.57*
|
1.10-2.24
|
1.1
|
1.87***
|
1.36-2.57
|
2.3
|
2.59***
|
1.96-3.43
|
6.2
|
0.13***
|
1.5
|
1.49**
|
1.11-1.99
|
1.1
|
adjusted | 1.39 | 0.95-2.04 | n.s. |
1.75***
|
1.26-2.41
|
4.5
|
2.25***
|
1.63-3.09
|
22.4
|
0.12**
|
6.5
| 1.30 | 0.96-1.76 | n.s. |
Little or no sexual desire (unadj.) | n.s. |
1.41
|
0.99-2.01
|
0.6
| n.s. | n.s. | n.s. | |||||||
adjusted | n.s. | 1.37 | 0.94-1.99 | n.s. | n.s. | n.s. | n.s. | |||||||
Difficulties with partner (unadj.) | n.s. | n.s. | n.s. | n.s. | n.s. | |||||||||
adjusted | n.s. | n.s. | n.s. | n.s. | n.s. | |||||||||
Thinking/dreaming about sth terrible that happened (unadj.) | n.s. |
2.33***
|
1.63-3.33
|
3.3
| n.s. | n.s. | n.s. | |||||||
adjusted | n.s. |
2.19***
|
1.51-3.17
|
5.5
| n.s. | n.s. | n.s. | |||||||
Having no one to turn to with problems (unadj.) | n.s. |
1.76**
|
1.23-2.51
|
1.5
| n.s. | n.s. |
2.02***
|
1.42-2.88
|
2.4
| |||||
adjusted | n.s. |
1.6*
|
1.11-2.31
|
3.6
| n.s. | n.s. |
1.87***
|
1.30-2.69
|
5.2
| |||||
Something bad that happened recently (unadj.) | n.s. | n.s. | n.s. | n.s. | n.s. | |||||||||
adjusted | n.s. | n.s. | n.s. | n.s. | n.s. | |||||||||
Stress of care taking (unadj.) | n.s. |
2.03***
|
1.36-3.03
|
1.9
|
1.59*
|
1.10-2.31
|
0.9
|
0.09*
|
0.6
|
1.72**
|
1.14-2.60
|
1.0
| ||
adjusted | n.s. |
2.00***
|
1.33-3.03
|
4.3
|
1.87**
|
1.22-2.87
|
20.2**
|
0.11*
|
6.1
|
1.64*
|
1.08-2.51
|
4.2
|