A Longitudinal Study of Bidirectional Relationships Between Multiple Unhealthy Lifestyles and Psychotic-Like...

Unhealthy lifestyles often co-occur and are associated with psychotic-like experiences (PLEs). Nevertheless, longitudinal research simultaneously incorporating multiple unhealthy lifestyles to explore their associations with PLEs remains limited.

The longitudinal survey was conducted at baseline from December 17 to 12, 2021 (Time 1, T1) and 6 months later from May 17 to June 5, 2022 (Time 2, T2), including 27 260 adolescents (M_age = 14.3 [1.5] years; 47.8% of females). The 8-item Positive Subscale of the Community Assessment of Psychic Experiences was used to assess PLE. Five lifestyles (i.e., sleep duration, physical activity, smoking, alcohol use, and BMI) were included, each classified as healthy or unhealthy, and the number of unhealthy lifestyles was summed into cumulative unhealthy lifestyles (at each assessment). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Baseline unhealthy lifestyles, including poor sleep duration, physical inactivity, smoking, alcohol use, and abnormal BMI, significantly increased the risk of PLEs 6 months later. Conversely, baseline PLEs also affect the four unhealthy lifestyles 6 months later, excluding abnormal BMI. Moreover, cumulative unhealthy lifestyles were associated with PLEs 6 months later, with the impact increasing as the cumulative lifestyle numbers increased. Conversely, individuals with PLEs would be most likely to experience more unhealthy lifestyles 6 months later.

The relationships between multiple unhealthy lifestyles and PLEs among adolescents were bidirectional, even after adjusting for confounders. Therefore, it is essential to promote healthy lifestyles and prevent PLEs simultaneously, so as to break the potential vicious cycle between the two.