Unhealthy lifestyle factors and the risk of incident depressive symptomatology in older adults: Findings from the Three-City study : WestminsterResearch

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Title	Unhealthy lifestyle factors and the risk of incident depressive symptomatology in older adults: Findings from the Three-City study
Type	Journal article
Authors	Norton, J., Jaussent, I., Edouard, E., Boubert, L., Mura, T. and Akbaraly, T.
Abstract	Background The association between unhealthy lifestyle factors and incident depressive symptoms has seldom been studied in the specific context of late-life depression. Methods Data were drawn from the Montpellier and Dijon centres of the Three-City study with community-dwellers (aged ≥65 years) followed at five time-points over 12 years. Analysis was performed on 3495 dementia-free participants, with no history of major depression, no antidepressant use and a CES-D score < 16 at inclusion. Lifestyle factors at inclusion included alcohol consumption, smoking, sleep disturbances, diet, social activity engagement and physical activity level. A cumulative unhealthy lifestyle index was built with one-point allocated per unhealthy lifestyle factor. Incident depressive symptomatology (DepS) was defined as a CES-D score ≥ 16 or antidepressant use. Results Over the median 9.02-year follow-up (range: 1.56–12.75), 922 participants (26.4 %) had incident DepS. Regarding the cumulative index, the DepS risk increased by 18 % [95 % CI, 12 %–16 %], per additional UHL risk factor. In the multi-adjusted model including the 6 factors, smoking (HR, 1.70 [95 % CI, 1.33–2.17]), sleep disturbances (HR, 1.37 [95 % CI, 1.20–1.57]) and low social activity engagement (HR, 1.20 [95 % CI, 1.04–1.39]) were independently associated with DepS. The risk increased for all two-by-two combinations of these three factors, the highest being for sleep disturbances combined with smoking (HR, 2.84 [95 % CI, 1.82–2.45]). Of those occurring in isolation, only sleep disturbances reached significance (HR, 1.18 [95 % CI, 1.00–1.39]). Conclusion The risk of DepS onset increased hand-in-hand with the number of unhealthy lifestyle factors. Interventions targeting unhealthy lifestyles, and in particular sleep disturbances, smoking and social isolation, could have a substantial public health impact on reducing late-onset depression.
Keywords	Depressive symptoms
	Late-onset depression
	Unhealthy lifestyle
	Older adults
	Prospective studies
Article number	121125
Journal	Journal of Affective Disorders
Journal citation	399
ISSN	1573-2517
Year	2026
Publisher	Elsevier
Accepted author manuscript	Norton et al. Journal of Affective Disorders 399 121125 (2026) - pour HAL.docx License CC BY-NC-ND 4.0 File Access Level Open (open metadata and files)
Digital Object Identifier (DOI)	https://doi.org/10.1016/j.jad.2025.121125
Web address (URL)	https://www.sciencedirect.com/science/article/pii/S0165032725025674?via%3Dihub
Published in print	15 Apr 2026
Published online	05 Jan 2026

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Unhealthy lifestyle factors and the risk of incident depressive symptomatology in older adults: Findings from the Three-City study

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