Association Between Mental Health and Self-Perceived Body Image Among Adolescents in Texas

BACKGROUND:  Mental health conditions such as major and minor depression are relatively common among adolescents. Adolescents’ ideas of desirable body image are influenced by social norms, media, peers and parents. Relatively little is known about the relation between mental health and self-perceived body image among adolescents. This study aims at finding if there is any association between mental health and perceived body image for self among adolescents in Texas.

METHODS:  Data from the 2009-2011 Texas School Physical Activity and Nutrition survey among 8^th and 11^th graders were analyzed. This was a cross-sectional survey administered in schools among 6,716 students. The survey asked a question on how the students think their body looks like and given a set of gender-specific images, from thin to heavy, to choose from. We assessed three categorical mental health variables in relation to the body image perceptions: emotional symptoms, life-satisfaction and depression. These measures were stratified by sex and adjusted for race/ethnicity, socioeconomic status, physical activity, screen time, and sugar-sweetened beverages consumption. We used SAS 9.2 to run weighted descriptive and logistic regression analyses.

RESULTS:  The prevalence of abnormal emotional symptoms was higher among boys who perceived their body as heavy (18.6%) than boys who perceived their body as thin (5.7%). The prevalence of high life satisfaction was lower among girls who perceived their body as heavy (7.1%) than girls who perceived their body as thin (22.3%). The prevalence of depression increased gradually among those who perceived their body image as thin to heavy. Logistic regression model adjusted for race/ethnicity, socioeconomic status, screen time, physical activity, screen time, and sugar-sweetened beverages consumption showed that boys who perceived their body as heavy were 1.8 times more likely to have abnormal or borderline abnormal emotional symptoms than boys who perceived their body as thin. Girls who perceived their body as heavy were 3.5 times more likely to have low or medium life satisfaction than girls who perceived their body as thin. Odds ratios for depression did not vary by the perceived body image among boys or girls.

CONCLUSIONS:  Mental health among adolescents was associated with the perception of their body image and it varied by sex. The impact on mental health due to perception of body image may make adolescents vulnerable to develop severe depression, eating disorders or other risk behaviors. Public health interventions should be developed to empower adolescents with positive outlook and mitigate influences about desirable body image.