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Cited by 130Psychological Well-being and Life SatisfactionHealth and Lifestyle StudiesHealth, psychology, and well-being

Major health-related behaviours and mental well-being in the general population: the Health Survey for England

Open access
Stranges, Saverio, Samaraweera, Preshila Chandimali, Taggart, Frances, Kandala, Ngianga-Bakwin, Stewart-Brown, Sarah·2014·BMJ Open
DOI 10.1136/bmjopen-2014-005878PMC PMC4170205
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Abstract

Background: Major behavioural risk factors are known to adversely affect health outcomes and be strongly associated with mental illness. However, little is known about the association of these risk factors with mental well-being in the general population. We sought to examine behavioural correlates of high and low mental well-being in the Health Survey for England. Methods: Participants were 13 983 adults, aged 16 years and older (56% females), with valid responses for the combined 2010 and 2011 surveys. Mental well-being was assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). ORs of low and high mental well-being, compared to the middle-range category, were estimated for body mass index (BMI), smoking, drinking habits, and fruit and vegetable intake. Results: ORs for low mental well-being were increased in obese individuals (up to 1.72, 95% CI 1.26 to 2.36 in BMI 40+ kg/m 2). They increased in a linear fashion with increasing smoking (up to 1.98, 95% CI 1.55 to 2.53, >20 cigarettes/day) and with decreasing fruit and vegetable intake (up to 1.53, 95% CI 1.24 to 1.90, <1 portion/day); whereas ORs were reduced for sensible alcohol intake (0.78, 95% CI 0.66 to 0.91, ≤4 units/day in men, ≤3 units/day in women). ORs for high mental well-being were not correlated with categories of BMI or alcohol intake. ORs were reduced among ex-smokers (0.81, 95% CI 0.71 to 0.92), as well as with lower fruit and vegetable intake (up to 0.79, 95% CI 0.68 to 0.92, 1 to <3 portions/day). Conclusions: Along with smoking, fruit and vegetable consumption was the health-related behaviour most consistently associated with mental well-being in both sexes. Alcohol intake and obesity were associated with low, but not high mental well-being.

AI snapshot

Written from the paper’s full text.

TL;DR

In a nationally representative sample of 13,983 English adults from the 2010/2011 Health Survey for England, smoking and fruit and vegetable intake were the behaviours most consistently associated with both low and high mental well-being. Obesity and alcohol intake were associated with low, but not high, mental well-being.

Key findings

  • Low mental well-being was more likely in obese individuals: fully adjusted OR 1.24 (95% CI 1.04 to 1.43) for BMI 30–<40 kg/m² and 1.72 (95% CI 1.26 to 2.36) for BMI 40+ kg/m².
  • Low mental well-being increased linearly with smoking, up to OR 1.98 (95% CI 1.55 to 2.53) for >20 cigarettes/day, and with decreasing fruit and vegetable intake, up to OR 1.53 (95% CI 1.24 to 1.90) for <1 portion/day; sensible alcohol intake was associated with reduced odds (OR 0.78, 95% CI 0.66 to 0.91).
  • High mental well-being was not associated with BMI or alcohol categories, but odds were reduced among ex-smokers (OR 0.81, 95% CI 0.71 to 0.92) and with lower fruit and vegetable intake (OR 0.79, 95% CI 0.68 to 0.92 for 1 to <3 portions/day; OR 0.83, 95% CI 0.72 to 0.96 for 3 to <5 portions/day).

Methods

  • Cross-sectional analysis of the combined 2010 and 2011 Health Survey for England, including 13,983 adults aged 16 years and older (56% females) with valid Warwick-Edinburgh Mental Well-being Scale (WEMWBS) responses.
  • WEMWBS scores defined low (14–42), middle-range (43–59), and high (60–70) mental well-being groups; logistic regression estimated ORs of low and high mental well-being compared with the middle-range category.
  • Models were unadjusted, partially adjusted for age and sex, and fully adjusted for sociodemographic variables plus BMI, smoking, alcohol drinking, and fruit and vegetable consumption.

Limitations

  • The paper states that physical activity was not included because data were not collected in the 2010 and 2011 surveys, and that fruit and vegetable intake may act as a marker for other healthy lifestyles including physical activity.
  • The paper states that the cross-sectional design cannot establish causality or temporality of the observed relationships.
  • The paper states that the 66.0% participation rate, the percentage of WEMWBS complete responders, and the sample being from a developed western country may reduce generalisability to other populations and socioeconomic settings.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmjopen-2014-005878

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 54 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In fully adjusted models, odds of low mental well-being (vs middle-range) increased with increasing smoking category, up to OR 1.98 (95% CI 1.55 to 2.53) for heavy smokers (>20 cigarettes/day).

    “They increased in a linear fashion with increasing smoking (up to 1.98, 95% CI 1.55 to 2.53, >20 cigarettes/day)”
    • Also stated in: § Statistical analysis · plain
      “Heavy Smoker >20/day | 3.16 (2.62–3.81) | 3.21 (2.67–3.87) | 1.98 (1.55–2.53) | <0.001”
    Quote in the paperSubstantial claim
  • Findingown data

    In fully adjusted models, odds of high mental well-being (vs middle-range) were reduced among ex-smokers (OR 0.81, 95% CI 0.71 to 0.92).

    “ORs were reduced among ex-smokers (0.81, 95% CI 0.71 to 0.92)”
    • Also stated in: § Statistical analysis · plain
      “Ex-Smoker | 0.88 (0.79–0.97) | 0.81 (0.73–0.90) | 0.81 (0.71–0.92) | 0.001”
    Quote in the paperSubstantial claim
  • Findingown data

    In fully adjusted models, odds of low mental well-being (vs middle-range) were increased in class III obesity (BMI 40+ kg/m2) (OR 1.72, 95% CI 1.26 to 2.36).

    “ORs for low mental well-being were increased in obese individuals (up to 1.72, 95% CI 1.26 to 2.36 in BMI 40+ kg/m2).”
    • Also stated in: § Statistical analysis · plain
      “40+ kg/m2 | 2.25 (1.73–2.93) | 2.28 (1.75–2.97) | 1.72 (1.26–2.36) | 0.001”
    Quote in the paperSubstantial claim
  • Findingown data

    In fully adjusted models, odds of low mental well-being (vs middle-range) were reduced for sensible alcohol intake (≤4 units/day men, ≤3 units/day women) (OR 0.78, 95% CI 0.66 to 0.91).

    “whereas ORs were reduced for sensible alcohol intake (0.78, 95% CI 0.66 to 0.91, ≤4 units/day in men, ≤3 units/day in women).”
    • Also stated in: § Statistical analysis · plain
      “≤4 /day/men or ≤3 /day/women | 0.59 (0.52–0.66) | 0.59 (0.52–0.67) | 0.78 (0.66–0.91) | 0.002”
    Quote in the paperSubstantial claim
  • Findingown data

    In fully adjusted models, odds of low mental well-being (vs middle-range) were increased for <1 portion/day fruit and vegetable intake (OR 1.53, 95% CI 1.24 to 1.90).

    “with decreasing fruit and vegetable intake (up to 1.53, 95% CI 1.24 to 1.90, <1 portion/day)”
    • Also stated in: § Statistical analysis · plain
      “<1 portion/day | 1.29 (1.94–2.70) | 2.35 (1.99–2.78) | 1.53 (1.24–1.90) | 0.000”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim. 2
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 34

  • The quote only partly states this claim.

    Findingown data

    In fully adjusted models, odds of high mental well-being (vs middle-range) were not associated with BMI categories.

    “ORs for high mental well-being were not correlated with categories of BMI or alcohol intake.”
    • Also stated in: § Statistical analysis · plain
      “18.5 kg/m2 to 25 kg/m2 | Ref | Ref | Ref | | 0.326 | 0.791”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In sex-stratified analyses, increased odds ratios for low mental well-being were found in underweight or obese female participants, with no significant association across BMI categories among male participants.

    “increased ORs for low mental well-being were found in underweight or obese female participants, with no significant association across BMI categories among male participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In fully adjusted models, compared to the middle-range mental well-being category, odds ratios for low mental well-being were increased for obese individuals (BMI 30-40 kg/m2: OR 1.24, 95% CI 1.04 to 1.43; BMI 40+ kg/m2: OR 1.72, 95% CI 1.26 to 2.36), especially in those with class III or extreme obesity, whereas there was no increased risk of low mental well-being in the overweight.

    “in fully adjusted models odds ratios were increased for obese individuals (1.24, 95% CI 1.04 to 1.43, BMI 30-40kg/m2; 1.72, 95% CI 1.26 to 2.36, BMI: 40+ kg/m2);”
    • Also stated in: § Discussion · plain
      “We found that ORs of low mental well-being were increased among obese individuals, especially in those with class III or extreme obesity (BMI 40+ kg/m2), whereas there was no increased risk of low mental well-being in the overweight.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In sex-stratified analyses, odds for low mental well-being were increased in the lowest category of fruit and vegetable intake (<1 portion/day) in both sexes and reduced for sensible alcohol intake in both sexes.

    “Odds were increased in the lowest category of fruit and vegetable intake (<1 portion/day) in both sexes and reduced for sensible alcohol intake in both sexes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In sex-stratified analyses, increased odds ratios for low mental well-being were observed in both current and ex-smokers among women, but not in male ex-smokers.

    “increased ORs for low mental well-being were observed in both current and ex-smokers among women, but not in male ex-smokers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Findings were generally consistent with the overall results for female participants but less so for men.

    “Findings were generally consistent with these overall results for female participants but less so for men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Individuals in the highest mental well-being category were more likely to be overweight, but not more likely to be ideal body weight.

    “they were more likely to be overweight, but not more likely to be ideal body weight.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Individuals in the highest mental well-being category (WEMWBS score 60-70) were more likely to be never smokers and to report higher intakes of fruit and vegetables than those in the low or middle category.

    “Individuals in the highest mental well-being category (WEMWBS score 60–70) were more likely to be never smokers and to report higher intakes of fruit and vegetables than those in the low or middle category;”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In sex-stratified analyses, odds ratios for high mental well-being were significantly reduced in ex-smokers of both sexes and in heavy female smokers, among harmful male drinkers, and across all categories of fruit and vegetable intake among female participants and one category in men.

    “ORs for high mental well-being were significantly reduced in ex-smokers of both sexes and in heavy female smokers, among harmful male drinkers, and across all categories of fruit and vegetable intake among female participants and one category in men.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Individuals in the lowest mental well-being category (WEMWBS score 14-42) were more likely to be obese, current smokers, never-drinkers or ex-drinkers and to report lower intakes of fruit and vegetables than those in the middle or highest category.

    “Specifically, individuals in the lowest mental well-being category (WEMWBS score 14–42) were more likely to be obese, current smokers, never-drinkers or ex-drinkers and to report lower intakes of fruit and vegetables than those in the middle or highest category.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Fruit and vegetable consumption was associated with increased odds of high mental well-being and reduced odds of low mental well-being, and these associations could be observed in men and women.

    “The latter was associated with increased odds of high mental well-being and reduced odds of low mental well-being and these associations could be observed in men and women.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Major behavioural risk factors such as obesity, smoking, excess alcohol consumption and poor dietary patterns account for large shares of the burden of morbidity and mortality, both nationally and globally.

    “Major behavioural risk factors such as obesity, smoking, excess alcohol consumption and poor dietary patterns account for large shares of the burden of morbidity and mortality, both nationally and globally.1–3”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] source

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  • Classified as probably not a substantial claim.

    Premisecitation

    Positive mental health or mental well-being has recently emerged as an important predictor of overall health and longevity.

    “Positive mental health or mental well-being has recently emerged as an important predictor of overall health and longevity.12–14”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [12] World Health Organization. Mental health: new understanding, new hope. The World Health Report . Geneva, Switzerland: World Health Organization, 2001.

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    • cites [13] source

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    • cites [14] Huppert, 2009, Psychological well-being: evidence regarding its causes and consequences, Appl Psychol Health Well-Being source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The Health Survey for England is an annual survey of a nationally representative population sample of England.

    “The Health Survey for England (HSE) is an annual survey of a nationally representative population sample of England.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Alcohol intake and obesity were associated with low, but not high, mental well-being.

    “Alcohol intake and obesity were associated with low, but not high mental well-being.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is a well-validated measure of mental well-being.

    “This scale is a well validated, popular measure currently used to monitor mental well-being in the English public health outcomes framework and the Scottish Government's Mental Health Indicators data set.22 24 25”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 22 24 25

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  • May combine two claims.

    Study design and conductreasoning

    The cross-sectional nature of the study allowed examination of associations between mental well-being and multiple behaviours, but cannot establish causality or temporality of the observed relationships.

    “Cross-sectional nature of the study allowed us to examine the associations between mental well-being and multiple behaviours, but it cannot establish the causality and temporality of the observed relationships.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Of the 17 030 adults interviewed, 3047 (17.9%) had missing data on mental well-being scores, and the analysis used 13 983 adults with valid responses for the combined 2010 and 2011 data sets.

    “Of these 17 030 adults, 3047 (17.9%) had missing data on mental well-being scores. For this analysis, data for the 13 983 adults who participated in the core surveys and with valid responses for the combined 2010 and 2011 data sets were used”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    This is the first comprehensive analysis of behavioural correlates of mental well-being in a large, nationally representative sample from the general population.

    “This is the first comprehensive analysis of behavioural correlates of mental well-being in a large, nationally representative sample from the general population.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Epidemiological evidence on the behavioural correlates of mental well-being is sparse.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A considerable body of observational and experimental evidence links these behaviours to measures of health-related quality of life, mental illness and psychiatric comorbidities.

    “A considerable body of observational and experimental evidence also links these behaviours to the measures of health-related quality of life, mental illness and psychiatric comorbidities.4–7”
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    Study design and conductcitation

    The selection of covariates and confounders for multivariate analyses was based on a previous study from the same data sets.

    “The selection of covariates and confounders for multivariate analyses was based on a previous study from the same data sets, which focused on demographic and socioeconomic correlates of mental well-being.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Stewart-Brown S Samaraweera P Taggart F . Socio-economic gradients and mental health: implications for public health. Br J Psychiatry (in press).

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The fully adjusted model included age, sex, behavioural and sociodemographic correlates.

    “fully adjusted (age, sex, behavioural and sociodemographic correlates; model 3) logistic regression modelling was used”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The 2010 and 2011 HSE had a 66% household response rate in both years.

    “A total of 8420 adults were interviewed in the 2010 HSE, while a total of 8610 adults were interviewed in the 2011 HSE, with a 66% household response rate in both years.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Missing values were included for all covariates in order to maximise sample size and avoid bias.

    “In order to maximise sample size and avoid bias, missing values were included for all covariates.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In a recent systematic review, mental health assessed by the mental component score of the Short Form-36 was reduced among class III obese individuals, but was not significantly different among obese (class I and class II) participants, and increased among overweight adults, compared to normal weight individuals.

    “In a recent systematic review of observational studies,36 mental health, as assessed by the mental component score of the Short Form-36, was reduced among class III obese individuals, but was not significantly different among obese (class I and class II) participants, and increased among overweight adults, compared to normal weight individuals.”
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    • cites [36] source

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    Premisecitation

    WEMWBS is the measure of choice in the UK for mental well-being.

    “While this is the measure of choice in the UK for mental well-being, it is not a clinically validated measure of mental illness”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] source

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    Premisecitation

    There is evidence that up to 50% of tobacco is now smoked by people with a mental illness.

    “There is evidence that up to 50% of tobacco is now smoked by people with a mental illness.8”
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    • cites [8] source

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    Interpretationcitation

    The findings are in line with evidence on the comorbidity between alcohol use disorders and mental health problems such as depression or anxiety.

    “They are, for example, in line with the unquestionable evidence on the comorbidity between alcohol use disorders and mental health problems such as depression or anxiety.35”
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    Premisecitation

    Findings mirror existing studies with regard to smoking, where evidence of correlation with both positive and negative measures of mental health have been presented, and there is some evidence that these associations may be causal.

    “Our findings also mirror those from existing studies with regard to smoking, where evidence of correlation with both positive and negative measures of mental health have been presented, and there is some evidence that these associations may be causal.”
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    • cites [38] source

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    Premisecitation

    Mental health problems in childhood predict the adoption of unhealthy lifestyles in adolescence.

    “Mental health problems in childhood also predict the adoption of unhealthy lifestyles in adolescence.11”
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    Premisecitation

    The Health Survey for England collected data on mental well-being in 2010 and 2011 using WEMWBS, as well as information on body weight, smoking, alcohol consumption, and fruit and vegetable intake.

    “The Health Survey for England21 collected data on mental well-being in 2010 and 2011 using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS),22 as well as information on body weight, smoking, alcohol consumption, and fruit and vegetable lifestyle intake.”
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    Interpretationcitation

    A reduced risk of low mental well-being in people consuming alcohol within sensible drinking limits is in line with a U-shaped association supported by epidemiological data linking regular moderate consumption to better health outcomes than abstinence or heavy drinking.

    “A reduced risk of low mental well-being in people consuming alcohol within the sensible drinking limits is also in line with a U-shaped association, as supported by a large body of epidemiological data linking regular moderate consumption of alcohol to better health outcomes than abstinence or heavy drinking, across several populations worldwide.3 4”
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    Premisecitation

    Obesity, alcohol and drug misuse are frequently associated with mental disorders.

    “Likewise, obesity, alcohol and drug misuse are frequently associated with mental disorders.9 10”
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    • cites 9 10

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    Premisecitation

    A WEMWBS score of 42 is below (clinically worse than) a CES-D score of 16 and just above (clinically better than) that consistent with a CES-D score of 26.

    “A WEMWBS score of 42, which defined the cut point for the low mental well-being group in this study, is below (clinically worse than) a CES-D score of 16 and just above (clinically better than) that consistent with a CES-D score of 26”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Bianca D . Performance of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) as a screening tool for depression in UK and Italy. http://www2.warwick.ac.uk/fac/med/research/platform/wemwbs/development/papers/donatella_bianco-thesis.pdf

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    Premisecitation

    The meta-analysis pooled results from 26 studies assessing anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect and stress.

    “The review pooled together results from 26 studies, which assessed anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect and stress.”
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    • cites [38] source

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    Premisecitation

    Recent compelling research suggests the economic benefits of promoting positive mental health are significant and wide-reaching.

    “Recent compelling research suggests the economic benefits of promoting positive mental health are significant and wide-reaching.19 20”
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    • cites 19 20

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    Premisecitation

    A recent meta-analysis of observational studies examined changes in mental health after smoking cessation compared with continuing to smoke.

    “a recent meta-analysis of observational studies examined changes in mental health after smoking cessation compared with continuing to smoke.38”
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    • cites [38] source

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Mental well-being now assumes an important place in mental health and public health policy.

    “As a consequence, mental well-being now assumes an important place in mental health and public health policy.16–18”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [16] HM Government. Healthy Lives Healthy People: Our strategy for Public Health in England. 2010. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216096/dh_127424.pdf

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    • cites [17] HM Government. No health without mental health: a cross-governmental mental health outcomes strategy for people of all ages. 2011. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf

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    • cites [18] HM Government. Preventing suicide in England: one year on. First annual report on the cross government strategy to save lives. January 2014.

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  • May combine two claims.

    Study design and conductreasoning

    The study is not able to disentangle the chronological order or causal nature of the associations found, or to examine the effects of cumulative experience of lifestyle factors across the life course.

    “this study is not able to disentangle the chronological order or causal nature of the associations found, or to examine the effects of cumulative experience of lifestyle factors across the life course.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies have shown a dose-response relationship between mental and physical health up to seven portions a day.

    “other studies have shown a dose–response relationship between mental42 and physical health43 up to seven portions a day.”
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    Study design and conductown data

    The suboptimal participation rate (66.0%) and the percentage of WEMWBS complete responders might reduce the generalisability of our findings to different populations and socioeconomic settings.

    “the suboptimal participation rate (66.0%) and the percentage of WEMWBS complete responders might reduce the generalisability of our findings to different populations and socioeconomic settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    To the best of our knowledge, this is the first comprehensive analysis of health-related behavioural correlates of mental health in a nationally representative sample from the general population.

    “To the best of our knowledge, this is the first comprehensive analysis of health-related behavioural correlates of mental health in a nationally representative sample from the general population”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The effect size of smoking cessation on mental health was as large for those with psychiatric disorders as for those without.

    “The effect size was as large for those with psychiatric disorders as for those without.”
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    • cites [38] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The meta-analysis found that smoking cessation was associated with reduced depression, anxiety and stress, as well as with improved positive mood and quality of life compared with continuing to smoke.

    “Findings showed that smoking cessation was associated with reduced depression, anxiety and stress, as well as with improved positive mood and quality of life compared with continuing to smoke.”
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    • cites [38] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We were only able to examine fruit and vegetable consumption up to five portions a day.

    “We were only able to examine fruit and vegetable consumption up to five portions a day”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Nine different antioxidants found in fruit and vegetables have been shown in another study to be associated with optimism in middle-aged adults.

    “nine different antioxidants found in fruit and vegetables have been shown in another study to be associated with optimism in middle-aged adults.41”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    This is not the first study to draw attention to a relationship between mental health and fruit and vegetable consumption.

    “This is not the first study to draw attention to a relationship between mental health, and fruit and vegetable consumption.39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Rooney, 2013, The potential role of fruit and vegetables in aspects of psychological well-being: a review of the literature and future directions, Proc Nutr Soc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One recent study showed positive affect to be predictable on the basis of the current and previous days' fruit and vegetable consumption.

    “one recent study40 showed positive affect to be predictable on the basis of the current and previous days’ fruit and vegetable consumption”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] White, 2013, Many apples a day keep the blues away—daily experiences of negative and positive affect and food consumption in young adults, Br J Health Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Our finding is in line with a large body of epidemiological and trial evidence on the beneficial role of fruit and vegetable intake in general well-being and prevention of major chronic disease across several populations and age groups.

    “Our finding is, of course, in line with a large body of epidemiological and trial evidence on the beneficial role of fruit and vegetable intake in general well-being and prevention of major chronic disease across several populations and age groups.28–29 44–46”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [28] DoH. 5 A DAY General Information. 2010. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/FiveADay/FiveADaygeneralinformation/DH_4002343 (accessed 1 Oct 2011).

      Not checked in the free run.

    • cites [29] Agriculture USDo, Services USDoHaH. U.S. Department of Agriculture and Dietary Guidelines for Americans. 7th edn. Washington, DC: US Government Printing Office, 2010. http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf (accessed 1 Oct 2011).

      Not checked in the free run.

    • cites [44] Myint, 2007, Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk): a population-based cross-sectional study, Public Health Nutr source

      Not checked in the free run.

    • cites [45] Takaoka, 2013, Fruit and vegetable consumption in adolescence and health in early adulthood: a longitudinal analysis of the statistics Canada's National Population Health Survey, BMC Public Health source

      Not checked in the free run.

    • cites [46] Hartley, 2013, Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases, Cochrane Database Syst Rev

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisenone given

    Consistent associations across all levels of mental health are more suggestive of an underlying causal relationship.

    “Consistent associations across all levels of mental health are more suggestive of an underlying causal relationship.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study allowed for the possibility that associations with low and high mental well-being may not mirror each other.

    “which allowed for the possibility that associations with low and high mental well-being may not mirror each other.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Fruit and vegetable intake is likely to represent an overall marker for healthy lifestyles including physical activity.

    “Fruit and vegetable intake is likely to represent an overall marker for healthy lifestyles including physical activity”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    In studies in which mental health is examined as a continuum, positive findings such as those reported for alcohol intake may reflect strong associations with only one end of the continuum.

    “In studies in which mental health is examined as a continuum, positive findings such as those reported for alcohol intake may reflect strong associations with only one end of the continuum.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The cross-sectional design of the study allowed examination of associations between mental well-being and multiple behaviours but did not allow establishment of causality and temporality of the observed relationships.

    “while the cross-sectional design of the study allowed us to examine the associations between mental well-being and multiple behaviours, it did not allow us to establish the causality and temporality of the observed relationships.”
    Quote in the paperSubstantial claim
54 of 54

  • The paper relies on this without support.

    Epidemiological evidence on the behavioural correlates of mental well-being is sparse.

    “Epidemiological evidence on the behavioural correlates of mental well-being is sparse.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • High-well-being result misstates the intake range

    Minor

    The Results text labels the 0.79 odds ratio as applying to "1 to > 3" portions per day, while Table 3 labels it "1 to <3" portions per day.

  • Unemployed count is incompatible with its percentage

    Minor

    In the low mental well-being group, 1,439 out of 2,252 participants would be 63.9%, not the reported 6.3%.

    Reported 6.3 · recomputed 63.898757

  • Low-well-being result reverses the intake category

    Minor

    The Results text assigns the odds ratio of 1.53 to more than one portion per day, whereas Table 2 assigns that same estimate and confidence interval to fewer than one portion per day.

  • Unadjusted odds ratio lies outside its confidence interval

    Minor

    For fewer than one fruit and vegetable portion per day, the unadjusted odds ratio is reported as 1.29, below its reported 95% CI of 1.94-2.70.

4 of 4

Cites

Flagged first, then by citations

2 of the 44 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Crawford V . Co-existing problems of mental disorder and substance misuse (‘Dual Diagnosis’): a review of relevant literature. Royal College of Psychiatrists’ Research and Training Unit. Final Report to the Department of Health, 2001.
  2. Bianca D . Performance of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) as a screening tool for depression in UK and Italy. http://www2.warwick.ac.uk/fac/med/research/platform/wemwbs/development/papers/donatella_bianco-thesis.pdf

Cited by

Sorted by citations

Related

Authors
Stranges, S., Samaraweera, P. C., Taggart, F., Kandala, N.-B., & Stewart-Brown, S.
Affiliations
University of Warwick (GB)
Corresponding author
Stranges, Saverio
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2014-09
Volume
4
Issue
9
Pages
e005878
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2014-005878
PMC
PMC4170205
OpenAlex
W2099071768
Semantic Scholar
2e70ef6dd2ec163a6da7c91a3a3b8c99c11521d9
Cited by
130
References
44
Citations by year
2026: 2 · 2025: 7 · 2024: 13 · 2023: 11 · 2022: 17 · 2021: 14 · 2020: 22 · 2019: 12 · 2018: 10 · 2017: 10 · 2016: 8 · 2015: 3
FWCI
10.36
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • Northumbria Research Link (Northumbria University) (submittedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
Funders
University College London
Topics
  • Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
  • Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
  • Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
Keywords
psychological well-being, behavioral risk factors, obesity, body mass index, smoking, alcohol consumption, fruit and vegetable intake, former smokers, general population, Warwick-Edinburgh Mental Well-being Scale, Health Survey for England
MeSH terms
Adolescent, Adult, England, Female, Health Surveys, Humans, Male, Mental Health, Middle Aged, Risk Factors, Health Behavior, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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