Beyond the ‘Big Three’: Prospective Associations Between Cumulative Lifestyle Protective Factors and Subsequent Adolescent Wellbeing

Abstract

ABSTRACT Introduction Lifestyle factors are increasingly recognized as important correlates of adolescent mental health and wellbeing. However, existing research has largely focused on sleep, nutrition, and physical activity in isolation, with less attention to cumulative multidomain lifestyle protective factors and their prospective associations with subsequent wellbeing beyond prior mental health. Methods Data were drawn from 163 adolescents (55.2% female; aged 12–17 years) participating in the Australian Longitudinal Adolescent Brain Study between 2018 and 2025. Lagged generalized estimating equation models examined associations between cumulative lifestyle protective factors and wellbeing at the subsequent assessment after adjustment for prior wellbeing, age, and sex. Two lifestyle protective factor indices were examined: a Base Index comprising nutrition, sleep, and physical activity, and an Extended Index additionally incorporating mindfulness and social connectedness. Outcomes were positive wellbeing measured using the COMPAS‐W and low psychological distress measured using the Kessler Psychological Distress Scale (K10). Results Lifestyle protective factors commonly co‐occurred across behavioral and psychosocial domains. Higher scores on both the Base and Extended lifestyle protective factor indices were associated with greater odds of subsequent positive wellbeing and low psychological distress after adjustment for prior wellbeing, age, and sex. Conclusions Cumulative lifestyle protective factors were prospectively associated with subsequent adolescent wellbeing after accounting for prior levels of wellbeing, highlighting multidomain lifestyle protection as a potentially important contributor to mental health across adolescence.