Association between adherence to a healthy lifestyle and firefighters’ depression and posttraumatic stress disorder in Taiwan: A longitudinal, prospective cohort study

Objective To investigate how an integrated healthy lifestyle can affect firefighters' mental health. Methods We prospectively followed a firefighter cohort in Taiwan from 2023 to 2024. We surveyed participants' adherence to a healthy lifestyle at baseline using a validated modified Mediterranean lifestyle score (MEDI-Lifestyle score, range: 0–7, encompassing non-obesity, no smoking, sufficient sleep and naps, adequate physical activity, reduced sedentary time, and quality diet). Mental health was repeatedly measured using the revised Beck Depression Inventory for Primary Care (BDI-PC, range: 0–18), Patient Health Questionnaire (PHQ-8, range: 0–24), and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5, range: 0–76). We built mixed-effects models to investigate the longitudinal associations. Results Among the 349 firefighters that participated in both years' surveys (retention rate: 71 %), a 1-point increment in the baseline modified MEDI-Lifestyle score was correlated with average score changes of −0.41 (95 % confidence interval [CI]: −0.64, −0.18), −0.55 (95 % CI: −0.85, −0.25), and − 1.47 (95 % CI: −2.42, −0.52) on the BDI-PC, PHQ-8, and PCL-5 after model adjustment, respectively, during the follow-up period. Regarding individual lifestyle behaviors, sufficient sleep and napping played key roles in the associations. Conclusions A healthier lifestyle is significantly correlated with more favorable mental health scores among Taiwanese firefighters.