The Relationship between Breakfast Frequency, Mental Health, and School Performance Among a Nationally Representative Sample of High School Students in the United States

Background and Purpose: Adequate food consumption and mental health are important aspects of adolescent well-being. According to family systems theory, stable family rituals/routines (such as regular meals, including breakfast) can impact mental health and academic performance. Additionally, consuming adequate amounts of nutritious food is essential for physical and psychophysiological development. The positive relationship between school performance and breakfast frequency, as well as school performance and mental health, have been independently established. However, there is a dearth of literature testing how these factors impact school performance in a single model. The present study tested the relationship between breakfast frequency and school performance mediated by depression symptomatology, with potential group differences by demographics.

Methods: Structural equation modeling was conducted using the 2019 Youth Risk Behavior Surveillance System: a nationally representative multistage cluster sample of 9^th-12^th graders in the United States (N=13,677). Breakfast frequency was measured by the number of days respondents ate breakfast in the past week (0-7). Depression symptomatology was operationalized as a latent variable including debilitating sadness, thoughts of suicide, suicide plans, and suicide attempts in the past year. School performance was operationalized as grade point averages (GPA, 0-4). The full model controlled for age, gender, race/ethnicity, and body mass index (BMI). Analyses were conducted on StataSE 17 and Mplus8. Weighted least square mean variance estimation was used to account for the mix of continuous, ordinal, and nominal variables in the model. Global and focused fit indices assessed model fit.

Results: Most students were male (51%), White (51%), Mixed-race (21%) or Black (12%). The average student was 16 years old (SD=1.25) with BMI at the 64th percentile (SD=28.99), and 3.1 GPAs (SD=.91). On average, students ate breakfast on four out of seven days (SD=2.67) and experienced some depressive symptoms (37% had debilitating sadness, 19% had thoughts of suicide, 16% had suicide plans, and 9% attempted suicide in the past year). The hypothesized model was compared among groups. Higher breakfast frequency positively predicted school performance for American Indian/Alaska Native (AI/AN; .10 ± .10; CR=1.99, p <.05) and Black students (.04 ± .03, CR=3.08, p<.05). Higher breakfast frequency also predicted fewer depressive symptoms among AI/AN students (-.13 ± .11; CR=-2.26, p<.05). The mediational effect where breakfast consumption predicted school performance through depressive symptoms was statistically significant only for Asian (.01 ± .01; CR=3.54, p<.05) and Hispanic students (.01 ± .01; CR=2.60, p<.05).

Conclusions and Implications: Understanding the relationship between breakfast consumption, depressive symptoms, and school performance is important as it builds on current literature to describe complex mechanisms that influence adolescent well-being. Group differences are also critical in highlighting the importance of maintaining school breakfast programs, which may foster positive mental health and academic performance, particularly for racial/ethnic adolescents. Efficacious implementation is especially important for schools that serve diverse populations as prior studies indicate racial/ethnic disparities where families of color experience more barriers to accessing school breakfast programs. Future studies also need to include other variables known to impact food consumption, mental health, and academic performance such as poverty and food insecurity.