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A randomised control trial assessing the effect of a Mediterranean diet on the symptoms of depression in young men (the “AMMEND” study): A study protocol
Abstract
Depression affects approximately 350 million people worldwide. Evidence suggests that diet plays an important role with the Mediterranean diet displaying promising preliminary results. Currently, most of the research is conducted on women and older adults however, the majority of mental illnesses occur before the age of 25. Men are less likely to seek help than women with only 13% of young men aged 15-24 seeking help for their mental health. Young men are hugely underrepresented in the current research which poses a significant issue. A 12-week randomised control trial will be conducted to examine the effect of a Mediterranean diet on the symptoms of depression in young men aged 18-25. Participants will be randomised to either follow a Mediterranean diet or receive the inactive control therapy befriending. Participants will attend 3 appointments at baseline, week 6 and week 12. The main outcome will be changes to the Becks depression Inventory score. This research aims to answer the question of whether diet can be used effectively in this population. This will be the first trial to examine the effect of a Mediterranean diet on the symptoms of depression in young men. This trial will help fill a significant research gap, contribute to the growing field of nutritional psychiatry, guide future research and inform advice given by clinicians to this specific demographic.
... This chronic disorder is characterised by mood dysregulation, sad, empty, or irritable emotions, as well as negative self-appraisal and withdrawal/isolating behaviours [3]. Depression is responsible for 50-70% of suicides globally and is the second leading cause of death for [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] year-olds [4]. The average treatment response rate for depression is 20-30% [5], prompting research to consider other modifiable lifestyle factors, such as diet, to address depressive symptoms [6]. ...
... Many observational, longitudinal, and intervention studies exploring diet and depression primarily focus on healthy (Mediterranean, anti-inflammatory) and unhealthy (Western) dietary patterns [6,[17][18][19][20][21][22][23]. Four randomised control trials assessed dietary change from unhealthy (Western) to healthy (Mediterranean) dietary patterns and depression; two assessed the general population [14,18,24] and two assessed young adults [19,20]. ...
... Many observational, longitudinal, and intervention studies exploring diet and depression primarily focus on healthy (Mediterranean, anti-inflammatory) and unhealthy (Western) dietary patterns [6,[17][18][19][20][21][22][23]. Four randomised control trials assessed dietary change from unhealthy (Western) to healthy (Mediterranean) dietary patterns and depression; two assessed the general population [14,18,24] and two assessed young adults [19,20]. All four studies found that the depressive symptoms of the participants significantly improved after the healthy dietary intervention compared with the control group. ...
Dietary patterns and depressive symptoms are associated in cross-sectional and prospective-designed research. However, limited research has considered depression risk related to meat-based and plant-based dietary patterns. This study explores the association between diet quality and depressive symptoms across omnivore, vegan, and vegetarian dietary patterns. A cross-sectional online survey utilised the Dietary Screening Tool (DST) and the Centre for Epidemiological Studies of Depression Scale (CESD-20) to measure diet quality and depressive symptoms, respectively. A total of 496 participants identified as either omnivores (n = 129), vegetarians (n = 151), or vegans (n = 216). ANOVA with Bonferroni post hoc corrections indicates that dietary quality was significantly different between groups F(2, 493) = 23.61, p < 0.001 for omnivores and vegetarians and omnivores and vegans. Diet quality was highest in the vegan sample, followed by vegetarian and omnivore patterns. The results show a significant, moderately negative relationship between higher diet quality and lower depressive symptoms (r = −0.385, p < 0.001) across groups. Hierarchical regression showed that diet quality accounted for 13% of the variability in depressive symptoms for the omnivore sample, 6% for vegetarians, and 8% for vegans. This study suggests that diet quality in a meat-based or plant-based diet could be a modifiable lifestyle factor with the potential to reduce the risk of depressive symptoms. The study indicates a greater protective role of a high-quality plant-based diet and lower depressive symptoms. Further intervention research is needed to understand the bi-directional relationship between diet quality and depressive symptoms across dietary patterns.
... J o u r n a l P r e -p r o o f 6 The AMMEND study was a 12-week randomised control trial of a MD intervention in the treatment of moderate to severe depression. A detailed study protocol has been published previously (21). This research presents the results from the end-of-project evaluation which included an anonymous online survey. ...
... Eligibility criteria included participants who identified as male, were aged 18-25 years of age, with moderate to severe depression, as measured by the twenty-one-item Beck Depression Inventory (BDI-II) score of 20 or above (26). Additionally, participants were required to have a poor baseline diet, measuring as <40/100 on the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Diet Survey (21). The exclusion criteria included the following disorders: bipolar disorder, posttraumatic stress, personality disorders, schizophrenia or a substance abuse disorder. ...
... A detailed description of the data collection tools used in the AMMEND trial can be found in the study protocol (21). Participants who completed the MD intervention arm of the trial were invited to complete an anonymous end-of-project evaluation survey. ...
Background:
Recent research has highlighted the beneficial effects of following a Mediterranean diet (MD) for depression. Unfortunately, adherence to specific diets presents many challenges and while previous research has aimed to understand these challenges, the focus has primarily been on weight-loss interventions in patients with obesity or cardiovascular disease. The aim of this study was to understand the experiences and challenges expressed by young men with clinical depression who completed a 12-week Mediterranean diet intervention.
Methods:
An online questionnaire was used to collect data from 36 young Australian men aged between 18 and 25 with diagnosed depression who participated in the Mediterranean Diet arm of the Mediterranean Diet for Men with Depression (AMMEND) study. Descriptive analyses were undertaken for each variable with results reported as percentages and frequencies.
Results:
Positive aspects highlighted by participants included enjoying the taste of foods, being highly motivated to continue with the diet and a perceived benefit to their depressive symptoms. The main challenges included increased cost and time commitment, and the negative attitudes of their friends and family towards the diet.
Conclusion:
We recommend that the influence of friends and family attitudes towards the diet and the impact this has on following a Mediterranean diet in young men be explored further, as this posed a challenge for many of our participants. These results may assist clinicians when promoting a Mediterranean diet to this specific demographic.
... This was a 12-wk, parallel-group, open label RCT of an MD intervention in the treatment of moderate to severe depression. A detailed study protocol has been published elsewhere (30). The trial was registered with Australia and New Zealand Clinical Trials Registry (trial ID: ACTRN12619001545156) prior to commencing recruitment. ...
... In order to measure compliance and assess diet quality, participants documented all meals and snacks consumed during their time in the study via a widget on their mobile device. A detailed description of each can be found in the study protocol (30). The primary outcome measure was the BDI-II. ...
Background:
Depression is a common mental health condition which affects 1 in 8 males each year, especially young adults. Young adulthood offers an opportunity for early dietary interventions, with research suggesting that a Mediterranean diet (MD) could be beneficial in treating depression.
Objective:
This study aimed to determine if a MD can improve depressive symptoms in young males with clinical depression.
Methods:
A 12-week, parallel-group, open-label, randomized control trial was conducted to assess the effect of a MD intervention in the treatment of moderate to severe depression in young males (18-25 years). Befriending therapy was chosen for the control group. Assessments were taken at baseline, week 6 and week 12. MD adherence was measured with the Mediterranean Adherence Score (MEDAS). The primary outcome measure was the Beck Depression Inventory Scale (BDI-II) and secondary outcome was Quality of Life (QoL).
Results:
A total of 72 participants completed the study. After 12 weeks, the MEDAS scores were significantly higher in the MD group compared to the befriending group (Mean diff: 7.8, 95% CI: 7.23, 8.37, p<0.001). The mean change in BDI-II score was significantly higher in the MD group compared to the befriending group at week 12 (Mean diff: 14.4, 95% CI: 11.41, 17.39, p<0.001). The mean change in QoL score was also significantly higher in the MD group compared to the befriending group at week 12 (Mean diff: 12.7, 95% CI: 7.92, 17.48), p<0.001).
Conclusion:
Our results demonstrate that compared to befriending, a MD intervention leads to significant increases in MEDAS score, decreases in BDI-II score and increases in QoL scores. These results highlight the important role of nutrition for the treatment of depression and should inform advice given by clinicians to this specific demographic population.
... Some biological factors include decreased monoamine function, dysfunctional hypothalamic pituitary adrenal (HPA) axis, neuro-progression/brain plasticity, mitochondrial disturbances (Lopresti et al., 2013;Pereira et al., 2020), cytokine-mediated inflammatory processes, increased oxidative stress, immune responses (Berk et al., 2013), immuno-inflammation, gut dysbiosis and gut/brain relationship (Kaplan et al., 2015;Pereira et al., 2020). While these biological factors play a role in the experience of depressive symptoms, they are also influenced by a diet rich in plant-based foods such as fruit and vegetables (Bayes et al., 2021;Daneshzad et al., 2020;Nguyen et al., 2017;Walsh et al., 2023). ...
Background:
In Australia, women report higher rates of depressive symptoms than men. Research suggests that dietary patterns rich in fresh fruit and vegetables could protect against depressive symptoms. The Australian Dietary Guidelines suggest that consuming two servings of fruit and five serves of vegetables per day is optimal for overall health. However, this consumption level is often difficult for those experiencing depressive symptoms to achieve.
Aims:
This study aims to compare diet quality and depressive symptoms in Australian women over time using (I) two serves of fruit and five serves of vegetables per day (FV7), and (ii) two serves of fruit and three serves of vegetables per day (FV5).
Materials and methods:
A secondary analysis was conducted using data from the Australian Longitudinal Study on Women's Health over 12 years at three time points 2006 (n = 9145, Mean age = 30.6, SD = 1.5), 2015 (n = 7186, Mean age = 39.7, SD = 1.5), and 2018 (n = 7121, Mean age = 42.4, SD = 1.5).
Results:
A linear mixed effects model found, after adjusting for covarying factors, a small significant inverse association between both FV7 (b = -.54, 95% CI = -.78, -.29) and FV5 (b = -.38, 95% CI = -.50, -.26) in depressive symptoms.
Discussion:
These findings suggest an association between fruit and vegetable consumption and decreased depressive symptoms. The small effect sizes indicate caution should be taken in interpreting these results. The findings also suggest that current Australian Dietary Guideline recommendations need not be prescriptive to two fruit and five vegetables for impact on depressive symptoms.
Conclusions:
Future research could evaluate reduced vegetable consumption (three serves per day) in identifying the protective threshold for depressive symptoms.
... Results from a meta-analysis (four cohort studies and two cross-sectional studies) indicated that people in the highest versus those in the lowest category of adherence to this diet had a 31% lower risk of incident depressive outcomes [10]. Randomized controlled trials (RCT) on the effect of the Mediterranean diet on depression symptoms are also being conducted, but no results have been published yet [11]. However, depression and anxiety are also diagnosed among vegetarians and vegans; thus, other factors than diet may play an important role [12]. ...
Due to the lack of studies comparing the determinants of well-being in omnivores and vegetarians, we examined associations of socio-demographic and lifestyle factors, including adherence to a Mediterranean-style diet, in relation to well-being in omnivorous, vegetarian, and vegan women. Well-being was assessed using a validated WHO-5 Well-Being Index. Adherence to the Mediterranean-style diet was determined using a modified Mediterranean diet score. The study was conducted on 636 women (23.9 ± 5.7 years), of whom 47.3% were omnivores, 33.2% vegetarians, and 19.5% vegans. The good well-being group (WHO-5 Index ≥ 13 points) comprised 30.9% of the omnivores, 46.0% of the vegetarians, and 57.3% of the vegans. The remaining participants were classified as belonging to the poor well-being group (<13 points). Compared to the omnivores, the vegetarians and vegans had a 1.6-fold (95% CI: 1.04–2.42) and a 2.4-fold (95% CI: 1.45–3.99) higher probability of having good well-being, respectively. In omnivores, the predictors of good well-being were adherence to the Mediterranean-style diet (a 1-score increment was associated with a 17% higher probability of good well-being, P-trend = 0.016), higher self-perceived health status, and lower levels of stress. In vegetarians and vegans, it was older age, higher physical activity (≥3 h/week), 7–8 h sleep time, and similarly to omnivores’ higher self-perceived health status and lower stress level. Our findings indicate that following a Mediterranean-style diet was associated with better well-being in omnivores. Furthermore, we identified that different determinants were associated with well-being in omnivorous and vegetarian and vegan women.
... Research suggests that high-quality diets rich in nutrient-dense vegetables, fruits, seeds, nuts, whole grains, and legumes [8] and reduced intakes of refined, sugary, and ultraprocessed foods [9] link to reductions in depressive symptoms [10]. Clinical trials demonstrating an inverse relationship between diet quality and symptoms of depression [11][12][13][14] indicate changes from an unhealthy to a healthy dietary pattern could form the basis of successful interventions for the treatment of depression. Systematic reviews and meta-analyses support these clinical findings [10,15,16], but the evidence is uncertain due to a large reliance on observational studies, high levels of unexplained heterogeneity, and risk of bias inherent in nutrition-related research [8,17]. ...
Epidemiological and intervention studies in nutritional psychiatry suggest that the risk of mood disorders is associated with what we eat. However, few studies use a person-centred approach to explore the food and mood relationship. In this qualitative study of 50 Australian participants, we explored individuals' experiences with food and mood as revealed during focus group discussions. Using a thematic template analysis, we identified three themes in the food and mood relationship: (i) social context: familial and cultural influences of food and mood, (ii) social economics: time, finance, and food security, and (iii) food nostalgia: unlocking memories that impact mood. Participants suggested that nutrients, food components or food patterns may not be the only way that food impacts mood. Rather, they described the social context of who, with, and where food is eaten, and that time, finances, and access to healthy fresh foods and bittersweet memories of foods shared with loved ones all impacted their mood. Findings suggest that quantitative studies examining the links between diet and mood should look beyond nutritional factors and give increased attention to the cultural, social, economic, and identity aspects of diet.
... Most of the research on dietary patterns and depression involves observational epidemiological studies that indicate an association between healthy dietary patterns and decreased depressive symptoms (37,38) , while unhealthy dietary patterns high in ultraprocessed, refined and sugary foods are associated with higher symptoms of depression (39,40) . Currently, there are four randomised control trials that have assessed the effect of changing from an unhealthy to a healthy dietary pattern (41)(42)(43)(44) . All four Australian randomised control trials found a significant improvement in depression scores between the intervention and social control groups. ...
Depression is a chronic and complex condition experienced by over 300 million people worldwide. While research on the impact of nutrition on chronic physical illness is well documented, there is growing interest in the role of dietary patterns for those experiencing symptoms of depression. This study aims to examine the association of diet quality (Dietary Questionnaire for Epidemiological Studies version 2) and depressive symptoms (Centre for Epidemiological Studies for Depression short form) of young Australian women over 6 years at two time points, 2003 (n 9081, Mean age = 27·6) and 2009 (n 8199, Mean age = 33·7) using secondary data from the Australian Longitudinal Study on Women’s Health. A linear mixed-effects model found a small and significant inverse association of diet quality on depressive symptoms (β =−0·03, 95 % CI (−0·04, −0·02)) after adjusting for covarying factors such as BMI, social functioning, alcohol and smoking status. These findings suggest that the continuation of a healthy dietary pattern may be protective of depressive symptoms. Caution should be applied in interpreting these findings due to the small effect sizes. More longitudinal studies are needed to assess temporal relationships between dietary quality and depression.
... Nutritional psychiatry is an emerging field in mental health [1]. The importance that nutrition plays in chronic lifestyle diseases such as cardiovascular disease and type 2 diabetes is generally well understood [2,3], and now several clinical trials suggest that whole-of-diet interventions could be beneficial for treating mental health disorders such as depression [4][5][6][7]. Current observational studies also suggest that healthy dietary patterns rich in fresh whole foods could protect against depressive symptoms, and that unhealthy dietary patterns high in ultra-processed and refined foods could contribute to depressive symptoms [8]. ...
Current observational and interventional studies in nutritional psychiatry suggest that healthy dietary patterns rich in fresh whole foods could protect against depressive symptoms, and that unhealthy dietary patterns high in ultra-processed and refined foods could contribute to depressive symptoms. However, no studies have explored detailed subjective accounts behind the food and mood relationship. This study aimed to uncover unknown factors in the human experience with food and mood. Using a phenomenological framework, this focus group study applied thematic template analysis to accounts of over 50 Australians aged between 18 and 72. Three themes were identified from the transcript of the focus groups: (i) reactive and proactive relationships with food, (ii) acknowledgement of individual diversity relating to eating and mental health, and (iii) improving mood by removing food restriction and eating intuitively. The data highlights the complexity of the relationship between food and mood that extends beyond biological mechanisms which could be used to extend current epidemiological and intervention studies in the field of dietary patterns and depression.
... This highlights a research gap with Bayes and colleagues conducting a 12-week RCT, the "AMMEND" study, to examine the effect of a MDP on symptoms of depression in young men aged 18-25 years. The primary outcome is the Becks depression inventory score (17) . The postprandial / acute effects of the MDP on depression, mood and quality of life is largely unknown, however there are several studies in progress including randomised controlled trials, exploring these outcome measures. ...
There is increasing evidence that mental health problems such as schizophrenia, depression and anxiety are linked with poor nutrition. At present, very few psychiatrists provide nutritional advice for their patients, despite such advice complimenting drug and psychological therapies. This edited volume is the first book to provide a comprehensive overview of the relationship between nutrition and mental health, for mental health professionals. Featuring contributions from leading authorities in the field, the book examines the link between diet and the microbiome-gut brain axis and how this correlates with a variety of psychiatric disorders. The book explores how enhancing the beneficial bacteria in the gut, through the use of psychobiotics, prebiotics or dietary change can improve mood and reduce anxiety. The book will appeal to psychiatrists and psychologists, behavioural scientists, neuroscientists and nutritionists.
There is increasing evidence that mental health problems such as schizophrenia, depression and anxiety are linked with poor nutrition. At present, very few psychiatrists provide nutritional advice for their patients, despite such advice complimenting drug and psychological therapies. This edited volume is the first book to provide a comprehensive overview of the relationship between nutrition and mental health, for mental health professionals. Featuring contributions from leading authorities in the field, the book examines the link between diet and the microbiome-gut brain axis and how this correlates with a variety of psychiatric disorders. The book explores how enhancing the beneficial bacteria in the gut, through the use of psychobiotics, prebiotics or dietary change can improve mood and reduce anxiety. The book will appeal to psychiatrists and psychologists, behavioural scientists, neuroscientists and nutritionists.
Purpose of review:
Diet is an essential modulator of the microbiota-gut-brain communication in health and disease. Consequently, diet-induced microbiome states can impact brain health and behaviour. The integration of microbiome into clinical nutrition perspectives of brain health is sparse. This review will thus focus on emerging evidence of microbiome-targeted dietary approaches with the potential to improve brain disorders.
Recent findings:
Research in this field is evolving toward randomized controlled trials using dietary interventions with the potential to modulate pathways of the microbiota-gut-brain-axis. Although most studies included small cohorts, the beneficial effects of Mediterranean-like diets on symptoms of depression or fermented foods on the immune function of healthy individuals shed light on how this research line can grow. With a clinical nutrition lens, we highlight several methodological limitations and knowledge gaps, including the quality of dietary intake information, the design of dietary interventions, and missing behavioural outcomes.
Summary:
Findings in diet-microbiome-brain studies can have groundbreaking implications in clinical nutrition practice and research. Modulating brain processes through diet via the gut microbiota raises numerous possibilities. Novel dietary interventions targeting the microbiota-gut-brain-axis can offer various options to prevent and treat health problems such as mental disorders. Furthermore, knowledge in this field will improve current nutritional guidelines for disease prevention.
Depression is a chronic and complex condition experienced by over 300 million people worldwide. While research on the impact of nutrition on chronic physical illness is well-documented, there is growing interest in the role of dietary patterns for those experiencing symptoms of depression. This study aims to examine the association of diet quality (Dietary Questionnaire for Epidemiological Studies version 2) and depressive symptoms (Centre for Epidemiological Studies for Depression short form) of young Australian women over six years at two time points, 2003 (n = 9,081, Mean age = 27.6) and 2009 (n = 8,199, Mean age = 33.7) using secondary data from the Australian Longitudinal Study on Women’s Health. A linear mixed-effects model found a small and significant inverse association of diet quality on depressive symptoms ( b = -0.03, 95% CI; -0.04, -0.02) after adjusting for covarying factors such as BMI, social functioning, alcohol and smoking status. These findings suggest that the continuation of a healthy dietary pattern may be protective of depressive symptoms. Caution should be applied in interpreting these findings due to the small effect sizes. More longitudinal studies are needed to assess temporal relationships between dietary quality and depression.
Depression is a mood disorder which currently affects 350 million individuals worldwide. Recently, research has suggested a protective role of diet for depression. The Mediterranean-style dietary pattern has been highlighted in several systematic reviews as a promising candidate for reducing depressive symptoms. It has been speculated that this could be due to the high polyphenol content of foods commonly found in the diet. Therefore, the aim of this review was to assess the effects of polyphenols found in a Mediterranean diet on the symptoms of depression. A systematic literature review was conducted of original research which assessed the role of polyphenols on the symptoms of depression in humans. The following databases were searched: PROQUEST, SCOPUS (Elsevier), MEDLINE (EBSCO), CINAHL, and EMBase, up to 18 February, 2019. The inclusion criteria consisted of both observational and experimental research in adults aged 18-80 y that assessed depression scores in relation to polyphenol intake. A total of 37 studies out of 12,084 met the full inclusion criteria. Of these, 17 were experimental studies and 20 were observational studies. Several different polyphenols were assessed including those from tea, coffee, citrus, nuts, soy, grapes, legumes, and spices. Twenty-nine of the studies found a statistically significant effect of polyphenols for depression. This review has found both an association between polyphenol consumption and depression risk, as well as evidence suggesting polyphenols can effectively alleviate depressive symptoms. The review uncovered gaps in the literature regarding the role of polyphenols for depressive symptoms in both young adults and men. This review was registered at www.crd.york.ac.uk/PROSPERO as CRD42019125747. Adv Nutr 2019;00:1-14.
The aim of this study was to examine the validity of the English version of the PREvencion con DIetaMEDiterranea (PREDIMED) 14-item Mediterranean Diet Adherence Screener (MEDAS), a brief questionnaire assessing adherence to the Mediterranean diet (MedDiet), which was used in the PREDIMED trial for assessment and immediate feedback. This instrument (MEDAS) was administered to 96 adults with a high cardiovascular risk (66% women, mean age 68.3 ± 6.0 years), recruited from general practices in Bristol, UK. Participants then completed a 3-day estimated food record, and the MEDAS was administered again one month later. A MedDiet score (range = 0-14) was calculated from the MEDAS' administrations and food record to assess concurrent validity and test-retest reliability. Predictive validity was assessed by examining the association of the MEDAS-derived score with cardiometabolic risk factors and dietary intakes derived from the food records. The MEDAS-derived MedDiet score was higher by 1.47 points compared to food records (5.47 vs.4.00, p < 0.001), correlated moderately with the record-derived score (r = 0.50, p < 0.001; ICC = 0.53, p < 0.001) and there was borderline fair agreement between the two methods (κ = 0.19, 95% CI 0.07-0.31, p = 0.002; 95% limits of agreement -2.2, 5.1). Exact agreement within score categories and gross misclassificationwere 45.8% and 21.9%, respectively. The distribution of dietary intakes, reported on the food records by the MEDAS-derived total MedDiet score, was in the expected direction, but no association was observed with cardiometabolic risk factors. The two administrations of the MEDAS produced similar mean total MedDiet scores (5.5 vs. 5.4, p = 0.706), which were correlated (r and ICC = 0.69, p < 0.001) and agreed fairly (κ = 0.38, 95% CI 0.24-0.52, p < 0.001; 95% limits of agreement -3.1, 3.2). The English version of the MEDAS has acceptable accuracy and reliability for assessing MedDiet adherence among individuals with a high cardiovascular risk, in the UK, and can be used to rank individuals according to MedDiet adherence in research and practice.
Objectives: We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression.
Methods: Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis.
Results: n = 152 eligible adults aged 18–65 were recruited (n = 95 completed 3-month and n = 85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t = 3.95, P < 0.01), consumed more vegetables (t = 3.95, P < 0.01), fruit (t = 2.10, P = 0.04), nuts (t = 2.29, P = 0.02), legumes (t = 2.41, P = 0.02) wholegrains (t = 2.63, P = 0.01), and vegetable diversity (t = 3.27, P < 0.01); less unhealthy snacks (t = −2.10, P = 0.04) and red meat/chicken (t = −2.13, P = 0.04). The MedDiet group had greater reduction in depression (t = −2.24, P = 0.03) and improved mental health QoL scores (t = 2.10, P = 0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r = −0.298, P = 0.01), nuts (r = −0.264, P = 0.01), and vegetable diversity (r = −0.303, P = 0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health.
Discussion: This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression.
Abstract Background The possible therapeutic impact of dietary changes on existing mental illness is largely unknown. Using a randomised controlled trial design, we aimed to investigate the efficacy of a dietary improvement program for the treatment of major depressive episodes. Methods ‘SMILES’ was a 12-week, parallel-group, single blind, randomised controlled trial of an adjunctive dietary intervention in the treatment of moderate to severe depression. The intervention consisted of seven individual nutritional consulting sessions delivered by a clinical dietician. The control condition comprised a social support protocol to the same visit schedule and length. Depression symptomatology was the primary endpoint, assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) at 12 weeks. Secondary outcomes included remission and change of symptoms, mood and anxiety. Analyses utilised a likelihood-based mixed-effects model repeated measures (MMRM) approach. The robustness of estimates was investigated through sensitivity analyses. Results We assessed 166 individuals for eligibility, of whom 67 were enrolled (diet intervention, n = 33; control, n = 34). Of these, 55 were utilising some form of therapy: 21 were using psychotherapy and pharmacotherapy combined; 9 were using exclusively psychotherapy; and 25 were using only pharmacotherapy. There were 31 in the diet support group and 25 in the social support control group who had complete data at 12 weeks. The dietary support group demonstrated significantly greater improvement between baseline and 12 weeks on the MADRS than the social support control group, t(60.7) = 4.38, p
Background:
Vitamin D may decrease depression symptoms through its beneficial effects on neurotransmitters, metabolic profiles, biomarkers of inflammation, and oxidative stress.
Objective:
This study was designed to assess whether vitamin D supplementation can reduce symptoms of depression, metabolic profiles, serum high-sensitivity C-reactive protein (hs-CRP), and biomarkers of oxidative stress in patients with major depressive disorder (MDD).
Methods:
This randomized, double-blind, placebo-controlled clinical trial was performed in 40 patients between 18 and 65 y of age with a diagnosis of MDD based on criteria from the Diagnostic and Statistical Manual of Mental Disorders. Patients were randomly assigned to receive either a single capsule of 50 kIU vitamin D/wk (n = 20) or placebo (n = 20) for 8 wk. Fasting blood samples were taken at baseline and postintervention to quantify relevant variables. The primary [Beck Depression Inventory (BDI), which examines depressive symptoms] and secondary (glucose homeostasis variables, lipid profiles, hs-CRP, and biomarkers of oxidative stress) outcomes were assessed.
Results:
Baseline concentrations of mean serum 25-hydroxyvitamin D were significantly different between the 2 groups (9.2 ± 6.0 and 13.6 ± 7.9 μg/L in the placebo and control groups, respectively, P = 0.02). After 8 wk of intervention, changes in serum 25-hydroxyvitamin D concentrations were significantly greater in the vitamin D group (+20.4 μg/L) than in the placebo group (-0.9 μg/L, P < 0.001). A trend toward a greater decrease in the BDI was observed in the vitamin D group than in the placebo group (-8.0 and -3.3, respectively, P = 0.06). Changes in serum insulin (-3.6 compared with +2.9 μIU/mL, P = 0.02), estimated homeostasis model assessment of insulin resistance (-1.0 compared with +0.6, P = 0.01), estimated homeostasis model assessment of β cell function (-13.9 compared with +10.3, P = 0.03), plasma total antioxidant capacity (+63.1 compared with -23.4 mmol/L, P = 0.04), and glutathione (+170 compared with -213 μmol/L, P = 0.04) in the vitamin D group were significantly different from those in the placebo group.
Conclusion:
Overall, vitamin D supplementation of patients with MDD for 8 wk had beneficial effects on the BDI, indicators of glucose homeostasis, and oxidative stress. This trial was registered at www.irct.ir as IRCT201412065623N29.
Objective
To examine the participant experiences regarding perceived barriers and facilitators which impact on consuming the Mediterranean diet in the East of England.
Design
Qualitative methodology with focus groups.
Setting
A healthy, middle-aged population situated in the East of England.
Intervention
An 8-week Mediterranean dietary intervention trial.
Participants
Eleven participants (including three co-habiting partners) in three focus groups, ranging between 50-65yrs with a mean age of 54.3yrs (±4.0)
Results
Thematic analysis from the focus groups revealed that participants considered that the MD intervention had introduced a better quality of food, widening the food-horizon and allowed them to re-define cultural eating habits. They also reported several physical benefits from adapting to this diet and found the experience as positive. Whilst claiming that the MD was an enjoyable and pleasurable, the participants did express difficulty adapting to the eating pattern, finding difficulty in purchasing food items, an increase in food costs and found work, stress and time pressures undermining adherence.
Conclusion
The participants’ experiences suggested that the MD was an encouraging dietary change with a middle aged non-Mediterranean based population group. Future MD interventions should tailor interventions and support participants closely, particularly with the necessary planning, organisation and purchasing involved with implementing this diet in non-Mediterranean countries. Secondly, researchers should also challenge any erroneous assumptions regarding the consumption of Mediterranean food, which may hinder implementation.
Objectives
To examine the participant experiences regarding perceived barriers and facilitators which impact on consuming the Mediterranean diet in the East of England. DesignQualitative methodology with focus groups. SettingA healthy, middle-aged population situated in the East of England. Intervention: An 8-week Mediterranean dietary intervention trial. ParticipantsEleven participants (including three co-habiting partners) in three focus groups, ranging between 50-65yrs with a mean age of 54.3yrs (±4.0) ResultsThematic analysis from the focus groups revealed that participants considered that the MD intervention had introduced a better quality of food, widening the food-horizon and allowed them to re-define cultural eating habits. They also reported several physical benefits from adapting to this diet and found the experience as positive. Whilst claiming that the MD was an enjoyable and pleasurable, the participants did express difficulty adapting to the eating pattern, finding difficulty in purchasing food items, an increase in food costs and found work, stress and time pressures undermining adherence. Conclusion
The participants’ experiences suggested that the MD was an encouraging dietary change with a middle aged non-Mediterranean based population group. Future MD interventions should tailor interventions and support participants closely, particularly with the necessary planning, organisation and purchasing involved with implementing this diet in non-Mediterranean countries. Secondly, researchers should also challenge any erroneous assumptions regarding the consumption of Mediterranean food, which may hinder implementation.
The Global Burden of Disease Study 2010 (GBD 2010), estimated that a substantial proportion of the world's disease burden came from mental, neurological and substance use disorders. In this paper, we used GBD 2010 data to investigate time, year, region and age specific trends in burden due to mental, neurological and substance use disorders.
For each disorder, prevalence data were assembled from systematic literature reviews. DisMod-MR, a Bayesian meta-regression tool, was used to model prevalence by country, region, age, sex and year. Prevalence data were combined with disability weights derived from survey data to estimate years lived with disability (YLDs). Years lost to premature mortality (YLLs) were estimated by multiplying deaths occurring as a result of a given disorder by the reference standard life expectancy at the age death occurred. Disability-adjusted life years (DALYs) were computed as the sum of YLDs and YLLs.
In 2010, mental, neurological and substance use disorders accounted for 10.4% of global DALYs, 2.3% of global YLLs and, 28.5% of global YLDs, making them the leading cause of YLDs. Mental disorders accounted for the largest proportion of DALYs (56.7%), followed by neurological disorders (28.6%) and substance use disorders (14.7%). DALYs peaked in early adulthood for mental and substance use disorders but were more consistent across age for neurological disorders. Females accounted for more DALYs in all mental and neurological disorders, except for mental disorders occurring in childhood, schizophrenia, substance use disorders, Parkinson's disease and epilepsy where males accounted for more DALYs. Overall DALYs were highest in Eastern Europe/Central Asia and lowest in East Asia/the Pacific.
Mental, neurological and substance use disorders contribute to a significant proportion of disease burden. Health systems can respond by implementing established, cost effective interventions, or by supporting the research necessary to develop better prevention and treatment options.
Objective
Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success.
Design
A systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014.
Results
Of the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47 %) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet.
Conclusions
Although there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.
Depression represents an increasing global health epidemic with profound effects in the workplace. Building a business case via the quantification of potentially avertable costs is essential to convince organizations to address depression at work. Our study objectives were to: (1) demonstrate a process path whereby job strain and bullying are related to productivity loss via their effects on depression; (2) estimate the costs to employers of sickness absence and presenteeism that are associated with depression; (3) investigate the relationship between depression severity and costs; and (4) estimate the contribution of job strain and bullying to depression-related productivity loss. A population-based telephone survey was conducted across two Australian states (N = 2074), with a one-year follow-up (cohort design). Results confirmed job strain and bullying affected productivity via depressive symptoms. Total national annual employer costs for lost productivity due to depression were estimated at $AUD8 billion per annum, most of which was due to mild depression. We calculated a population-attributable risk (PAR) estimate of 8.7% for depression attributable to bullying and job strain, equating to $AUD693 million in preventable lost productivity costs per annum. Findings suggest that even sub-clinical levels of depression represent a significant productivity and economic burden not previously recognized.
Objective:
To review the psychometric properties of the Beck Depression Inventory-II (BDI-II) as a self-report measure of depression in a variety of settings and populations.
Methods:
Relevant studies of the BDI-II were retrieved through a search of electronic databases, a hand search, and contact with authors. Retained studies (k = 118) were allocated into three groups: non-clinical, psychiatric/institutionalized, and medical samples.
Results:
The internal consistency was described as around 0.9 and the retest reliability ranged from 0.73 to 0.96. The correlation between BDI-II and the Beck Depression Inventory (BDI-I) was high and substantial overlap with measures of depression and anxiety was reported. The criterion-based validity showed good sensitivity and specificity for detecting depression in comparison to the adopted gold standard. However, the cutoff score to screen for depression varied according to the type of sample. Factor analysis showed a robust dimension of general depression composed by two constructs: cognitive-affective and somatic-vegetative.
Conclusions:
The BDI-II is a relevant psychometric instrument, showing high reliability, capacity to discriminate between depressed and non-depressed subjects, and improved concurrent, content, and structural validity. Based on available psychometric evidence, the BDI-II can be viewed as a cost-effective questionnaire for measuring the severity of depression, with broad applicability for research and clinical practice worldwide.
To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.
Zinc is an essential micronutrient with diverse biological roles in cell growth, apoptosis and metabolism, and in the regulation of endocrine, immune, and neuronal functions implicated in the pathophysiology of depression. This study sought to quantitatively summarize the clinical data comparing peripheral blood zinc concentrations between depressed and nondepressed subjects.
PubMed, Cumulated Index to Nursing and Allied Health Literature, and PsycINFO were searched for original peer-reviewed studies (to June 2012) measuring zinc concentrations in serum or plasma from depressed subjects (identified by either screening or clinical criteria) and nondepressed control subjects. Mean (±SD) zinc concentrations were extracted, combined quantitatively in random-effects meta-analysis, and summarized as a weighted mean difference (WMD).
Seventeen studies, measuring peripheral blood zinc concentrations in 1643 depressed and 804 control subjects, were included. Zinc concentrations were approximately -1.85 µmol/L lower in depressed subjects than control subjects (95% confidence interval: [CI]: -2.51 to -1.19 µmol/L, Z17 = 5.45, p < .00001). Heterogeneity was detected (χ(2)17 = 142.81, p < .00001, I(2) = 88%) and explored; in studies that quantified depressive symptoms, greater depression severity was associated with greater relative zinc deficiency (B = -1.503, t9 = -2.82, p = .026). Effect sizes were numerically larger in studies of inpatients (WMD -2.543, 95% CI: -3.522 to -1.564, Z9 = 5.09, p < .0001) versus community samples (WMD -.943, 95% CI: -1.563 to -.323, Z7 = 2.98, p = .003) and in studies of higher methodological quality (WMD -2.354, 95% CI: -2.901 to -1.807, Z7 = 8.43, p < .0001).
Depression is associated with a lower concentration of zinc in peripheral blood. The pathophysiological relationships between zinc status and depression, and the potential benefits of zinc supplementation in depressed patients, warrant further investigation.
Recent evidence suggests that diet modifies key biological factors associated with the development of depression; however, associations between diet quality and depression are not fully understood. We performed a systematic review to evaluate existing evidence regarding the association between diet quality and depression.
A computer-aided literature search was conducted using Medline, CINAHL, and PsycINFO, January 1965 to October 2011, and a best-evidence analysis performed.
Twenty-five studies from nine countries met eligibility criteria. Our best-evidence analyses found limited evidence to support an association between traditional diets (Mediterranean or Norwegian diets) and depression. We also observed a conflicting level of evidence for associations between (i) a traditional Japanese diet and depression, (ii) a "healthy" diet and depression, (iii) a Western diet and depression, and (iv) individuals with depression and the likelihood of eating a less healthy diet.
To our knowledge, this is the first review to synthesize and critically analyze evidence regarding diet quality, dietary patterns and depression. Further studies are urgently required to elucidate whether a true causal association exists.
High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol.
This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org).
The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.
Background
Research on the role of diet in the prevention of depression is scarce. Some evidence suggests that depression shares common mechanisms with cardiovascular disease.
Discussion
Before considering the role of diet in the prevention of depression, several points need to be considered. First, in general, evidence has been found for the effects of isolated nutrients or foods, and not for dietary patterns. Second, most previous studies have a cross-sectional design. Third, information is generally collected though questionnaires, increasing the risk of misclassification bias. Fourth, adequate control of confounding factors in observational studies is mandatory.
Summary
Only a few cohort studies have analyzed the relationship between overall dietary patterns, such as the Mediterranean diet, and primary prevention of depression. They have found similar results to those obtained for the role of this dietary pattern in cardiovascular disease. To confirm the findings obtained in these initial cohort studies, we need further observational longitudinal studies with improved methodology, as well as large randomized primary prevention trials, with interventions based on changes in the overall food pattern, that include participants at high risk of mental disorders.
There is increasing evidence that cognitive behavioural therapy (CBT) is efficacious in treating psychosis. However, very little attention has been paid to the nature of the control treatments used in studies of this. Befriending has been used as a control treatment in several randomized control trials (RCTs) of CBT for psychosis as it is simple to learn and administer. The aim of the present study was to examine whether Befriending controlled for important non-specific aspects of therapy when compared to CBT in a RCT for acute first episode psychosis (FEP). These non-specific factors included time in, expectancy created by, and acceptability of therapy. Expectations and enjoyment of therapy were measured by questionnaire. Time in therapy and the number of drop-outs were also recorded. Results showed that Befriending was comparable to CBT on measures of expectancy, enjoyment of therapy and drop-out rate, but significantly different with regard to time in therapy. This suggests that Befriending is a credible and acceptable control therapy for FEP with modification to increase time in therapy sessions. Methodological issues are raised, and suggestions for future research are made regarding control treatments.
In this article, we provide information on patient-reported side effects from a cross-section of real-world patients. Specifically, data on side effects was tabulated for patients taking one of the following selective serotonin reuptake inhibitor antidepressants: citalopram, escitalopram, fluoxetine, paroxetine, and sertraline. Thirty-eight percent of the approximately 700 patients surveyed reported having experienced a side effect as a result of taking a selective serotonin reuptake inhibitor antidepressant; the most common side effects mentioned were sexual functioning, sleepiness, and weight gain. Only 25 percent of the side effects were considered "very bothersome" or "extremely bothersome." Regardless of how bothersome the side effects were, however, only 40 percent of patients mentioned the side effects to their prescribing physicians.
Few studies have investigated the associations of takeaway food consumption with overall diet quality and abdominal obesity. Young adults are high consumers of takeaway food so we aimed to examine these associations in a national study of young Australian adults.
A national sample of 1,277 men and 1,585 women aged 26-36 completed a self-administered questionnaire on demographic and lifestyle factors, a 127 item food frequency questionnaire, usual daily frequency of fruit and vegetable consumption and usual weekly frequency of takeaway food consumption. Dietary intake was compared with the dietary recommendations from the Australian Guide to Healthy Eating. Waist circumference was measured for 1,065 men and 1,129 women. Moderate abdominal obesity was defined as >/= 94 cm for men and >/= 80 cm for women. Prevalence ratios (PR) were calculated using log binomial regression. Takeaway food consumption was dichotomised, with once a week or less as the reference group.
Consumption of takeaway food twice a week or more was reported by more men (37.9%) than women (17.7%, P < 0.001). Compared with those eating takeaway once a week or less, men eating takeaway twice a week or more were significantly more likely to be single, younger, current smokers and spend more time watching TV and sitting, whereas women were more likely to be in the workforce and spend more time watching TV and sitting. Participants eating takeaway food at least twice a week were less likely (P < 0.05) to meet the dietary recommendation for vegetables, fruit, dairy, extra foods, breads and cereals (men only), lean meat and alternatives (women only) and overall met significantly fewer dietary recommendations (P < 0.001). After adjusting for confounding variables (age, leisure time physical activity, TV viewing and employment status), consuming takeaway food twice a week or more was associated with a 31% higher prevalence of moderate abdominal obesity in men (PR: 1.31; 95% CI: 1.07, 1.61) and a 25% higher prevalence in women (PR: 1.25; 95% CI: 1.04, 1.50).
Eating takeaway food twice a week or more was associated with poorer diet quality and a higher prevalence of moderate abdominal obesity in young men and women.
To determine and describe the extent to which European dietary data collected in disparate surveys can be meaningfully compared.
Seven independent population-based surveys from six European countries were initially included. Differences in study designs and methodological approaches were examined. Risk factor data for 31,289 adults aged 40-59 y were harmonized and pooled in a common, centralized database.
Direct comparisons of dietary measures across studies were not deemed appropriate due to methodological heterogeneity. Nonetheless, comparisons of intra-population contrasts by gender across sites were considered valid. Women consumed fruit and vegetables more often than men. Age-standardized gender differences in the prevalence of low fruit and vegetable consumption ranged from 7 to 18% and 5 to 15%, respectively. Data on energy intake showed good agreement across study populations. The proportion of total energy from macronutrients was similar for women and men. Gender differences for relative intakes of saturated fatty acids (percentage energy) were small and only in France were they significant. Dietary fibre density was significantly higher in women than in men. Overall, the participating Southern European populations from Italy and Spain exhibited more healthful food composition patterns.
Contrasts in dietary patterns by gender across populations may provide the basis for health promotion campaigns. The most favourable patterns observed may serve as attainable goals for other populations. An international risk factor surveillance programme based upon locally run, good quality studies has the potential to provide the needed data.
European Community (DG V), project 96CVVF3-446-0; Swiss Federal Office for Education and Science, OFES 96.0089.
Gender differences in health behaviors have been reported in many studies but casual mechanisms have been neglected.
This study examines 4 food choice behaviors in a large sample of young adults from 23 countries and tests 2 possible explanatory mechanisms for the gender differences-women's greater likelihood of dieting and women's greater beliefs in the importance of healthy diets.
Women were more likely than men to report avoiding high-fat foods, eating fruit and fiber, and limiting salt (to a lesser extent) in almost all of the 23 countries. They were also more likely to be dieting and attached greater importance to healthy eating. Dieting status explained around 22% of fiber choices, and 7% of fruit, but none of the gender difference in salt. Health beliefs explained around 40% of the differences in each of the dietary behaviors and together they explained almost 50%. Gender differences in food choices therefore appear to be partly attributable to women's greater weight control involvement and partly to their stronger beliefs in healthy eating.
Further research is needed to understand the additional factors that could promote men's participation in simple healthy eating practices.
Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.
We examined trends in fruit and vegetable consumption in the United States.
A 6-item food frequency questionnaire was used to assess consumption among 434 121 adults in 49 states and the District of Columbia who were sampled in random-digit-dialed telephone surveys administered in 1994, 1996, 1998, and 2000.
Although the geometric mean frequency of fruit and vegetable consumption declined slightly, the proportion of respondents consuming fruits and vegetables 5 or more times per day did not change. With the exception of the group aged 18 to 24 years, which experienced a 3-percentage-point increase, little change was seen among sociodemographic subgroups.
Frequency of fruit and vegetable consumption changed little from 1994 to 2000. If increases are to be achieved, additional efforts and new strategies will be needed.
The present study assessed the psychometric properties of the Brazilian version of the World Health Organization's Quality of Life Instrument--Short Version (WHOQOL BREF) in a sample of 89 adult outpatients with major depression. After analyses, the WHOQOL BREF showed good internal consistency, and was sensitive to improvement after treatment with antidepressants. Convergent validity between the WHOQOL BREF and the Beck Depression Inventory was statistically significant, as well as WHOQOL BREF's ability to discriminate between outpatients on the basis of their level of depression. In conclusion, the WHOQOL BREF seems to be a psychometrically valid and reliable instrument that it is suitable for evaluating the quality of life of Brazilian-speaking depressed outpatients.
Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.
Previous research has reported associations between diet and risk of depression and anxiety; however, this is underexplored in emerging adulthood (EA; 18–29 years). This systematic review examined associations between diet quality and common mental disorders and their related symptomatology in the published EA literature. A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted for articles published between 2009 and 2019. Grading of evidence was performed using an established quality assessment tool for quantitative studies. Sixteen studies were included for review. Findings supported EA as a risk period for both poor mental health and low diet quality. There was moderate support for associations between diet quality and depression, anxiety, positive/negative affect, suicide ideation, and psychological health. Methodological quality overall was weak. EA appears to be a critical period for both diet quality and mental health. Further research is needed to better understand diet and mental health associations among EAs.
Background
Currently 1 million Australians are living with depression each year, with an average of one in eight men experiencing the disorder. Studies have shown that individual nutrients, fruit and vegetable intake, polyphenols and whole dietary patterns can have a positive impact on depressive symptoms. In particular, the Mediterranean diet has shown promising preliminary findings.
Objectives
To assess the diet quality and knowledge of young men in relation to depressive symptoms.
Design
A cross-sectional online survey collected data from 384 young Australian men aged between 18-25 with diagnosed depression. Pearson's chi-square test was used for ordinal categorical variables.
Results
Dietary intake amongst this demographic was poor. Discretionary foods were consumed 2-3 times per week, including pizza (41%), fried potato such as French fries or hash browns (29%) and chocolate (25%). Roughly half of participants (47%) report never consuming wholegrains or legumes and only 9% consume vegetables twice or more per day. Healthy eating is perceived as both time consuming (82%) and expensive (70%). One third (32%) of participants perceive diet to have a big impact and 29% a slight impact on their mental health with only 5% reporting that diet has no impact on their mental health. However, the majority of participants (84%) believe it is ‘important’ or ‘very important’ to eat an overall healthy diet and 77% reported being willing to change their diet if it improved their depression symptoms.
Conclusions
These results highlight the relatively poor diets of this demographic who would greatly benefit from a quality diet such as the Mediterranean diet. The reported willingness to change their diets is encouraging and supports the viability of dietary intervention trials in this demographic. The dietary data presented in this study can be used to develop targeted interventions aimed at improving the diets of depressed young men.
Background:
This study assessed whether a combined intervention of omega-3 polyunsaturated fatty acids (PUFAs) and psychoeducation better improved mild to moderate depression in workers compared to psychoeducation alone.
Methods:
This study was a double-blinded, parallel group, randomized controlled trial that compared the intervention group, receiving omega-3 fatty acids, with a control group, receiving a placebo supplement. Participants receiving omega-3 fatty acids took 15 × 300 mg capsules per day for 12 weeks. The total daily dose of omega-3 PUFAs was 500 mg docosahexaenoic acid and 1000 mg eicosapentaenoic acid (EPA). The Beck Depression Inventory®-II (BDI-II) was used to assess the severity of depression after treatment.
Results:
After 12 weeks of treatment, BDI-II scores were significantly lower in the placebo and omega-3 group, when compared to their respective baseline scores (Placebo: t = - 4.6, p < 0.01; Omega-3: t = - 7.3, p < 0.01). However, after 12 weeks of treatment, we found no significant difference between both groups with respect to changes in the BDI-II scores (0.7; 95% CI, - 0.7 to 2.1; p = 0.30).
Limitations:
This study did not measure blood omega-3 fatty acid concentration and presented a high-dropout rate. Moreover, our results may not be generalizable to other regions.
Conclusions:
The results show that a combination of omega-3 fatty acids and psychoeducation and psychoeducation alone can contribute to an improvement in symptoms in people with mild to moderate depression. However, there is no difference between the interventions in ameliorating symptoms of depression.
Findings from observational studies investigating the association between fruit and vegetable consumption and risk of depression were inconsistent. We conducted a systematic review and meta-analysis to summarise available data on the association between fruit and vegetable intake and depression. A systematic literature search of relevant reports published in Medline/PubMed, ISI (Web of Science), SCOPUS and Google Scholar until Oct 2017 was conducted. Data from 27 publications (sixteen cross-sectional, nine cohort and two case–control studies) on fruit, vegetables and/or total fruit and vegetable consumption in relation to depression were included in the systematic review. A total of eighteen studies that reported relative risks (RR), hazard ratios or OR for the relationship were included in the meta-analysis. The pooled RR for depression in the highest v . the lowest category of fruit intake was 0·83 (95 % CI 0·71, 0·98) in cohort studies and 0·76 (95 % CI 0·63, 0·92) in cross-sectional studies. Consumption of vegetables was also associated with a 14 % lower risk of depression (overall RR=0·86; 95 % CI 0·75, 0·98) in cohort studies and a 25 % lower risk of depression (overall RR=0·75; 95 % CI 0·62, 0·91) in cross-sectional studies. Moreover, an inverse significant association was observed between intake of total fruit and vegetables and risk of depression (overall RR=0·80; 95 % CI 0·65, 0·98) in cross-sectional studies. In a non-linear dose–response association, we failed to find any significant association between fruit or vegetable intake and risk of depression (fruit (cross-sectional studies): Pnon-linearty =0·12; vegetables (cross-sectional studies): Pnon-linearty <0·001; (cohort studies) Pnon-linearty =0·97). Meta-regression of included observational studies revealed an inverse linear association between fruit or vegetable intake and risk of depression, such that every 100-g increased intake of fruit was associated with a 3 % reduced risk of depression in cohort studies (RR=0·97; 95 % CI 0·95, 0·99). With regard to vegetable consumption, every 100-g increase in intake was associated with a 3 % reduced risk of depression in cohort studies (RR=0·97; 95 % CI 0·95, 0·98) and 5 % reduced odds in cross-sectional studies (RR=0·95; 95 % CI 0·91, 0·98). This meta-analysis of observational studies provides further evidence that fruit and vegetable intake was protectively associated with depression. This finding supports the current recommendation of increasing fruit and vegetable intake to improve mental health.
Objective:
Obesity, metabolic syndrome (MetS) and low adherence to Mediterranean diet are frequent in major depression patients and have been separately related with prognosis. The aim of this study is to analyse their predictive power on major depression outcome, at 6 and 12 months.
Methods:
273 Major depressive patients completed the Beck Depression Inventory for depressive symptoms and the 14-item Mediterranean diet adherence score. MetS was diagnosed according to the International Diabetes Federation (IDF).
Results:
At the baseline Mediterranean diet adherence was inversely associated with depressive symptoms (p=0.007). Depression response was more likely in those patients with normal weight (p=0.006) and not MetS (p=0.013) but it was not associated with Mediterranean diet adherence (p=0.625). Those patients with MetS and obesity were less likely to improve symptoms of depression than patients with obesity but not MetS.
Conclusions:
Obesity and MetS, but not low adherence to the Mediterranean diet at baseline, predicted a poor outcome of depression at 12 months. Our study suggests that MetS is the key factor that impacts negatively in depression prognosis, rather than obesity or diet. If this finding is confirmed, clinicians should be aware about MetS diagnosis and treatment in overweight depressed patients, especially if outcome is not being satisfactory enough.
Background:
Folate and vitamin B12 insufficiencies have been associated with increased risk of depression. This systematic review aimed to clarify if, compared with placebo, treatment with folate and/or vitamin B12 reduces depression scale scores, increases remission, and prevents the onset of clinically significant symptoms of depression in people at risk.
Methods:
This systematic review searched the PubMed, PsychInfo, Embase, and Cochrane databases from inception to 6 June 2014, using the following terms and strategy: (vitamin B12 or vitamin B9 or folate or folic acid or cobalamin or cyanocobalamin) and (depression or depressive disorder or depressive symptoms) and (randomized controlled trial or RCT). The electronic search was supplemented by manual search. Two independent reviewers assessed all papers retrieved for eligibility and bias, and extracted crude data. Review Manager 5 was used to manage and analyze the data.
Results:
Two hundred and sixty-nine manuscripts were identified, of which 52 were RCTs and 11 fulfilled criteria for review. We found that the short-term use of vitamins (days to a few weeks) does not contribute to improve depressive symptoms in adults with major depression treated with antidepressants (5 studies, standardized mean difference = −0.12, 95% confidence interval – 95% CI = −0.45, 0.22), but more prolonged consumption (several weeks to years) may decrease the risk of relapse (1 study, odds ratio (OR) = 0.33, 95% CI = 0.12, 0.94) and the onset of clinically significant symptoms in people at risk (2 studies, risk ratio = 0.65, 95% CI = 0.43, 0.98).
Conclusions:
The number of available trials remains small and heterogeneity between studies high. The results of these meta-analyses suggest that treatment with folate and vitamin B12 does not decrease the severity of depressive symptoms over a short period of time, but may be helpful in the long-term management of special populations.
INTRODUCTION: The incidence of depression is increasing worldwide. Much is still unknown about the possible role of magnesium in depression prevention and treatment. Magnesium has an effect on biological and transduction pathways implicated in the pathophysiology of depression. The possible role of magnesium in depression prevention and treatment remains unclear. OBJECTIVES: We systematically reviewed the possible links between magnesium and depression in humans. METHODS: Twenty-one cross-sectional studies, three intervention trials, one prospective study, one case only study, and one case series study were included based on specific selection criteria. RESULTS: A higher intake of dietary magnesium seems to be associated with lower depression symptoms though reverse causality cannot be excluded. The results assessing the association between blood and cerebrospinal fluid magnesium and depression are inconclusive. DISCUSSION: Magnesium seems to be effective in the treatment of depression but data are scarce and incongruous. Disturbance in magnesium metabolism might be related to depression. Oral magnesium supplementation may prevent depression and might be used as an adjunctive therapy. However, more interventional and prospective studies are needed in order to further evaluate the benefits of magnesium intake and supplementation for depression.
This article provides psychometric information on the second edition of the Beck Depression Inventory (BDI–II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996), with respect to internal consistency, factorial validity, and gender differences. Both measures demonstrated high internal reliability in the full student sample. Significant differences between the mean BDI and BDI-II scores necessitated the development of new cutoffs for analogue research on the BDI–II. Results from exploratory and confirmatory factor analyses indicated that a 2-factor solution optimally summarized the data for both versions of the inventory and accounted for a cumulative 41% and 46% of the common variance in BDI and BDI–II responses, respectively. These factor solutions were reliably cross-validated, although the importance of each factor varied by gender. The authors conclude that the BDI–II is a stronger instrument than the BDI in terms of its factor structure. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The aim of the present paper is to study the performance of Beck's Depression Inventory (BDI) as a screening instrument for depressive disorders in a general population sample.
1250 subjects, from 18 to 64 years old, were randomly selected from the Santander (Spain) municipal census. A two-stage method was used: in the first stage, all individuals selected completed the BDI; in the second, 'probable cases' (BDI cut-off>/=13) and a random 5% sample of the total sample with a BDI score less than 13 were interviewed by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), which generates diagnoses of depressive disorders.
Our data confirm the predictive value of the selected cut-off point (12/13): 100% sensitivity, 99% specificity, 0. 72 PPV, 1 NPV, and 98% overall diagnostic value. The area under ROC (AUC) was found to be 0.99. There were no statistical differences in terms of sex or age. We conclude that the BDI is a good instrument for screening depressive disorders in community surveys.
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
The influence of sex on dietary trends, eating habits, and nutrition self-assessment and beliefs of a group of college students at a large Midwestern university was investigated. A questionnaire was completed by 105 male and 181 female undergraduate students. Men had significantly higher (P<0.0001) height, weight, and body mass index values. Significantly higher percentages of women than men had tried a low-fat diet (P=0.0075) and a low-carbohydrate diet (P=0.0285). Significantly lower percentages of women than men had never tried a diet (P=0.0173). Significantly higher percentages of women than men reported gaining nutrition knowledge from family (P=0.0033) and magazines/newspapers (P=0.0345). Significantly higher percentages of women than men agreed that they had too much sugar in their diets (P=0.0157), that it is important to limit carbohydrate consumption (P=0.0077), that it is important to limit the amount of fat consumed to lose weight (P=0.0194), and that they needed to lose weight (P<0.0001). It is important to eat a variety of foods for good health according to 94.4% of subjects. Sex differences existed in these college students with regard to anthropometric measurements, certain choices of diets, some sources of nutrition knowledge, and some nutrition beliefs.
To describe food-preparation behaviors, cooking skills, resources for preparing food, and associations with diet quality among young adults.
Cross-sectional analyses were performed in a sample of young adults who responded to the second wave of a population-based longitudinal study. Measures pertaining to food preparation were self-reported and dietary intake was assessed by a food frequency questionnaire, both by a mailed survey.
Males (n = 764) and females (n = 946) ages 18 to 23 years.
Cross-tabulations and chi2 tests were used to examine associations between food preparation, skills/resources for preparing foods, and characteristics of young adults. Mixed regression models were used to generate expected probabilities of meeting the Healthy People 2010 dietary objectives according to reported behaviors and skills/resources.
Food-preparation behaviors were not performed by the majority of young adults even weekly. Sex (male), race (African American), and living situation (campus housing) were significantly related to less frequent food preparation. Lower perceived adequacy of skills and resources for food preparation was related to reported race (African American or Hispanic) and student status (part-time or not in school). The most common barrier to food preparation was lack of time, reported by 36% of young adults. Young adults who reported frequent food preparation reported less frequent fast-food use and were more likely to meet dietary objectives for fat (P < 0.001), calcium (P < 0.001), fruit (P < 0.001), vegetable (P < 0.001), and whole-grain (P = 0.003) consumption.
To improve dietary intake, interventions among young adults should teach skills for preparing quick and healthful meals.
National Survey of Mental Health and Wellbeing: Summary of Results
Australian Bureau of Statistics (2008) National Survey of Mental
Health and Wellbeing: Summary of Results 2007. Canberra: ABS.
The mental health of Australians 2: report on the
- J Slade
- W Teesson
- P Burgess
Slade J, Teesson W, Burgess P. The mental health of Australians 2: report on the 2007
An Investigation into The Diets and Nutritional Knowledge of
- J Bayes
- J Schloss
- D Sibbritt
Bayes J, Schloss J, Sibbritt D. An Investigation into The Diets and Nutritional Knowledge of
Young Men with Depression (The "MENDDS" survey)
Young Men with Depression (The "MENDDS" survey). Nutrition (Burbank, Los Angeles
County, Calif). 2020:110946.
CSIRO Healthy Diet Score
- G Hendrie
- D Baird
- S Golley
Hendrie G, Baird D, Golley S, et al. (2016) CSIRO Healthy Diet
Score 2016. https://www.totalwellbeingdiet.com/media/2127/
2016-csiro-healthy-diet-score.pdf (accessed September 2016).
Beck Depression Inventory to screen for depression in the general population: a preliminary analysis
Beck Depression Inventory to screen for depression in the general population: a preliminary
analysis. Journal of affective disorders. 2000;57(1-3):261-265.
Validation of the English version of the 14-item
- A Papadaki
- L Johnson
- Z Toumpakari
Papadaki A, Johnson L, Toumpakari Z, et al. Validation of the English version of the 14-item
at 00:34:16, subject to the Cambridge Core terms of use
Accepted manuscript
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https://doi.org/10.1017/S0007114520004699
The association between diet quality, dietary patterns and depression in adults: a systematic review
- Quirk
- Se
- L J Williams
- A Neil