Diet quality, stress and common mental health problems: A cohort study of 121,008 adults

Clin Nutr. 2021 Mar;40(3):901-906. doi: 10.1016/j.clnu.2020.06.016. Epub 2020 Jun 30.


Background & aims: Overall diet quality may partially mediate the detrimental effects of stress and neuroticism on common mental health problems: stressed and/or neurotic individuals may be more prone to unhealthy dietary habits, which in turn may contribute to depression and anxiety. Lifestyle interventions for depressed, anxious or at-risk individuals hinge on this idea, but evidence to support such pathway is missing. Here, we aim to prospectively evaluate the role of overall diet quality in common pathways to developing depression and anxiety.

Methods: At baseline, N = 121,008 individuals from the general population (age 18-93) completed an extensive food frequency questionnaire, based on which overall diet quality was estimated. Participants also reported on two established risk factors for mental health problems, i.e. past-year stress exposure (long-term difficulties, stressful life-events) and four neuroticism traits (anger-hostility, self-consciousness, impulsivity, vulnerability). Depression and anxiety were assessed at baseline and follow-up (n = 65,342, +3.6 years). Overall diet quality was modeled as a mediator in logistic regression models predicting the development of depression and anxiety from common risk factors.

Results: High stress and high neuroticism scores were - albeit weakly - associated with poorer diet quality. Poor diet quality, in turn, did not predict mental health problems. Overall diet quality did not mediate the relationship between stress/neuroticism and common mental health problems: effects of stress, neuroticism and stress-by-neuroticism interactions on mental health problems at follow-up consisted entirely of direct effects (98.6%-100%).

Conclusions: Diet quality plays no mediating role in two established pathways to common mental health problems. As overall diet quality was reduced in stressed and neurotic individuals, these groups may benefit from dietary interventions. However, such interventions are unlikely to prevent the onset or recurrence of depression and anxiety.

Keywords: Depression; Overall diet quality; Prevention; Prospective cohort study; Public health; Stress.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety / etiology*
  • Depression / etiology*
  • Diet Surveys
  • Diet, Healthy / psychology*
  • Feeding Behavior / psychology*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mental Disorders / etiology*
  • Middle Aged
  • Neuroticism
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Risk Factors
  • Young Adult