Hostname: page-component-669899f699-b58lm Total loading time: 0 Render date: 2025-04-27T20:46:40.790Z Has data issue: false hasContentIssue false
  • English
  • Français

The relationship between anxiety and diet quality in adolescent populations: a cross-sectional analysis

Published online by Cambridge University Press:  28 October 2024

Susan C. Campisi Open the ORCID record for Susan C. Campisi [Opens in a new window] ,
Katarina A. Savel  and
Daphne J. Korczak Open the ORCID record for Daphne J. Korczak [Opens in a new window]
Susan C. Campisi
Affiliation:
Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Canada Nutrition and Dietetics Program, Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
Katarina A. Savel
Affiliation:
Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Canada
Daphne J. Korczak*
Affiliation:
Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Canada Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
*
*Corresponding author: Daphne J. Korczak, email [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Globally, more than 13 % of adolescents have clinically significant mental health problems, with anxiety and depression comprising over 40 % of cases. Despite the high prevalence of anxiety disorders among youth, dietary research has been focused on youth with depression, resulting in a significant knowledge gap regarding the impact of anxiety on adolescent diet quality. Adolescents with diagnosed anxiety disorders and healthy controls were included in this study. Anxiety symptoms were measured using the Screen for Child Anxiety-Related Disorders. Diagnosis of anxiety disorder was determined using the Kiddie Schedule for Affective Disorders and Schizophrenia interview. Five diet quality indices were scored from FFQ. Diet quality indices associated with anxiety symptoms in the correlation matrix were interrogated using multiple linear regression modelling. All models were adjusted for depression. One hundred and twenty-eight adolescents (mean age 14·8 years (sd: 2·1); 66·4 % female) were included in this cross-sectional analysis. Although healthy controls and outpatient participants had similar unhealthy dietary index subscale scores, outpatient participants had lower healthy index scores. Higher anxiety symptoms were associated with lower healthy dietary indices in univariate analysis; after adjusting for comorbid depression; however, anxiety symptoms were no longer associated with dietary indices following adjustment for multiple testing (P = 0·038 to P = 0·077). The association between anxiety symptoms and a poor diet is attenuated by depression. The results of this study support the need for an integrated approach to the assessment of mental and physical well-being and further research aimed at understanding the unique contribution of depression to healthy dietary patterns.

Keywords

AdolescentsDiet qualityAnxietyDepression
Type
Research Article
Information
British Journal of Nutrition , First View , pp. 1 - 9
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

†

These authors equally contributed to this work

References

Keeley, B (2021) The State of the World’s Children 2021: On My Mind--Promoting, Protecting and Caring for Children’s Mental Health. New York, NY: United Nations Children’s Fund (UNICEF); 2021-Oct. Report No.: 9280652850.Google Scholar
Liu, J, Chen, X & Lewis, G (2011) Childhood internalizing behaviour: analysis and implications. J Psychiatr Mental Health Nursing 18, 884–894.CrossRefGoogle ScholarPubMed
Walter, HJ, Abright, AR, Bukstein, OG, et al. (2023) Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders. J Am Acad Child Adolesc Psychiatry 62, 479–502.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Clarke, GN, Seeley, JR, et al. (1994) Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry 33, 809–818.CrossRefGoogle ScholarPubMed
Korczak, DJ, Perruzza, S, Chandrapalan, M, et al. (2022) The association of diet and depression: an analysis of dietary measures in depressed, non-depressed, and healthy youth. Nutr Neurosci 25, 1948–1955.CrossRefGoogle ScholarPubMed
Wang, Y, Liu, J, Compher, C, et al. (2022) Associations between dietary intake, diet quality and depressive symptoms in youth: a systematic review of observational studies. Health Promot Perspect 12, 249.CrossRefGoogle ScholarPubMed
McMartin, SE, Kuhle, S, Colman, I, et al. (2012) Diet quality and mental health in subsequent years among Canadian youth. Public Health Nutr 15, 2253–2258.CrossRefGoogle ScholarPubMed
Francis, HM, Stevenson, RJ, Chambers, JR, et al. (2019) A brief diet intervention can reduce symptoms of depression in young adults–a randomised controlled trial. PLoS One 14, e0222768.CrossRefGoogle ScholarPubMed
Al-Asadi, AM, Klein, B & Meyer, D (2015) Multiple comorbidities of 21 psychological disorders and relationships with psychosocial variables: a study of the online assessment and diagnostic system within a web-based population. J Med Internet Res 17, e55.CrossRefGoogle ScholarPubMed
Konac, D, Young, KS, Lau, J, et al. (2021) Comorbidity between depression and anxiety in adolescents: bridge symptoms and relevance of risk and protective factors. J Psychopathol Behav Assessment 43, 583–596.CrossRefGoogle ScholarPubMed
Kovacs, M, Gatsonis, C, Paulauskas, SL, et al. (1989) Depressive disorders in childhood. IV. A longitudinal study of comorbidity with and risk for anxiety disorders. Arch Gen Psychiatry 46, 776–782.Google Scholar
Angold, A & Costello, EJ (1993) Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues. Am J Psychiatry 150, 1779–1791.Google ScholarPubMed
Aucoin, M, LaChance, L, Naidoo, U, et al. (2021) Diet and anxiety: a scoping review. Nutrients 13, 4418.CrossRefGoogle ScholarPubMed
Pickering, C, Alsio, J, Hulting, AL, et al. (2009) Withdrawal from free-choice high-fat high-sugar diet induces craving only in obesity-prone animals. Psychopharmacology (Berl) 204, 431–443.CrossRefGoogle ScholarPubMed
Dallman, MF, Pecoraro, N, Akana, SF, et al. (2003) Chronic stress and obesity: a new view of ‘comfort food’. Proc Natl Acad Sci 100, 11696–11701.CrossRefGoogle Scholar
O’neil, A, Quirk, SE, Housden, S, et al. (2014) Relationship between diet and mental health in children and adolescents: a systematic review. Am J Public Health 104, e31–e42.CrossRefGoogle ScholarPubMed
Murphy, M & Mercer, JG (2013) Diet-regulated anxiety. Int J Endocrinol 2013, 701967.CrossRefGoogle ScholarPubMed
Scott, KM (2014) Depression, anxiety and incident cardiometabolic diseases. Curr Opin Psychiatry 27, 289–293.CrossRefGoogle ScholarPubMed
Shrestha, R & Copenhaver, M (2015) Long-term effects of childhood risk factors on cardiovascular health during adulthood. Clin Med Rev Vascular Health 7, 1–5.Google ScholarPubMed
Brady, EU & Kendall, PC (1992) Comorbidity of anxiety and depression in children and adolescents. Psychol Bull 111, 244.CrossRefGoogle ScholarPubMed
Axelson, DA & Birmaher, B (2001) Relation between anxiety and depressive disorders in childhood and adolescence. Depression Anxiety 14, 67–78.CrossRefGoogle ScholarPubMed
Kalin, NH (2020) The critical relationship between anxiety and depression. Am Psychiatric Assoc 117, 365–367.CrossRefGoogle Scholar
Firth, J, Solmi, M, Wootton, RE, et al. (2020) A meta-review of ‘lifestyle psychiatry’: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry 19, 360–380.CrossRefGoogle ScholarPubMed
Rao, S, Shah, N, Jawed, N, et al. (2015) Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: results from the National Survey of 4583 individuals. BMC Public Health 15, 1–9.CrossRefGoogle ScholarPubMed
Weng, T-T, Hao, J-H, Qian, Q-W, et al. (2012) Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents? Public Health Nutr 15, 673–682.CrossRefGoogle ScholarPubMed
Tehrani, AN, Salehpour, A, Beyzai, B, et al. (2018) Adherence to Mediterranean dietary pattern and depression, anxiety and stress among high-school female adolescents. Mediterr J Nutr Metab 11, 73–83.CrossRefGoogle Scholar
Vajdi, M & Farhangi, MA (2020) A systematic review of the association between dietary patterns and health-related quality of life. Health Qual Life Outcomes 18, 337.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, et al. (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42, 377–381.CrossRefGoogle ScholarPubMed
Kaufman, J, Birmaher, B, Brent, D, et al. (1997) Schedule for affective disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36, 980–988.CrossRefGoogle ScholarPubMed
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.Google Scholar
Bernaras, E, Jaureguizar, J & Garaigordobil, M (2019) Child and adolescent depression: a review of theories, evaluation instruments, prevention programs, and treatments. Front Psychol 10, 543.CrossRefGoogle ScholarPubMed
Birmaher, B, Khetarpal, S, Brent, D, et al. (1997) The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36, 545–553.CrossRefGoogle ScholarPubMed
Runyon, K, Chesnut, SR & Burley, H (2018) Screening for childhood anxiety: a meta-analysis of the screen for child anxiety related emotional disorders. J Affect Disord 240, 220–229.CrossRefGoogle ScholarPubMed
Birmaher, B, Brent, DA, Chiappetta, L, et al. (1999) Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 38, 1230–1236.CrossRefGoogle ScholarPubMed
Fendrich, M, Weissman, MM & Warner, V (1990) Screening for depressive disorder in children and adolescents: validating the center for epidemiologic studies depression scale for children. Am J Epidemiol 131, 14.CrossRefGoogle Scholar
Heart Niagra Inc (2008) Healthy Heart Schools ‘Program: Identifying and Managing Adolescent Cardiovascular Disease Risk. Niagara Falls, ON: Heart Niagara Inc.Google Scholar
Dalwood, P, Marshall, S, Burrows, TL, et al. (2020) Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review. Nutr J 19, 1–43.CrossRefGoogle ScholarPubMed
Jacka, FN, Kremer, PJ, Leslie, ER, et al. (2010) Associations between diet quality and depressed mood in adolescents: results from the Australian Healthy Neighbourhoods Study. Aust NZ J Psychiatry 44, 435–442.CrossRefGoogle ScholarPubMed
Yannakoulia, M, Lykou, A, Kastorini, CM, et al. (2016) Socio-economic and lifestyle parameters associated with diet quality of children and adolescents using classification and regression tree analysis: the DIATROFI study. Public Health Nutr 19, 339–347.CrossRefGoogle ScholarPubMed
Wardle, J, Jarvis, MJ, Steggles, N, et al. (2003) Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS). Prev Med 36, 721–730.CrossRefGoogle ScholarPubMed
Feskanich, D, Rockett, HRH & Colditz, GA (2004) Modifying the healthy eating index to assess diet quality in children and adolescents. J Am Dietetic Assoc 104, 1375–1383.CrossRefGoogle ScholarPubMed
Burke, NL & Storch, EA (2015) A meta-analysis of weight status and anxiety in children and adolescents. J Dev Behav Pediatr 36, 133–145.CrossRefGoogle ScholarPubMed
Khalid, S, Williams, CM & Reynolds, SA (2016) Is there an association between diet and depression in children and adolescents? A systematic review. Br J Nutr 116, 2097–2108.CrossRefGoogle ScholarPubMed
McLaughlin, KA, Costello, EJ, Leblanc, W, et al. (2012) Socioeconomic status and adolescent mental disorders. Am J Public Health 102, 1742–1750.CrossRefGoogle ScholarPubMed
McLean, CP, Asnaani, A, Litz, BT, et al. (2011) Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatric Res 45, 1027–1035.CrossRefGoogle ScholarPubMed
McMakin, DL & Alfano, CA (2015) Sleep and anxiety in late childhood and early adolescence. Curr Opin Psychiatry 28, 483–489.CrossRefGoogle ScholarPubMed
Biddle, SJH, Ciaccioni, S, Thomas, G, et al. (2019) Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality. Psychol Sport Exerc 42, 146–155.CrossRefGoogle Scholar
Carter, T, Pascoe, M, Bastounis, A, et al. (2021) The effect of physical activity on anxiety in children and young people: a systematic review and meta-analysis. J Affect Disord 285, 10–21.CrossRefGoogle Scholar
de Onis, M, Onyango, AW, Borghi, E, et al. (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85, 660–667.CrossRefGoogle ScholarPubMed
Schober, P, Boer, C & Schwarte, LA (2018) Correlation coefficients: appropriate use and interpretation. Anesthesia Analgesia 126, 1763–1768.CrossRefGoogle ScholarPubMed
Wansink, B, Cheney, MM & Chan, N (2003) Exploring comfort food preferences across age and gender. Physiol Behav 79, 739–747.CrossRefGoogle ScholarPubMed
Nguyen-Rodriguez, ST, Chou, C-P, Unger, JB, et al. (2008) BMI as a moderator of perceived stress and emotional eating in adolescents. Eating Behav 9, 238–246.CrossRefGoogle ScholarPubMed
DeJesus, RS, Breitkopf, CR, Ebbert, JO, et al. (2016) Associations between anxiety disorder diagnoses and Body Mass Index differ by age, sex and race: a population based study. Clin Pract Epidemiol Ment Health 12, 67–74.CrossRefGoogle ScholarPubMed
Armstrong, RA (2014) When to use the Bonferroni correction. Ophthalmic Physiol Optics: J Br Coll Ophthalmic Opticians (Optometrists) 34, 502–508.CrossRefGoogle Scholar
Team, RC (2020) R: A Language and Environment for Statistical Computing, 3.6.3 ed. Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Gibson-Smith, D, Bot, M, Brouwer, IA, et al. (2018) Diet quality in persons with and without depressive and anxiety disorders. J Psychiatric Res 106, 1–7.CrossRefGoogle ScholarPubMed
Goldstein, BI & Korczak, DJ (2020) Links between child and adolescent psychiatric disorders and cardiovascular risk. Can J Cardiol 36, 1394–1405.CrossRefGoogle ScholarPubMed
Rofey, DL, Kolko, RP, Iosif, A-M, et al. (2009) A longitudinal study of childhood depression and anxiety in relation to weight gain. Child Psychiatry Hum Dev 40, 517–526.CrossRefGoogle ScholarPubMed
Pandita, A, Sharma, D, Pandita, D, et al. (2016) Childhood obesity: prevention is better than cure. Diabetes, Metab Syndrome Obes: Targets Therapy 9, 83–89.CrossRefGoogle ScholarPubMed
Campisi, SC, Cost, KT & Korczak, DJ (2022) Food intake reporting bias among adolescents with depression. Eur J Clin Nutr 76, 904–906.CrossRefGoogle ScholarPubMed
Supplementary material: File

Campisi et al. supplementary material

Campisi et al. supplementary material
Download Campisi et al. supplementary material(File)
File 31.6 KB