Dietary patterns and depression: are there associations in the Russian population? Results of the ESSE-RF epidemiological study

Aim. To study the associations between depression and dietary pat­terns, including alcohol consumption, in the Russian population.

Material and methods. Representative samples of men and women aged 25-64 (n=22217, 8519 men, 13698 women) from 13 Russian regions were surveyed. The response rate was approximately 80%. Dietary patterns were assessed based on the consumption rate of key food groups. Depression was assessed using the Hospital Anxiety and Depression Scale (HADS), with the following criteria: 0-7 — no depression, 8-10 — subclinical depression, and ≥11 — clinical depression. Results are presented as percentages, odds ratios (OR), and 95% confidence intervals (CI).

Results. Depression in both men and women reduces the consumption of natural foods. Men and women, regardless of depression severity, reduce their consumption of dairy products, as well as vegetables and fruits (p<0,05). Men and women with clinically significant depression reduce their red meat consumption (OR 0,78, CI: [0,63-0,97] (p=0,0283) and OR 0,76, CI: [0,65-0,88] (p=0,0004), respectively). Wo­men with clinically significant depression consume sweets less often in their diet than healthy women (OR 0,84, CI: [0,73-0,97] (p=0,018)). Excessive salt intake is more common in the diet of individuals with depression than in healthy ones. A higher frequency of adding extra salt to food was observed in men (OR 1,35, CI: [1,16-1,57] (p<0,001) and OR 1,28, CI: [1,03-1,6] (p=0,027)) and women (OR 1,36, CI: [1,22-1,52] (p<0,0001) and OR 1,47, CI: [1,27-1,7] (p<0,001)) with subclinical and clinical depression, respectively. Among individuals with subclinical depression, an increase in the consumption of processed foods (pickles in men and meat and sausage products in women) was noted (p<0,05). As depression worsened in individuals of both sexes, alcohol consumption decreased both in frequency and quantity.

Conclusion. The dietary patterns of individuals with depression significantly differ from those of healthy individuals. Individuals with depression are less likely to include animal products (red meat, fish, poultry, dairy products), vegetables/fruits, and sweets in their daily diet, but are more likely to consume processed foods high in salt and calories.

1. Akbaraly TN, Sabia S, Shipley MJ, et al. Adherence to healthy dietary guidelines and future depressive symptoms: evidence for sex differentials in the Whitehall II study. Am J Clin Nutr. 2013;97(2):419-27. doi:10.3945/ajcn.112.041582.

2. Li Y, Lv MR, Wei YJ, et al. Dietary patterns and depression risk: A meta-analysis. Psychiatry Res. 2017;253:373-82. doi:10.1016/j.psychres.2017.04.020.

3. Nicolaou M, Colpo M, Vermeulen E, et al. Association of a priori dietary patterns with depressive symptoms: a harmonised meta-analysis of observational studies. Psychol Med. 2020;50(11): 1872-83. doi:10.1017/S0033291719001958.

4. O'Neill S, Minehan M, Knight-Agarwal CR, et al. Depression, Is It Treatable in Adults Utilising Dietary Interventions? A Systematic Review of Randomised Controlled Trials. Nutrients. 2022;27;14(7):1398. doi:10.3390/nu14071398.

5. Lassale C, Batty GD, Baghdadli A, et al. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry. 2019; 24(7):965-86. doi:10.1038/s41380-018-0237-8.

6. Elstgeest LEM, Visser M, Penninx BWJH, et al. Bidirectional associations between food groups and depressive symp­toms: longitudinal findings from the Invecchiare in Chianti (InCHIANTI) study. Br J Nutr. 2019;121(4):439-50. doi:10.1017/S0007114518003203.

7. Matsuoka YJ, Sawada N, Mimura M, et al. Dietary fish, n-3 polyunsaturated fatty acid consumption, and depression risk in Japan: a population-based prospective cohort study. Transl Psychiatry. 2017;26;7(9):e1242. doi:10.1038/tp.2017.206.

8. Andreu-Reinón ME, Chirlaque MD, Gavrila D, et al. Mediterranean Diet and Risk of Dementia and Alzheimer's Disease in the EPIC-Spain Dementia Cohort Study. Nutrients. 2021;22;13(2):700. doi:10.3390/nu13020700.

9. Mikolajczyk RT, El Ansari W, Maxwell AE. Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutr J. 2009;15; 8:31. doi:10.1186/1475-2891-8-31.

10. Rius-Ottenheim N, Kromhout D, Sijtsma FPC, et al. Dietary patterns and mental health after myocardial infarction. PLoS One. 2017;12(10):e0186368. doi:10.1371/journal.pone.0186368.

11. Gibson-Smith D, Bot M, Brouwer IA, et al. Association of food groups with depression and anxiety disorders. Eur J Nutr. 2020;59(2):767-78. doi:10.1007/s00394-019-01943-4.

12. Parletta N, Zarnowiecki D, Cho J, et al. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutr Neurosci. 2019;22(7):474-87. doi:10.1080/1028415X.2017.1411320.

13. Jacka FN, O'Neil A, Opie R, et al. A randomised controlled trial of dietary improvement for adults with major depression (the "SMILES" trial). BMC Med. 2017;15(1):23. doi:10.1186/s12916-017-0791-y.

14. Molendijk M, Molero P, Ortuño Sánchez-Pedreño F, et al. Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. J Affect Disord. 2018;(226):346-54. doi:10.1016/j.jad.2017.09.022.

15. Boytsov SA, Chazov EI, Shlyakhto EV, et al. The Scientific Organizing Committee of the ESSE-RF project. Epidemiology of cardiovascular diseases in different regions of Russia (ESSE-RF). The rationale for and design of the study. Profilakticheskaya meditsina [Russian Journal of Preventive Medicine]. 2013; 16(6):25-34. (In Russ.)

16. Karamnova NS, Maksimov SA, Shalnova SA, et al. Car­dio­protective diet: prevalence, associations and prevention reser­ves. Russian Journal of Cardiology. 2020;25(6):3769. (In Russ.) doi:10.15829/1560-4071-2020-3769.

17. Peltonen M, Laatikainen T, Borodulin K, et al. Prevalence of ideal cardiovascular health in an adult Finnish population: the national FINRISK 2007 study. Int Heart Vasc Dis J. 2014;2(3):3-14.

18. Shalnova SA, Evstifeeva SE, Deev AD, et al. The prevalence of anxiety and depression in different regions of the Russian Federation and its association with sociodemographic factors (according to the data of the ESSE-RF study). Therapeutic Archive. 2014;86(12):53-60. (In Russ.) doi:10.17116/terarkh2014861253-60.

19. Evstifeeva SE, Shalnova SA, Kutsenko VA, et al. Anxiety and depression: ten-year changes of prevalence and its association with demographic and socio-economic characteristics according to the ESSE-RF study. Cardiovascular Therapy and Prevention. 2023;22(8S):3796. (In Russ.) doi:10.15829/1728-8800-2023-3796.

20. Karamnova NS, Shalnova SA, Tarasov VI, et al. On behalf of the participants of the ESSE-RF study. Gender differences in the nutritional pattern of the adult population of the Russian Federation. The results of ESSE-RF epidemiological study. Russian Journal of Cardiology. 2019;(6):66-72. (In Russ.) doi:10.15829/1560-4071-2019-6-66-72.

21. Calcaterra V, Rossi V, Magenes VC, et al. Dietary habits, depression and obesity: an intricate relationship to explore in pediatric preventive strategies. Front Pediatr. 2024;12:1368283. doi:10.3389/fped.2024.1368283.

22. Friedman M, Chang R, Amin ZM, et al. Understanding the bidirectional association between obesity and risk of psychological distress and depression in young adults in the US: available evidence, knowledge gaps, and future directions. Front Psychiatry. 2025;15:1422877. doi:10.3389/fpsyt.2024.1422877.

23. Dębski J, Przybyłowski J, Skibiak K, et al. Depression and Obesity — Do We Know Everything about It? A Narrative Review. Nutrients. 2024;16:3383. doi:10.3390/nu16193383.

24. Zhyrov V, Gorman A, Walker RA, et al. The relationships between body weight, appetite, depression, and anxiety: Findings from the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Health Psychol Open. 2025;12:20551029251359056. doi:10.1177/20551029251359056.

25. Qi P, Huang M, Zhu H. Association between alcohol drinking frequency and depression among adults in the United States: a cross-sectional study. BMC Psychiatry. 2024;24:836. doi:10.1186/s12888-024-06296-9.

26. Yang JH, Choi CK, Kim HY, et al. Association between Alcohol Drinking Status and Depressive Symptoms in Korean Adults. Chonnam Med J. 2021;57(1):68-75. doi:10.4068/cmj.2021.57.1.68.

27. Liang L, Hua R, Tang S, et al. Low-to-Moderate Alcohol Intake Associated with Lower Risk of Incidental Depressive Symptoms: A Pooled Analysis of Three Intercontinental Cohort Studies. J Affect Disord. 2021;286:49-57. doi:10.1016/j.jad.2021.02.050.

28. Kim Y, Kim J, Oh JW, et al. Association between drinking behaviors, sleep duration, and depressive symptoms. Sci Rep. 2024;14:5992. doi:10.1038/s41598-024-56625-x.