Associação entre transtorno depressivo maior e seus sintomas e consumo alimentar em adultos brasileiros: pesquisa nacional de saúde de 2019

Abstract

The association between depression and dietary intake has been explored through different approaches and dietary classification methods. However, the relationship between specific depressive symptoms and diet quality, as well as the use of a composite score to evaluate diet quality, remains underexplored. Objective: To analyze the association between major depressive disorder (MDD), its symptoms and diet quality. Methods: This cross sectional analysis, based on data from the 2019 Brazilian National Health Survey, included individuals aged 20-59 years. The Patient Health Questionnaire-9 assessed the presence of MDD symptoms in the 14 days preceding the interview, including sleep disturbances, fatigue, lack of interest, concentration difficulties, eating-related problems, psychomotor changes, depressed mood, feelings of worthlessness, and thoughts of self-harm. Symptom frequency was considered high when responses were as “More than half the days” or “Nearly every day”, and MDD was defined as score ≥10. The healthy eating score was constructed from the weekly frequency of food consumption markers. Healthy markers (beans, vegetables, fruits, and natural juice) were scored from 0 (none) to 7 (seven days per week), while unhealthy markers (soft drinks, artificial juices, sweets, and replacing lunch with snacks) were inversely scored. Descriptive analyses used relative frequencies (%) for sociodemographic, lifestyle, depression, and symptoms variables. The mean healthy eating score and its statistical differences were assessed using 95% confidence intervals (95% CI). Crude and adjusted linear regression models (for sociodemographic and lifestyle factors) were applied to evaluate the associations between MDD, its symptoms, and diet quality. Results: A total of 63,782 individuals were included, of whom 10.8% met the criteria for MDD. The most prevalent symptom was “Sleep disturbance” (17.1%), whereas “thoughts of self- harm” was the least prevalent (1.7%). Female sex, widowed/divorced marital status, smoking, and lack of leisure-time physical activity were associated with higher prevalence of MDD and all evaluated symptoms. The mean healthy eating score was 1.81 points lower among individuals with MDD compared with those without the disorder. High frequency of all symptoms was also associated with poorer diet quality, with “thoughts of self-harm” showing the largest difference (2.69 points lower) compared with low frequency. Conclusion: Significant associations were observed between all MDD symptoms and poorer diet quality. These findings highlight the relevance of the interplay between mental health and dietary habits, as well as the need for integrated nutritional and psychological care strategies. Moreover, they reinforce the importance of promoting health eating as a complementary approach in the care of MDD and its symptoms.