Nutrition-focused group intervention with a strength-based counseling approach for people with clinical depression: a study protocol for the Food for Mind randomized controlled trial

Abstract

Background Depression is a highly prevalent mental disorder with major public health effects globally. It impairs the quality of life and reduces the ability to work and function, leading to increasing costs of sick leaves and disability pensions. Current treatment strategies focus on biological and psychological pathways while understating the role of lifestyle factors. Epidemiological studies have shown convincing evidence of an inverse relationship between diet quality and depression. However, only limited data are available on the therapeutic effects of diet quality improvement on depression. Using a randomized controlled trial design, our primary aim is to investigate the effectiveness and cost-effectiveness of a behavioral nutrition group intervention compared to a social support intervention in the treatment of depression. Methods Participants (N=144, aged 20–65 years) with a diagnosis of moderate or severe depression recruited in collaboration with outpatient care units will be randomized into two arms: Food for Mind (FM) nutrition intervention (n=72) or Bring Good Mood (BGM) social support control group (n=72). Both arms will be provided with 6 group sessions over an 8-week period. FM involves improving diet quality by applying strength-based behavioral nutrition counseling and activities facilitated by a registered dietitian. The control arm comprises a befriending protocol. During the interventions, all participants will continue their treatment for depression as usual. Longitudinal data are collected at baseline, at 8 weeks, and at 6- and 12-month follow-ups. Depressive symptoms, diet quality, eating behavior, ability to work and function, and quality of life are assessed by self-reported questionnaires. A treatment expectancy questionnaire will be administered at baseline and an acceptability questionnaire at 8 weeks. The Center for Epidemiologic Studies Depression Scale is used as the primary endpoint at 1 year. The results will be analyzed with linear mixed-effects models. Economic evaluation includes both cost-effectiveness and cost-utility analysis. Two incremental cost-effectiveness ratios will be calculated to evaluate the incremental cost per QALY and the incremental cost per improvement in CES-D. Discussion If the intervention proves to be cost-effective and acceptable, it be can be implemented in healthcare to support the treatment of depression. Trial registration ClinicalTrials.gov NCT03904771. Retrospectively registered on 5 April 2019

Influence of Nutrition on Mental Health: Scoping Review

“…Another study in which nutrition or healthy eating habits were theoretically accounted for as an independent variable in those investigations also found or predicted that this would contribute to positive outcomes in mental health status [28,37,42]. One of them was directly a clinical practice recommendation guideline [28].…”

“…To begin with the interpretation of the results, it is possible to state that there is a relationship between the state or quality of mental health and the intake of nutrients and/or supplementation, whether based on some type of vitamin or mineral, or probiotics [28,29,[31][32][33][34][35][36][39][40][41][42]. This may be due to the relationship between reduced levels of magnesium, together with elevated levels of calcium and stress, which generate agitation, anxiety, hallucinations, confusion, asthenia, insomnia, delirium and/or headache, among others [43].…”

“…Favorable research was found for the relationship between healthy changes in nutritional habits and a decrease in depressive symptoms [28,29,[31][32][33]35,36,39,42]. There was a single study in which there was no significant improvement in depressive symptomatology in the sample due to supplementation [30].…”

“…Both groups obtained positive results for the reduction in anxiety, depression, or stress, although the improvements were greater in the combined supplementation group for daily physical activity. Finally, Roponen et al [42] assumed that there are studies that inversely relate diet quality to the severity of depressive disorder. In their work, they argued the influence of nutritional education and social support intervention for the treatment of depressive symptomatology.…”