Skip to main content

Prospective study on the association between diet quality and depression in mid-aged women over 9 years



To examine the longitudinal association between diet quality and depression using prospective data from the Australian Longitudinal Study on Women’s Health.


Women born in 1946–1951 (n = 7877) were followed over 9 years starting from 2001. Dietary intake was assessed using the Dietary Questionnaire for Epidemiological Studies (version 2) in 2001 and a shortened form in 2007 and 2010. Diet quality was summarised using the Australian Recommended Food Score. Depression was measured using the 10-item Centre for Epidemiologic Depression Scale and self-reported physician diagnosis. Pooled logistic regression models including time-varying covariates were used to examine associations between diet quality tertiles and depression. Women were also categorised based on changes in diet quality during 2001–2007. Analyses were adjusted for potential confounders.


The highest tertile of diet quality was associated marginally with lower odds of depression (OR 0.94; 95 % CI 0.83, 1.00; P = 0.049) although no significant linear trend was observed across tertiles (OR 1.00; 95 % CI 0.94, 1.10; P = 0.48). Women who maintained a moderate or high score over 6 years had a 6–14 % reduced odds of depression compared with women who maintained a low score (moderate vs low score—OR 0.94; 95 % CI 0.80, 0.99; P = 0.045; high vs low score—OR 0.86; 95 % CI 0.77, 0.96; P = 0.01). Similar results were observed in analyses excluding women with prior history of depression.


Long-term maintenance of good diet quality may be associated with reduced odds of depression. Randomised controlled trials are needed to eliminate the possibility of residual confounding.

This is a preview of subscription content, access via your institution.


  1. Commonwealth Department of Health and Aged Care & AIHW (1999) NHPA report on mental health 1998: a report focusing on depression. Cat. no. PHE 11. AIHW, Canberra

  2. World Health Organization (2012) Depression. WHO. Accessed 10 Dec 2012

  3. Mitchell AJ, Subramaniam H (2005) Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. Am J Psychiatry 162(9):1588–1601. doi:10.1176/appi.ajp.162.9.1588

    Article  Google Scholar 

  4. Haralambous B, Lin X, Dow B, Jones C, Tinney J, Bryant C (2009) Depression in older age: a scoping study. National Ageing Research Institute, Parkville

    Google Scholar 

  5. Rodda J, Walker Z, Carter J (2011) Depression in older adults. BMJ 343:d5219. doi:10.1136/bmj.d5219

    Article  Google Scholar 

  6. Jacka F, Mykletun A, Berk M (2012) Moving towards a population health approach to the primary prevention of common mental disorders. BMC Med 10(1):149

    Article  Google Scholar 

  7. Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J (2014) A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr 99(1):181–197. doi:10.3945/ajcn.113.069880

    Article  CAS  Google Scholar 

  8. Akbaraly TN, Sabia S, Shipley MJ, Batty GD, Kivimaki M (2013) Adherence to healthy dietary guidelines and future depressive symptoms: evidence for sex differentials in the Whitehall II study. Am J Clin Nutr 97(2):419–427

    Article  CAS  Google Scholar 

  9. Chocano-Bedoya PO, O’Reilly EJ, Lucas M, Mirzaei F, Okereke OI, Fung TT, Hu FB, Ascherio A (2013) Prospective study on long-term dietary patterns and incident depression in middle-aged and older women. Am J Clin Nutr 98(3):813–820. doi:10.3945/ajcn.112.052761

    Article  CAS  Google Scholar 

  10. Willett W (1998) Nutritional epidemiology, 2nd edn. Oxford University Press, New York

    Book  Google Scholar 

  11. Flood VM, Burlutsky G, Webb KL, Wang JJ, Smith WT, Mitchell P (2010) Food and nutrient consumption trends in older Australians: a 10-year cohort study. Eur J Clin Nutr 64(6):603–613

    Article  CAS  Google Scholar 

  12. Australian Institute of Health and Welfare (2012) Australia’s food and nutrition 2012. Cat. no. PHE 163. AIHW, Canberra

  13. Australian Bureau of Statistics (2012) Australian Health Survey: first results, 2011–12. ABS cat. no. 4364.0.55.001. ABS, Canberra

  14. Rienks J, Dobson AJ, Mishra GD (2013) Mediterranean dietary pattern and prevalence and incidence of depressive symptoms in mid-aged women: results from a large community-based prospective study. Eur J Clin Nutr 67(1):75–82. doi:10.1038/ejcn.2012.193

    Article  CAS  Google Scholar 

  15. Lee C, Dobson AJ, Brown WJ, Bryson L, Byles J, Warner-Smith P, Young AF (2005) Cohort Profile: the Australian Longitudinal Study on Women’s Health. Int J Epidemiol 34(5):987–991. doi:10.1093/ije/dyi098

    Article  Google Scholar 

  16. Giles G, Ireland P (1996) Dietary Questionnaire for Epidemiological Studies (Version 2). Cancer Council Victoria, Melbourne

    Google Scholar 

  17. Ireland P, Jolley D, Giles G, O’Dea K, Powles J, Rutishauser I, Wahlqvist M, Williams J (1994) Development of the Melbourne FFQ: a food frequency questionnaire for use in an Australian prospective study involving ethnically diverse cohort. Asia Pac Clin Nutr 3:19–31

    CAS  Google Scholar 

  18. Hodge A, Patterson AJ, Brown WJ, Ireland P, Giles G (2000) The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Aust NZ J Public Health 24(6):576–583. doi:10.1111/j.1467-842X.2000.tb00520.x

    Article  CAS  Google Scholar 

  19. Collins CE, Young AF, Hodge A (2008) Diet quality is associated with higher nutrient intake and self-rated health in mid-aged women. J Am Coll Nutr 27(1):146–157

    Article  Google Scholar 

  20. Kant AK, Thompson FE (1992) Measures of overall diet quality from a food frequency questionnaire: National Health Interview Survey. Nutr Res 17(9):1443–1456. doi:10.1016/S0271-5317(97)00135-8

    Article  Google Scholar 

  21. National Health and Medical Research Council (2013) Australian Dietary Guidelines. NHMRC, Canberra

    Google Scholar 

  22. Smith A, Kellett E, Schmerlaib Y (1998) The Australian guide to healthy eating. Commonwealth Department of Health and Family Services, Canberra

    Google Scholar 

  23. Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 10(2):77–84

    CAS  Google Scholar 

  24. Boey KW (1999) Cross-validation of a short form of the CES-D in Chinese elderly. Int J Geriatr Psychiatry 14(8):608–617

    Article  CAS  Google Scholar 

  25. D’Agostino RB, Lee M-L, Belanger AJ, Cupples LA, Anderson K, Kannel WB (1990) Relation of pooled logistic regression to time dependent cox regression analysis: the Framingham heart study. Stat Med 9(12):1501–1515. doi:10.1002/sim.4780091214

    Article  Google Scholar 

  26. Stata Corp LP (1996-2013) Stata, version 11. College Station

  27. Le Port A, Gueguen A, Kesse-Guyot E, Melchior M, Lemogne C, Nabi H, Goldberg M, Zins M, Czernichow S (2012) Association between dietary patterns and depressive symptoms over time: a 10-year follow-up study of the GAZEL cohort. PLoS ONE 7(12):e51593

    Article  Google Scholar 

  28. Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A (2009) Dietary pattern and depressive symptoms in middle age. Br J Psychiatry 195(5):408–413

    Article  Google Scholar 

  29. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O’Reilly SL, Nicholson GC, Kotowicz MA, Berk M (2010) Association of western and traditional diets with depression and anxiety in women. Am J Psychiatry 167(3):305–311

    Article  Google Scholar 

  30. Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A, Schlatter J, Lahortiga F, Majem LS, Martinez-Gonzalez MA (2009) Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) Cohort. Arch Gen Psychiatry 66(10):1090–1098

    Article  Google Scholar 

  31. Michels KB (2003) Nutritional epidemiology—past, present, future. Int J Epidemiol 32(4):486–488. doi:10.1093/ije/dyg216

    Article  Google Scholar 

  32. McNaughton S (2010) Dietary patterns and diet quality: approaches to assessing complex exposures in nutrition. Australas Epidemiol 17(1):35–37

    Google Scholar 

  33. Alhazmi A, Stojanovski E, McEvoy M, Brown W, Garg ML (2014) Diet quality score is a predictor of type 2 diabetes risk in women: the Australian Longitudinal Study on Women’s Health. Br J Nutr 112(6):945–951

    Article  CAS  Google Scholar 

  34. Helmersson J, Arnlov J, Larsson A, Basu S (2009) Low dietary intake of beta-carotene, alpha-tocopherol and ascorbic acid is associated with increased inflammatory and oxidative stress status in a Swedish cohort. Br J Nutr 101(12):1775–1782

    Article  CAS  Google Scholar 

  35. Holt EM, Steffen LM, Moran A, Basu S, Steinberger J, Ross JA, Hong CP, Sinaiko AR (2009) Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. J Am Diet Assoc 109(3):414–421. doi:10.1016/j.jada.2008.11.036

    Article  CAS  Google Scholar 

  36. Krishnan V, Nestler EJ (2008) The molecular neurobiology of depression. Nature 455(7215):894–902

    Article  CAS  Google Scholar 

  37. Djernes JK (2006) Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand 113(5):372–387. doi:10.1111/j.1600-0447.2006.00770.x

    Article  CAS  Google Scholar 

  38. Copeland KT, Checkoway H, McMichael AJ, Holbrook RH (1977) Bias due to misclassification in the estimation of relative risk. Am J Epidemiol 105(5):488–495

    CAS  Google Scholar 

  39. Watson LC, Pignone MP (2003) Screening accuracy for late-life depression in primary care: a systematic review. J Fam Pract 52(12):956–964

    Google Scholar 

  40. Ayuso-Mateos JL, Nuevo R, Verdes E, Naidoo N, Chatterji S (2010) From depressive symptoms to depressive disorders: the relevance of thresholds. Br J Psychiatry 196(5):365–371. doi:10.1192/bjp.bp.109.071191

    Article  Google Scholar 

Download references


The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health, the University of Newcastle and the University of Queensland. We are grateful to the Australian Government Department of Health who funded the study and the women who provided the survey data. The authors would also like to thank Professor Graham Giles of the Cancer Epidemiology Centre of Cancer Council Victoria, for permission to use the Dietary Questionnaire for Epidemiological Studies (Version 2), Melbourne: Cancer Council Victoria, 1996.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jun S. Lai.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study was approved by the Human Research Ethics Committees of the University of Newcastle and the University of Queensland. The research was carried out in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to inclusion in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 132 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lai, J.S., Hure, A.J., Oldmeadow, C. et al. Prospective study on the association between diet quality and depression in mid-aged women over 9 years. Eur J Nutr 56, 273–281 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: