The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials
Open accessAbstract
Objective: Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success. Design: A systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014. Results: Of the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47 %) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet. Conclusions: Although there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.
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Lifestyle targeted behavioral interventions in depression have typically shown small-to-medium effect sizes of ~0.3-0.5, while the placebo effect of behavioral interventions is even smaller ~0.2 in RCTs.
“Lifestyle targeted behavioral interventions in depression have typically shown small-to-medium effect sizes of ~0.3–0.5 [4–16], while the placebo effect of behavioral interventions are even smaller ~0.2 in RCTs [101, 102].”
From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [5]
The Summary of evidence (page unavailable) reports that successful whole-of-diet interventions had depression effect sizes of 0.19–2.02, ranging from small to very large. It does not establish that lifestyle-targeted behavioral interventions typically have effect sizes of 0.3–0.5. The placebo-effect figure is attached to different citations in the citing sentence and is not assessed here. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPhysical activity/exercise, dietary modification, adequate sleep, social interaction, and mindfulness-based meditation have shown treatment efficacy in separate clinical trials of depression.
“These include physical activity/exercise, dietary modification, adequate sleep and social interaction, as well as mindfulness-based meditation, all of which have shown treatment efficacy in separate clinical trials of depression [4–16].”
From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [5]
The 6-week iMAP protocols in sleep, exercise, diet, or social connection were grounded in evidence-based intervention protocols for these lifestyle domains in depression.
“Description of each 6-week iMAP in either sleep/ exercise/ diet/ social connection domain is provided in Supplementary Methods section S.5 and is grounded in evidence-based intervention protocols in these lifestyle domains in the context of depression [5, 6, 8, 11, 16, 68–70].”
From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [5]
Improvements in all lifestyle domains targeted are associated with improvements in the QOL mental component summary measure.
“This is aligned with evidence showing that improvements in all lifestyle domains that we targeted is associated with improvements in the QOL mental component summary measure [5, 6, 70, 81, 82].”
From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [5]
The Summary of evidence (page unavailable) reports that some whole-of-diet interventions improved depression scores, but it does not assess improvements across all targeted lifestyle domains against a QOL mental component summary measure. The study table lists QOL outcomes for some trials without reporting the claimed association. Searches for “mental component summary” and lifestyle-domain improvements found no passage establishing it. (LLM, conf=0.72)
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“…up to 20% attrition, so as to obtain at least 40 complete study samples that were powered to detect a statistically meaningful medium effect size (Cohen ’ s d > 0.45) primary outcome difference in pre vs post comparisons of PHQ9 scores at 0.8 power and alpha level of 0.05, computed a priori [41].”
Influential
- Authors
- Opie, R. S., O’Neil, A., Itsiopoulos, C., & Jacka, F. N.
- Affiliations
- La Trobe University (AU)
- Deakin University (AU)
- Corresponding author
- Opie, Rachelle S
- Venue
- Public Health Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-08
- Volume
- 18
- Issue
- 11
- Pages
- 2074-2093
- ISSN
- 1368-9800 (ISSN-L)
- 1475-2727
- PMC
- PMC10271872
- OpenAlex
- W2136009994
- Cited by
- 243
- References
- 45
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 20 · 2023: 26 · 2022: 21 · 2021: 25 · 2020: 29 · 2019: 22 · 2018: 18 · 2017: 21 · 2016: 15 · 2015: 10 · 2014: 1
- FWCI
- 2.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Public Health Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Eli Lilly and Company
- Pfizer
- Sanofi
- Geelong Region Medical Research Foundation
- David and Elaine Potter Foundation
- Australian Rotary Health
- Ian Potter Foundation
- Meat and Livestock Australia
- La Trobe University
- Deakin University (1052865)
- University of Melbourne
- Servier
- Medical Research Council
- National Health and Medical Research Council (1052865)
- Brain and Behaviour Research Institute, University of Wollongong
- Cilag
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Keywords
- dietary intervention, depression, anxiety, diet quality, non-pharmacological treatment, lifestyle intervention, red meat consumption, cholesterol-lowering diet, mood disturbance, mental health
- MeSH terms
- Anxiety, Anxiety Disorders, Depression, Depressive Disorder, Humans
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