Economic evaluation of a dietary intervention for adults with major depression (the “SMILES” trial)
Open accessAbstract
BACKGROUND: Recently, the efficacy of dietary improvement as a therapeutic intervention for moderate to severe depression was evaluated in a randomised controlled trial. The SMILES trial demonstrated a significant improvement in Montgomery-Åsberg Depression Rating Scale scores favouring the dietary support group compared with a control group over 12 weeks. We used data collected within the trial to evaluate the cost-effectiveness of this novel intervention. METHODS: In this prospective economic evaluation, sixty-seven adults meeting DSM-IV criteria for a major depressive episode and reporting poor dietary quality were randomised to either seven sessions with a dietitian for dietary support or to an intensity matched social support (befriending) control condition. The primary outcome was Quality Adjusted Life Years (QALYs) as measured by the AQoL-8D, completed at baseline and 12 week follow-up (endpoint) assessment. Costs were evaluated from health sector and societal perspectives. The time required for intervention delivery was costed using hourly wage rates applied to the time in counselling sessions. Food and travel costs were also included in the societal perspective. Data on medications, medical services, workplace absenteeism and presenteesim (paid and unpaid) were collected from study participants using a resource-use questionnaire. Standard Australian unit costs for 2013/2014 were applied. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in average costs between groups divided by the difference in average QALYs. Confidence intervals were calculated using a non-parametric bootstrap procedure. RESULTS: Compared with the social support condition, average total health sector costs were $856 lower (95% CI -1247 to - 160) and average societal costs were $2591 lower (95% CI -3591 to - 198) for those receiving dietary support. These differences were driven by lower costs arising from fewer allied and other health professional visits and lower costs of unpaid productivity. Significant differences in mean QALYs were not found between groups. However, 68 and 69% of bootstrap iterations showed the dietary support intervention was dominant (additional QALYs at less cost) from the health sector and societal perspectives. CONCLUSIONS: This novel dietary support intervention was found to be likely cost-effective as an adjunctive treatment for depression from both health sector and societal perspectives. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000251820 . Registered on 29 February 2012.
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There is evidence that decreased anxiety symptoms are related to healthy eating habits.
“There is evidence that indicates a relationship between decreased anxiety symptoms and healthy eating habits.”
From The Effect of Anxiety and Nutritional Habits on the Body Distortion of Athletes. (2025) · cites this paper as [6]
The Background reports a relationship between diet quality and depression, and improvement in depressive symptoms after dietary support. Searches for anxiety symptoms and anxiety found no passage in our copy linking healthy eating to decreased anxiety symptoms. (LLM, conf=0.75)
Experimental — accuracy not yet measuredAdopting dietary improvement as a treatment strategy for mental health is cost-effective.
“An added benefit of adopting dietary improvement as a treatment strategy for mental health is its cost-effectiveness, given the compelling economic evaluations of 2 landmark trials investigating the efficacy of a Mediterranean-style dietary intervention on reducing depression symptoms (522, 523).”
From Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health (2021) · cites this paper as [522]
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1 retracted
RETRACTED: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1200303 · Cited by 4,257 · see citing works
RetractedMethods for the Economic Evaluation of Health Care Programmes
Drummond, M. E., Sculpher, M. J., Torrance, G. W., O’Brien, B. J., & Stoddart, G. L. (2005) · doi:10.1093/oso/9780198529446.001.0001 · Cited by 13,648 · see citing works
Multiple imputation using chained equations: Issues and guidance for practice
White, I. R., Royston, P., & Wood, A. M. (2011) · Statistics in Medicine · doi:10.1002/sim.4067 · Cited by 9,792 · cited 1× · see citing works
“Missing data were imputed 33 times based on the percentage missing from the health care utilisation variables [34].”
MethodWhiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61611-6 · Cited by 6,006 · see citing works
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61415-9 · Cited by 4,070 · cited 1× · see citing works
“chronic health conditions, including cardiovascular disease, metabolic syndrome, type 2 diabetes and obesity [39, 40].”
BackgroundNo health without mental health
Prince, M. J., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., & Rahman, A. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61238-0 · Cited by 3,835 · see citing works
Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., Kuntz, K. M., Meltzer, D. O., Owens, D. K., Prosser, L. A., et al. (2016) · JAMA · doi:10.1001/jama.2016.12195 · Cited by 3,069 · cited 5× · see citing works
“As recommended by the Second Panel on Cost-effectiveness in Health and Medicine, both health sector and societal perspectives are presented as reference case analyses [9].”
BackgroundMethodInfluentialWeight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet
Shai, I., Schwarzfuchs, D., Henkin, Y., Shahar, D. R., Witkow, S., Greenberg, I., Golan, R., Fraser, D., Bolotin, A., Vardi, H., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0708681 · Cited by 2,143 · see citing works
Goetzel, R. Z., Long, S. R., Ozminkowski, R. J., Hawkins, K., Wang, S., & Lynch, W. (2004) · Journal of Occupational and Environmental Medicine · doi:10.1097/01.jom.0000121151.40413.bd · Cited by 1,259 · cited 1× · see citing works
“2 h of productivity was lost per day when a person reported working while suffering health problems [24].”
BackgroundMultiple Imputation by Chained Equations (MICE): Implementation in <i>Stata</i>
Royston, P., & White, I. (2011) · Journal of Statistical Software · doi:10.18637/jss.v045.i04 · Cited by 1,248 · cited 1× · see citing works
“To account for missing utility values, health care, transportation, and lost productivity costs, the ICE multiple imputation technique in Stata was used [33].”
MethodJacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., et al. (2017) · BMC Medicine · doi:10.1186/s12916-017-0791-y · Cited by 1,093 · see citing works
Self-citationEconomic Evaluation in Clinical Trials
Glick, H. A., Doshi, J. A., Sonnad, S. S., & Polsky, D. E. (2014) · Oxford University Press eBooks · doi:10.1093/med/9780199685028.001.0001 · Cited by 910 · see citing works
Lai, J. S., Hiles, S., Bisquera, A., Hure, A. J., McEvoy, M., & Attia, J. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.069880 · Cited by 786 · see citing works
National Survey of Mental Health and Wellbeing: Summary of Results
(2008) · PsycEXTRA Dataset · doi:10.1037/e681292012-001 · Cited by 525 · see citing works
Furukawa, T. A., Noma, H., Caldwell, D. M., Honyashiki, M., Shinohara, K., Imai, H., Chen, P., Hunot, V., & Churchill, R. (2014) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12275 · Cited by 521 · cited 1× · see citing works
“The study design used the social support condition as an active control, which was intended to avoid a nocebo effect that a usual care comparator may induce and to control for the non-specific benefits of face to face interactions [43].”
MethodRichardson, J., Iezzi, A., Khan, M. A., & Maxwell, A. (2014) · The Patient - Patient-Centered Outcomes Research · doi:10.1007/s40271-013-0036-x · Cited by 504 · cited 1× · see citing works
“health-related quality of life and utility, the Assessment of Quality of Life – Eight Dimension (AQoL-8D) [30] was completed at each assessment.”
Mediterranean dietary pattern and depression: the PREDIMED randomized trial
Sánchez-Villegas, A., Martínez-González, M. A., Estruch, R., Salas-Salvadó, J., Corella, D., Covas, M. I., Arós, F., Romaguera, D., Gómez-Gracia, E., Lapetra, J., et al. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-208 · Cited by 403 · see citing works
Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure
Hawthorne, G., & Osborne, R. (2005) · Australian and New Zealand Journal of Public Health · doi:10.1111/j.1467-842x.2005.tb00063.x · Cited by 294 · cited 1× · see citing works
“83 [41], but similar to the average for individuals with depression”
BackgroundDiätumstellung gegen Depression
(2017) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/s-0043-103782 · Cited by 287 · see citing works
The value of productivity: human-capital versus friction-cost method
van den Hout, W. B. (2009) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2009.117150 · Cited by 279 · cited 1× · see citing works
“The human capital approach [25] was used to value lost paid productivity by using an average hourly wage rate calculated from the average weekly earnings reported by the Australian Bureau of Statistics plus 25% overhead costs [26].”
MethodNutritionist Visits, Diabetes Classes, and Hospitalization Rates and Charges
Robbins, J. M., Thatcher, G. E., Webb, D. A., & Valdmanis, V. G. (2008) · Diabetes Care · doi:10.2337/dc07-1871 · Cited by 183 · cited 1× · see citing works
“Nutrition and dietetic services have been shown to be cost-effective for the reduction in LDL cholesterol levels in type 2 diabetes patients [35], and provide a positive return on investment when used to treat patients with hypercholesterolemia [36], as well as other patient groups [37, 38].”
BackgroundCarter, R., Vos, T., Moodie, M., Haby, M. M., Magnus, A., & Mihalopoulos, C. (2008) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/14737167.8.6.593 · Cited by 162 · cited 1× · see citing works
“For example, in Australia $50,000/QALY has been used as a rule of thumb to denote value-for-money [28, 29].”
MethodThe Economic Analysis of Prevention in Mental Health Programs
Mihalopoulos, C., Vos, T., Pirkis, J., & Carter, R. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104601 · Cited by 159 · cited 1× · see citing works
“For example, in Australia $50,000/QALY has been used as a rule of thumb to denote value-for-money [28, 29].”
MethodOpie, R. S., O'Neil, A., Jacka, F. N., Pizzinga, J., & Itsiopoulos, C. (2018) · Nutritional Neuroscience · doi:10.1080/1028415x.2017.1312841 · Cited by 130 · cited 2× · see citing works
“diet quality in participants with poor diet quality using a modified Mediterranean diet model [5], would be superior to a social support control condition (befriending) in reducing the severity of depressive symptoms.”
MethodSelf-citationClinical and Cost Outcomes of Medical Nutrition Therapy for Hypercholesterolemia
Delahanty, L. M., Sonnenberg, L. M., Hayden, D. L., & Nathan, D. M. (2001) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(01)00250-4 · Cited by 89 · cited 1× · see citing works
“Nutrition and dietetic services have been shown to be cost-effective for the reduction in LDL cholesterol levels in type 2 diabetes patients [35], and provide a positive return on investment when used to treat patients with hypercholesterolemia [36], as well as other patient groups [37, 38].”
BackgroundThe Measurement of Indirect Costs in the Health Economics Evaluation Literature:A Review
Jacobs, P., & Fassbender, K. (1998) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462300012095 · Cited by 82 · cited 1× · see citing works
“housework) was valued at 25% of the average wage rate plus overhead costs to represent the value of participants’ lost leisure time [27].”
BackgroundLee, Y.-C., Chatterton, M. L., Magnus, A., Mohebbi, M., Le, L. K., & Mihalopoulos, C. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417710730 · Cited by 82 · see citing works
Mihalopoulos, C., Chen, G., Iezzi, A., Khan, M. A., & Richardson, J. R. J. (2014) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.113.136036 · Cited by 78 · cited 1× · see citing works
“from a representative survey of the Australian population [42].”
BackgroundO'Neil, A. E., Berk, M., Itsiopoulos, C., Castle, D. J., Opie, R., Pizzinga, J., Brazionis, L., Hodge, A. M., Mihalopoulos, C., Chatterton, M. L., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-114 · Cited by 69 · see citing works
The contribution of dietitians to the primary health care workforce
Howatson, A., Wall, C. R., & Turner-Benny, P. (2015) · Journal of Primary Health Care · doi:10.1071/hc15324 · Cited by 64 · cited 1× · see citing works
“While dietary counselling has efficacy and costeffectiveness credentials in the management of obesity, cardiovascular disease and diabetes, it has not previously been evaluated as an adjunctive therapy for the treatment of depression [8].”
BackgroundBendall, S., Jackson, H. J., Killackey, E., Allott, K., Johnson, T., Harrigan, S., Gleeson, J., & McGorry, P. D. (2006) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465806002815 · Cited by 48 · see citing works
Systematic review of literature on the cost-effectiveness of nutrition services
Pavlovich, W., Waters, H., Weller, W. E., & Bass, E. B. (2004) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2003.09.025 · Cited by 34 · cited 1× · see citing works
“Nutrition and dietetic services have been shown to be cost-effective for the reduction in LDL cholesterol levels in type 2 diabetes patients [35], and provide a positive return on investment when used to treat patients with hypercholesterolemia [36], as well as other patient groups [37, 38].”
BackgroundAssessing healthy diet affordability in a cohort with major depressive disorders
Rachelle, S. O., Leonie, S., Felice, N. J., Laura, N., Dash, S. R., Josephine, P., & Itsiopoulos, C. (2015) · Journal of Public Health and Epidemiology · doi:10.5897/jphe2014.0668 · Cited by 17 · cited 1× · see citing works
“This was based on the cost of the first 20 study participants’ dietary intake at baseline compared to the cost of the prescribed healthy alternative, the modified Mediterranean diet [13].”
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Firth, J., Marx, W., Dash, S., Carney, R., Teasdale, S. B., Solmi, M., Stubbs, B., Schuch, F. B., Carvalho, A. F., Jacka, F., et al. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000673 · Cited by 566 · see citing works
Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health
Berding, K., Vlckova, K., Marx, W., Schellekens, H., Stanton, C., Clarke, G., Jacka, F., Dinan, T. G., & Cryan, J. F. (2021) · Advances in Nutrition · doi:10.1093/advances/nmaa181 · Cited by 451 · see citing works
Self-citationMicrobiota-Gut-Brain Axis: New Therapeutic Opportunities
Long-Smith, C., O'Riordan, K. J., Clarke, G., Stanton, C., Dinan, T. G., & Cryan, J. F. (2020) · Annual Review of Pharmacology and Toxicology · doi:10.1146/annurev-pharmtox-010919-023628 · Cited by 419 · see citing works
Interventions to improve return to work in depressed people
Nieuwenhuijsen, K., Verbeek, J. H. A. M., Neumeyer‐Gromen, A., Verhoeven, A. C., Bültmann, U., & Faber, B. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006237.pub4 · Cited by 221 · see citing works
Nutrition and mental health: A review of current knowledge about the impact of diet on mental health
Grajek, M. K., Krupa-Kotara, K. H., Białek-Dratwa, A., Sobczyk, K., Grot, M., Kowalski, O., & Staśkiewicz‐Bartecka, W. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.943998 · Cited by 239 · see citing works
Diet and Anxiety: A Scoping Review
Aucoin, M., LaChance, L., Naidoo, U., Remy, D., Shekdar, T., Sayar, N., Cardozo, V., Rawana, T., Chan, I., & Cooley, K. (2021) · Nutrients · doi:10.3390/nu13124418 · Cited by 223 · see citing works
“In the absence of a contraindication such as an allergy or specific medical condition, dietary interventions are considered low in risk, cost-effective [113], may confer secondary benefit to physical aspects of health and have at least some evidence suggesting a beneficial effect.”
BackgroundMarx, W., Manger, S., Blencowe, M., Murray, G., Ho, F. Y., Lawn, S., Blumenthal, J. A., Schuch, F. B., Stubbs, B., Ruusunen, A. A., et al. (2022) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2022.2112074 · Cited by 189 · see citing works
“There is also emerging evidence of productivity gains owing to lifestyle-based mental health care related to work performance and fewer absences from work (Chatterton et al. 2018).”
BackgroundAn integrative collaborative care model for people with mental illness and physical comorbidities
Ee, C., Lake, J., Firth, J., Hargraves, F., de Manincor, M., Meade, T., Marx, W., & Sarris, J. J. (2020) · International Journal of Mental Health Systems · doi:10.1186/s13033-020-00410-6 · Cited by 153 · see citing works
“Individual lifestyle interventions have also demonstrated cost-effectiveness [98, 99].”
BackgroundDiet and Psychosis: A Scoping Review
Aucoin, M., LaChance, L., Cooley, K., & Kidd, S. A. (2018) · Neuropsychobiology · doi:10.1159/000493399 · Cited by 114 · see citing works
Freijy, T. M., Cribb, L., Oliver, G., Metri, N., Opie, R., Jacka, F. N., Hawrelak, J. A., Rucklidge, J. J., Ng, C. H., & Sarris, J. J. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1097278 · Cited by 81 · see citing works
“Such changes appear to be simple, economical (Opie et al., 2015), cost-effective (Chatterton et al., 2018; Segal et al., 2020), and safe to implement.”
BackgroundTeasdale, S. B., Machaczek, K. K., Marx, W., Eaton, M., Chapman, J. J., Milton, A. C., Oyeyemi, A. L., Pelupessy, D. C., Schuch, F. B., Gatera, G., et al. (2025) · The Lancet Psychiatry · doi:10.1016/s2215-0366(25)00170-1 · Cited by 68 · see citing works
Nutrition and bipolar disorder: a systematic review
Gabriel, F. C., Oliveira, M., Martella, B. D. M., Berk, M., Brietzke, E., Jacka, F. N., & Lafer, B. (2023) · Nutritional Neuroscience · doi:10.1080/1028415x.2022.2077031 · Cited by 59 · see citing works
Hickman, I. J., Hannigan, A., Johnston, H. E., Elvin‐Walsh, L., Mayr, H. L., Staudacher, H. M., Barnett, A., Stoney, R. M., Salisbury, C. E., Jarrett, M., et al. (2021) · Transplantation Direct · doi:10.1097/txd.0000000000001118 · Cited by 40 · see citing works
Diet and depression-from confirmation to implementation
Berk, M., & Jacka, F. N. (2019) · JAMA · doi:10.1001/jama.2019.0273 · Cited by 40 · see citing works
Effectiveness of dietary interventions in mental health treatment: A rapid review of reviews
Burrows, T. L., Teasdale, S. B., Rocks, T., Whatnall, M. C., Schindlmayr, J., Plain, J., Latimer, G., Roberton, M., Harris, D. M., & Forsyth, A. K. (2022) · Nutrition & Dietetics · doi:10.1111/1747-0080.12754 · Cited by 40 · see citing works
“20,21 22 – 25 Review evidence also suggests the effectiveness of dietary intervention in substance use disorder treatment.”
BackgroundSegal, L., Twizeyemariya, A., Zarnowiecki, D., Niyonsenga, T., Bogomolova, S., Wilson, A., O’Dea, K., & Parletta, N. (2020) · Nutritional Neuroscience · doi:10.1080/1028415x.2018.1556896 · Cited by 37 · see citing works
“Excluding potential clinical benefits and missing likely cost savings [18] will yield a conservative estimate of ‘value for money’.”
BackgroundGalekop, M. M. J., Groot, C. A. U., & Redekop, K. (2021) · Value in Health · doi:10.1016/j.jval.2020.12.006 · Cited by 39 · see citing works
Le, L. K.-D., Sanci, L., Chatterton, M. L., Kauer, S., Buhagiar, K., & Mihalopoulos, C. (2019) · Journal of Medical Internet Research · doi:10.2196/13065 · Cited by 35 · see citing works
“The different versions of the RUQ have been used in other trials in mental health [25].”
Self-citationMueller‐Stierlin, A. S., Cornet, S., Peisser, A., Jaeckle, S., Lehle, J., Mörkl, S., & Teasdale, S. B. (2022) · Nutrients · doi:10.3390/nu14132616 · Cited by 34 · see citing works
“Diet quality is inversely associated with depressive symptoms and incident depression [19], with a whole-of-diet approach being effective in reducing depressive symptoms [20,21] and cost-effective in terms of QALYs [22,23].”
BackgroundThe specifics of food design: Insights from professional design practice
Bordewijk, M., & Schifferstein, H. N. J. (2020) · International Journal of Food Design · doi:10.1386/ijfd_00001_1 · Cited by 33 · see citing works
Role of Nutrition and Diet on Healthy Mental State
Granero, R. (2022) · Nutrients · doi:10.3390/nu14040750 · Cited by 26 · see citing works
Prescott, S. L., Logan, A. C., D’Adamo, C. R., Holton, K. F., Lowry, C. A., Marks, J., Moodie, R., & Poland, B. D. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21020120 · Cited by 26 · see citing works
“Importantly, researchers have estimated that dietary intervention studies have the potential to save millions of dollars in healthcare costs alone [168,169].”
BackgroundZhang, W., Tocher, P., L’Heureux, J., Sou, J., & Sun, H. (2022) · Value in Health · doi:10.1016/j.jval.2022.06.015 · Cited by 18 · see citing works
Diet and depression: future needs to unlock the potential
Marx, W., Lane, M. M., Hockey, M., Aslam, H., Walder, K. R., Borsini, A., Firth, J., Pariante, C. M., Berding, K., Cryan, J. F., et al. (2021) · Molecular Psychiatry · doi:10.1038/s41380-021-01360-2 · Cited by 18 · see citing works
Opie, R. S., Jacka, F. N., Marx, W., Rocks, T., Young, C., & O’Neil, A. (2021) · Nutrients · doi:10.3390/nu13113766 · Cited by 16 · see citing works
Antidepressant-like Effects of Representative Types of Food and Their Possible Mechanisms
Piao, J., Wang, Y., Zhang, T., Zhao, J., Lv, Q., Ruan, M., Yu, Q., & Li, B. (2023) · Molecules · doi:10.3390/molecules28196992 · Cited by 15 · see citing works
“Dietary interventions are considered cost-effective potential treatment options for depression [174].”
BackgroundGut Health = Mental Health? The Impact of Diet and Dietary Supplements on Mood Disorders
Mueller, M. R., Ganesh, R., & Bonnes, S. L. R. (2020) · Current Nutrition Reports · doi:10.1007/s13668-020-00340-2 · Cited by 14 · see citing works
Zhang, W., & Sun, H. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01330-w · Cited by 13 · see citing works
Lawrence, K., Myrissa, K., Toribio-Mateas, M. A., Minini, L., & Gregory, A. M. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01058-4 · Cited by 12 · see citing works
“A trial implementing a modified Mediterranean diet in adults with depressive disorder found that those following the diet (which was similar in nature to that advised in this study) actually spent less money on their weekly shop than those in the control [108].”
MethodYoung, L. M., Moylan, S., John, T., Turner, M., Opie, R., Hockey, M., Saunders, D., Bruscella, C., Jacka, F. N., Teychenne, M. J., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03840-3 · Cited by 12 · see citing works
Logan, A. C., & Schoenthaler, S. J. (2023) · Challenges · doi:10.3390/challe14030037 · Cited by 13 · see citing works
“These interventions have been estimated to save millions of dollars in healthcare costs [146].”
Gao, L., Maddison, R., Rawstorn, J. C., Ball, K., Oldenburg, B. F., Chow, C. K., McNaughton, S. A., Lamb, K. E., Amerena, J. V., Nadurata, V., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-038178 · Cited by 12 · see citing works
The SMILES trial: an important first step
Jacka, F. N., O'Neil, A. E., Itsiopoulos, C., Opie, R., Cotton, S., Mohebbi, M., Castle, D. J., Dash, S. R., Mihalopoulos, C., Chatterton, M. L., et al. (2018) · BMC Medicine · doi:10.1186/s12916-018-1228-y · Cited by 12 · see citing works
Holloway, E. E., Gray, S., Mihalopoulos, C., Versace, V. L., Gautier, R. L., Chatterton, M. L., Hagger, V. L., Halliday, J., Henshaw, K., Harrap, B., et al. (2023) · Trials · doi:10.1186/s13063-023-07338-5 · Cited by 11 · see citing works
“At each time point within the trial, participants will be asked to complete a brief resource use questionnaire to collect information about other healthcare resources used and lost productivity [37, 38].”
BackgroundMethodStress-system activation in children with chronic pain: A focus for clinical intervention
McInnis, P., Braund, T. A., Chua, Z. K., & Kozlowska, K. (2019) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104519864994 · Cited by 11 · see citing works
“…system, simple dietary interventions that help maintain the health of that system – promoting an anti-inflammatory effect and helping decrease rates of comorbid anxiety and depression – may emerge as an important component of interventions for chronic pain (Chatterton et al., 2018).”
BackgroundNutrition interventions in populations with mental health conditions: a scoping review
Cherak, S. J., Fiest, K. M., VanderSluis, L., Basualdo‐Hammond, C., Lorenzetti, D., Buhler, S., Stadnyk, J., Driedger, L., Hards, L., Gramlich, L. M., et al. (2020) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2019-0683 · Cited by 10 · see citing works
What do Climate Change, Nutrition, and the Environment Have to do With Mental Health?
Sugden, S. G., & Merlo, G. (2024) · American Journal of Lifestyle Medicine · doi:10.1177/15598276241280245 · Cited by 9 · see citing works
“23 Men in the AMMEND study showed improvement in the Beck Inventory Scales after 12 weeks of MD compared to the control group.”
Using lifestyle interventions and the gut microbiota to improve PTSD symptoms
Sugden, S. G., & Merlo, G. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1488841 · Cited by 11 · see citing works
Burrows, T. L., Teasdale, S. B., Rocks, T., Whatnall, M. C., Schindlmayr, J., Plain, J., Roberton, M., Latimer, G., Harris, D. M., & Forsyth, A. K. (2021) · Nutrition & Dietetics · doi:10.1111/1747-0080.12703 · Cited by 9 · see citing works
Roponen, J., Ruusunen, A. A., Absetz, P., Partonen, T., Kuvaja-Köllner, V., Hujo, M., & Nuutinen, O. (2021) · Trials · doi:10.1186/s13063-021-05279-5 · Cited by 7 · see citing works
The Effect of Anxiety and Nutritional Habits on the Body Distortion of Athletes.
Ramírez-Goerke, M. I., Tornero-Aguilera, J. F., Martín-Rodríguez, A., & Clemente-Suárez, V. J. (2025) · Nutrients · doi:10.3390/nu17040682 · Cited by 6 · see citing works
“A diet intervention is a treatment that does not involve a high risk and it is cost-effective [6].”
Shiri, R., Varje, P., & Toppinen‐Tanner, S. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112140 · Cited by 6 · see citing works
Policy Actions Required to Improve Nutrition for Brain Health
Higgs, S., Aarts, K., Adan, R. A. H., Buitelaar, J. K., Cirulli, F., Cryan, J. F., Dickson, S. L., Kőrösi, A., van der Beek, E. M., & Dye, L. (2024) · Nutrition Reviews · doi:10.1093/nutrit/nuae160 · Cited by 7 · see citing works
Hockey, M., Aslam, H., Berk, M., Pasco, J. A., Ruusunen, A. A., Mohebbi, M., Macpherson, H., Chatterton, M. L., Marx, W., O'Neil, A. E., et al. (2021) · Trials · doi:10.1186/s13063-021-05812-6 · Cited by 6 · see citing works
“Lost work productivity, also captured in the RUQ, will be costed using the human capital approach by applying an average hourly wage rate plus 25% overhead costs [50, 51].”
MethodFletcher, S. L., Chondros, P., Palmer, V. J., Chatterton, M. L., Spittal, M. J., Mihalopoulos, C., Wood, A., Harris, M., Burgess, P. M., Bassilios, B., et al. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.12.014 · Cited by 6 · see citing works
“ A self-report resource use questionnaire (RUQ), adapted from one used previously in Australian trials of mental health interventions [15, 45, 46].”
MethodStaudacher, H. M., Teasdale, S., Cowan, C., Opie, R., Rocks, T., & Jacka, F. N. (2023) · Cambridge University Press eBooks · doi:10.1017/9781009299862 · Cited by 5 · see citing works
Stephenson, C., Jagayat, J., Kumar, A., Khamooshi, P., Eadie, J., Pannu, A., Meartsi, D., Danaee, E., Gutiérrez, G., Khan, F., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1220607 · Cited by 4 · see citing works
Deenik, J., van Lieshout, C., Driel, H. F. V., Frederix, G., Hendriksen, I. J. M., van Harten, P. N., & Tenback, D. E. (2022) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgac022 · Cited by 4 · see citing works
Diet Interventions for Anxiety and Depression
Staudacher, H. M., Teasdale, S. B., Cowan, C. S. M., Opie, R., Rocks, T., & Jacka, F. N. (2023) · Cambridge University Press eBooks · doi:10.1017/9781009299862.006 · Cited by 4 · see citing works
Steenson, S. (2019) · Nutrition Bulletin · doi:10.1111/nbu.12365 · Cited by 4 · see citing works
“…intervention had significantly lower average health sector costs ($856 lower; 95% CI: 1247, 160) and societal costs ($2591 lower; 95% CI: 3591, 198), relative to the social support group, due to fewer health professional visits and lower costs of unpaid productivity (Chatterton et al. 2018).”
BackgroundChilean Digital Press Coverage of the Relation between Diet and Mental Health
Sánchez-Sabaté, R., Zunino, E. A., Badilla-Briones, Y., Celedón-Celis, N., & Saldías, D. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052273 · Cited by 4 · see citing works
“In addition, it is likely that reinforcing treatments for mental illnesses with healthy diets is cost-effective in Chile, just as it is in Australia and New Zealand [42].”
BackgroundSkinner, J. A., Leary, M., Wynne, O., Hay, P., Collins, C. E., & Burrows, T. L. (2024) · Journal of Public Health · doi:10.1093/pubmed/fdae273 · Cited by 3 · see citing works
Gill, S. D., Stella, J., Chatterton, M. L., Lowry, N., Kloot, K., Reade, T., Baker, T. R., Hayden, G., Ryan, M., Seward, H. G., et al. (2023) · Emergency Medicine Australasia · doi:10.1111/1742-6723.14156 · Cited by 3 · see citing works
“Eligible participants were identified from a previous study8 investigating injury profiles of patients presenting to one of 10 public or private EDs in regional Victoria, Australia.”
MethodInfluentialFrom Fork to Feelings: How Foods Shape Mental Health via the Microbiota–Gut–Brain Axis
Ferri, A., Paes, L. T., Schneider, E., Clarke, G. A., & Cryan, J. F. (2026) · Annual Review of Food Science and Technology · doi:10.1146/annurev-food-053124-110137 · Cited by 3 · see citing works
Inflammatory potential of diet in mental disorders and psychosocial stress
Davis, J. A., Aslam, H., Jacka, F. N., & Marx, W. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-822130-3.00010-7 · Cited by 2 · see citing works
The Microbiome, Metabolism, and Networks in Precision Nutrition
Mensah, G. E., Maseng, M. G., Allard, S., & Gilbert, J. A. (2024) · Precision Nutrition · doi:10.1016/b978-0-443-15315-0.00011-0 · Cited by 2 · see citing works
Halliday, J. A., Holmes‐Truscott, E., Thuraisingam, S., Søholm, U., Chatterton, M. L., Russell‐Green, S., Eric, O., Andrikopoulos, S., Black, T., Davidson, S., et al. (2024) · Trials · doi:10.1186/s13063-024-08556-1 · Cited by 2 · see citing works
“Health economics At each timepoint, participants will complete a resource use questionnaire in the online survey, to collect information about the use of other health-care resources used and lost productivity [39, 40].”
Oostermeijer, S., Morgan, A. J., Rossetto, A., Kelly, C., Pirkis, J., Le, L. K., Mihalopoulos, C., & Reavley, N. J. (2022) · Mental Health & Prevention · doi:10.1016/j.mhp.2022.200250 · Cited by 2 · see citing works
Aucoin, M., & Barbaro, D. (2023) · CAND Journal · doi:10.54434/candj.148 · Cited by 1 · see citing works
Kik, J., Alma, M., Hofman, M. S., Panjer, J. A., Berger, M. Y., Burger, H., & Cath, D. C. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2025.100948 · Cited by 1 · see citing works
Pedroso, I., Saravanan, S. K., Kumbhare, S. V., Sharma, G., Almonacid, D. E., & Sinha, R. (2025) · Healthcare · doi:10.3390/healthcare13233147 · Cited by 1 · see citing works
“…of these findings: the SMILES trial demonstrated health-sector savings of approximately $218 PMPM and societal savings of $660 PMPM alongside improved depression outcomes, while the HELFIMED trial established favorable cost-utility ratios for Mediterranean diet programs in major depression [26].”
InfluentialThe Candesartan Adjunctive Depression Trials—CADET
Ashton, M. M., Park, C. H. J., Fernandes, B. S., Hope, J., Ng, C. H., Hopwood, M., Khoo, J., Malhi, G. S., Gwini, S. M., Amerena, J. V., et al. (2026) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000002156 · Cited by 1 · see citing works
Young, C., Rocks, T., Opie, R., Berk, M., & O'Neil, A. E. (2022) · Psychiatric Annals · doi:10.3928/00485713-20220126-02
Holloway, E. E., Gray, S., Mihalopoulos, C., Versace, V. L., Gautier, R. L., Chatterton, M. L., Hagger, V. L., Halliday, J., Henshaw, K., Harrap, B., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2659192/v1
Kipfer, A., Kahala, M., Kyhä, H., Nurmi, K., Puustinen, J., Korkeila, J. A., Ruusunen, A. A., & Kunvik, S. (2025) · Nutrition and Health · doi:10.1177/02601060251332358
“…or group counselling, have signi fi cantly improved moderate to severe depressive symptoms (Bayes et al., 2022; Francis et al., 2019; Jacka et al., 2017; Parletta et al., 2019), with two studies demonstrating good results in cost-effectiveness analyses (Chatterton et al., 2018; Segal et al. 2020).”
Roponen, J., Ruusunen, A., Nuutinen, O., Partonen, T., & Absetz, P. (2025) · British Journal of Nutrition · doi:10.1017/s0007114525103565
“However, it has also been shown that adhering to the recommended intervention diet (modified Mediterranean diet) was more affordable compared to the participants ’ typical diet (50) .”
Turner, M., O’Shea, M., Thurston, L., Jinnette, R., Beaconsfield, A., Mahoney, S., Ashtree, D. N., Bryan, M., Saunders, D., John, T., et al. (2025) · Mental health and physical activity · doi:10.1016/j.mhpa.2025.100730
Holloway, E. E., Gray, S., Mihalopoulos, C., Versace, V. L., Gautier, R. L., Chatterton, M. L., Hagger, V. L., Halliday, J., Henshaw, K., Harrap, B., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26591276
Hockey, M., Aslam, H., Berk, M., Pasco, J. A., Ruusunen, A. A., Mohebbi, M., Macpherson, H., Chatterton, M. L., Marx, W., O’Neil, A., et al. (2021) · Figshare · doi:10.6084/m9.figshare.17162819
Roponen, J., Ruusunen, A. A., Absetz, P., Partonen, T., Kuvaja-Köllner, V., Hujo, M., & Nuutinen, O. (2021) · Figshare · doi:10.6084/m9.figshare.14608894
Hockey, M., Aslam, H., Berk, M., Pasco, J. A., Ruusunen, A. A., Mohebbi, M., Macpherson, H., Chatterton, M. L., Marx, W., O’Neil, A., et al. (2021) · Figshare · doi:10.6084/m9.figshare.17162825
Holloway, E. E., Gray, S., Mihalopoulos, C., Versace, V. L., Gautier, R. L., Chatterton, M. L., Hagger, V. L., Halliday, J., Henshaw, K., Harrap, B., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26591279
Manger, S. (2025) · Springer eBooks · doi:10.1007/978-3-032-05888-1_1
Koleva‐Kolarova, R., Hulse, E. S. G., Németh, B. B., Mölken, M. R., Edwards, R. T., Babarczy, B., Nagy, B., Wordsworth, S., & Tsiachristas, A. (2026) · Applied Health Economics and Health Policy · doi:10.1007/s40258-025-01023-1
“Cost-utility analysis [25, 27, 29, 30, 33, 37–40, 42, 44, 46–53, 55–57, 60, 61, 63, 65–67, 70, 72–74, 77, 78, 81–85, 87–107, 111–113, 115, 116, 118–122, 124–128, 131–133, 135–141, 144–149, 151, 152, 154–156, 158, 159, 161–169, 172–179, 181, 183, 184, 187, 189–198, 213–215, 218, 225, 226]…”
Aucoin, M., Yu, H., Murphy, M., Yoannou, N., LaChance, L., Cooley, K., & Herman, P. M. (2026) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70302
Morley, K. C., Arunogiri, S., Mills, K. L., Watt, J., Teesson, M., Baillie, A., Lee, Y. Y., Morse, A. R., Back, S. E., Lubman, D. I., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-114896
“The MPATHY study will be the first double-blind RCT to examine the therapeutic and cost-effectiveness of evidence-based (1) integrated exposure therapy for PTSD and AUD+MDMA versus (2) integrated exposure therapy+active control in improving PTSD and alcohol outcomes.”
Health Economics of Primary Care Nutrition Interventions: a Systematic Review and Meta-Analysis
Wosser, C., Apergi, K., & O'Reilly, S. L. (2026) · Nutrition Reviews · doi:10.1093/nutrit/nuag051
Hsu, M. S. H., Guo, F., Morrow, W., Watkins, A., & Teasdale, S. B. (2026) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70349
- Authors
- Chatterton, M. L., Mihalopoulos, C., O’Neil, A., Itsiopoulos, C., Opie, R., Castle, D., Dash, S., Brazionis, L., Berk, M., & Jacka, F.
- Affiliations
- Deakin University (AU)
- La Trobe University (AU)
- The University of Melbourne (AU)
- Barwon Health (AU)
- Corresponding author
- Chatterton, Mary Lou
- ORCID
- Venue
- BMC Public Health
- Published
- 2018-05-22
- Volume
- 18
- Issue
- 1
- Pages
- 599-599
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC5963026
- OpenAlex
- W2803694214
- Cited by
- 81
- References
- 34
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 8 · 2023: 11 · 2022: 13 · 2021: 16 · 2020: 7 · 2019: 6 · 2018: 4
- FWCI
- 12.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Victoria University Research Repository (Victoria University) (submittedVersion, cc-by)
- RMIT Research Repository (RMIT University Library) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Funders
- National Health and Medical Research Council (1021347)
- Meat and Livestock Australia (2013)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- major depressive disorder, dietary intervention, dietitian support, cost-effectiveness, quality-adjusted life years, social support, adjunctive therapy, social costs, productivity loss, food costs, absenteeism, presenteeism, resource utilization (health care), Australia and New Zealand, New Zealand
- MeSH terms
- Adult, Australia, Cost-Benefit Analysis, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Social Support, Treatment Outcome, Health Care Costs, Quality-Adjusted Life Years
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