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A brief diet intervention can reduce symptoms of depression in young adults—a randomised controlled trial
Open accessAbstract
There is strong epidemiological evidence that poor diet is associated with depression. The reverse has also been shown, namely that eating a healthy diet rich in fruit, vegetables, fish and lean meat, is associated with reduced risk of depression. To date, only one randomised controlled trial (RCT) has been conducted with elevated depression symptoms being an inclusion criterion, with results showing that a diet intervention can reduce clinical levels of depression. No such RCTs have been performed in young adults. Young adults with elevated levels of depression symptoms and who habitually consume a poor diet were randomly allocated to a brief 3-week diet intervention (Diet Group) or a habitual diet control group (Control Group). The primary and secondary outcome measures assessed at baseline and after the intervention included symptoms of depression (Centre for Epidemiological Studies Depression Scale; CESD-R; and Depression Anxiety and Stress Scale- 21 depression subscale; DASS-21-D), current mood (Profile of Mood States), self-efficacy (New General Self-Efficacy Scale) and memory (Hopkins Verbal Learning Test). Diet compliance was measured via self-report questionnaires and spectrophotometry. One-hundred-and-one individuals were enrolled in the study and randomly assigned to the Diet Group or the Control Group. Upon completion of the study, there was complete data for 38 individuals in each group. There was good compliance with the diet intervention recommendations assessed using self-report and spectrophotometry. The Diet group had significantly lower self-reported depression symptoms than the Control Group on the CESD-R (p = 0.007, Cohen's d = 0.65) and DASS-21 depression subscale (p = 0.002, Cohen's d = 0.75) controlling for baseline scores on these scales. Reduced DASS-21 depression subscale scores were maintained on follow up phone call 3 months later (p = .009). These results are the first to show that young adults with elevated depression symptoms can engage in and adhere to a diet intervention, and that this can reduce symptoms of depression. The findings provide justification for future research into the duration of these benefits, the impacts of varying diet composition, and their biological basis.
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“several recent RCTs (not captured in our meta-review) have reported significant improvements in clinical depression from Mediterranean diet interventions, observing moderately large positive effects 102-104 .”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [102]
Experimental — accuracy not yet measuredIn the citing paper
“While there is existing evidence from clinical interventions showing improvements in depression and anxiety symptoms following dietary manipulation (199, 311, 326), these studies have not, to date, collected gut microbiota data.”
From Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health (2021) · cites this paper as [326]
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“On the other hand, several recent smaller trials in individuals with current depression observed moderately large improvements from interventions based on the Mediterranean diet.35 36 37”
From Food and mood: How do diet and nutrition affect mental wellbeing? (2020) · cites this paper as [35]
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“71 Moreover, sleep quality promotes adolescent mental health more than healthy behaviors such as physical exercise, sleep intake, and healthy diet; this phenomenon is prevalent in different geographical and cultural settings.”
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“A recent study has also shown that a certain amount of vegetables and fish intake has a significant improvement in clinical levels of depression in young and older adults [43–45].”
BackgroundPolicy 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 8
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“Consideration has also been given to intervention duration; prior studies have indicated that dietary changes can affect depressive symptoms in as little as 3 weeks [71]; thus, the duration of the intervention (16 weeks) should be long enough for us to adequately examine the effects of beta-casein consumption on sympt…”
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BackgroundStaudacher, 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
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“Various studies have demonstrated an improvement in mood with dietary interventions (Bayes et al., 2022; Francis et al., 2019; Jacka et al., 2017; O’Neill et al., 2022), and dietary behavior seems to be associated with subjective well-being and happiness (e.g., De Leon et al., 2022; Ocean et al.,…”
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“…participants with depressive disorders have reported significant improvement in depression symptoms following dietary interventions aimed at improving diet quality and increasing consistency with the Mediterranean diet [9–12] alone or in combination with omega-3 fatty acid supplementation [13].”
BackgroundBack to Basics: Lifestyle Interventions for Adolescent Depression
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“their depressive symptomswere reduced from themoderately severe range to the normal range following the intervention.(110)”
The A, B, C, D’s of dietary trials
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“It was a Mediterranean-style diet based on Greek and Spanish guidelines, and the food group recommendations fit parameters of a traditional Mediterranean diet, except for fish consumption, which was at the lower end of that recommended in the guidelines referenced (references 35–37) and slightly lower than that recomm…”
BackgroundMethodDiet 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
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Indirect Interventions: Lifestyle Options to Treat Mental Disorders
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Is the association between food insecurity and depression mediated by diet?
Melissa Bateson, B., Neal, C., Shannon, O., & Nettle, D. (2026) · Appetite · doi:10.1016/j.appet.2026.108696 · Cited by 3
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“Stress, a significant predisposing factor for depression [78], is also linked to dietary habits, including the excessive consumption of sugar and processed foods, which are correlated with heightened depressive symptoms [9,79].”
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Yogic Diet, Trigunas and Mental Health: Implications for Research
Suresh, V. N., Srilakshmidevi, B., & Suresh, V. N. (2020) · Indian Journal of Health Studies · doi:10.56490/ijhs.2020.2204 · Cited by 3
“A study by Francis et al. (2019) found that brief dietary intervention can decrease the symptoms of depression in young adults.”
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“Education level* High school and less 28(25) 39(28.”
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“Poor diet is detrimental to mental health and dietary interventions had significantly altered the depressive state among young adults and adolescents that had been well documented [45, 46].”
Okada, M., Pehlivan, M., Miskovic‐Wheatley, J., Barakat, S., Griffiths, K. R., Touyz, S. W., Simpson, S. J., Maguire, S., & Holmes, A. J. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1281855 · Cited by 3
Chan, G., Rosic, T., Pasyk, S., Dehghan, M., & Samaan, Z. (2021) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s295026 · Cited by 3
“A randomized controlled trial (RCT) found significantly reduced depressive symptoms in their intervention group which was told to eat moderate amounts of fruit, whole grains, nuts, seeds, and fish.(46) The amounts recommended by Francis et al’s study were well below the average intake reported by our participants, whi…”
BackgroundKipfer, A., Laatikainen, T., Partonen, T., Roponen, J., Lamidi, M., & Nuutinen, O. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2025.100914 · Cited by 2
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Inflammatory potential of diet in mental disorders and psychosocial stress
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Stress and Disordered Eating Patterns
Tsofliou, F., Casey, C., & Hughes, C. (2022) · Springer eBooks · doi:10.1007/978-3-030-67929-3_3-1 · Cited by 2
Specific Foods Associated with Depressive Symptoms among Young Adults and Their Bioactive Effects
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“Throughout the entire life cycle, strong epidemiological evidence indicates that poor diet or unhealthy foods are associated with depression, especially in young adults who are more susceptible to poor diet compared to other age groups [17,18].”
BackgroundSimultaneous Inference Using Multiple Marginal Models
Hothorn, L. A., Ritz, C., Schaarschmidt, F., Jensen, S. M., & Ristl, R. (2024) · Pharmaceutical Statistics · doi:10.1002/pst.2428 · Cited by 2
“A recent study compared a diet consisting of more fruit and vegetables as well as other foods known to be associated with reduced risk of depression to a habitual control diet [44].”
Kardel, K. R., Iversen, P. O., Kaaya, A. N., Muhoozi, G. K. M., Veierød, M. B., Wangen, K. R., Børøsund, E., & Atukunda, P. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06056-9 · Cited by 2
“Francis et al. [45] reported a mean difference in CES-D score of 6 points between young adults on a healthy diet vs. 12).”
BackgroundThe association between the number of food kinds and risk of depression in U.S. adults
Xu, Q.-H., Yang, T., Jiang, K.-Y., Liu, J., Guo, H., & Xia, E.-Q. (2024) · BMC Public Health · doi:10.1186/s12889-024-19344-6 · Cited by 2
“By 2030, Depression was predicted to be the leading cause of disease burden depression and other mental diseases [6, 7].”
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“A growing body of literature now confirms that adolescents with depression are more likely to have unhealthy dietary patterns and consume fewer healthy foods, compared with non-depressed youth (5 – 8) .”
Campisi, S. C., Liang, M., Anthony, S. J., Dettmer, E. L., & Korczak, D. J. (2024) · British Journal Of Nutrition · doi:10.1017/s0007114524001338 · Cited by 2
Dudley, L. M., Stevenson, R. J., Mruk, A., Saluja, S., & Francis, H. (2025) · Appetite · doi:10.1016/j.appet.2025.108222 · Cited by 2
Self-citationKozyra, M., Zimnicki, P., Kaczerska, J., Śmiech, N., Nowińska, M., & Milanowska, J. (2020) · Journal of Education Health and Sport · doi:10.12775/jehs.2020.10.08.011 · Cited by 2
“Comparison of the two groups with the CESD-R and DASS-21-Depression scale indicated a statistically significantly reduced depression after a 3-week healthy diet of the subjects to the control group [14].”
Ekeanyanwu, R. C., Chikezie, P. C., & Chile-Agada, A. B. (2022) · Scientific African · doi:10.1016/j.sciaf.2022.e01397 · Cited by 2
The relationship of diet quality and body composition with depression level in young women
Yardımcı, H., & Demir, G. (2022) · Acta Scientiarum Health Sciences · doi:10.4025/actascihealthsci.v45i1.60410 · Cited by 2
role of the gut microbiota in pathogenesis and treatment of depression
Bogusz, K., Baran, N., Maksymowicz, M., BIELAK, A., NOWAK, A., CYWKA, Ł., Szwed, W., Nowak, A., & Machowiec, P. A. (2023) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.31.01.006 · Cited by 2
Wakui, N., Ichikawa, K., Okami, A., Kagi, H., Kawakubo, S., Togawa, C., Matsuoka, R., Watanabe, M., Yamamura, M., Shirozu, S., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0294357 · Cited by 2
Nan, J., Purpura, S., Jaiswal, S., Afshar, H., Maric, V., Manchanda, J. K., Taylor, C. T., Ramanathan, D., & Mishra, J. (2026) · NPP—Digital Psychiatry and Neuroscience · doi:10.1038/s44277-026-00062-3 · Cited by 1
Fathi, M., Alavinejad, P., Haidari, Z., & Amani, R. (2022) · Journal of Trace Elements and Minerals · doi:10.1016/j.jtemin.2022.100035 · Cited by 1
Cheung, A., Dutta, P., Kovic, Y., Stojcevski, M., & Fan, X. (2022) · Academic Psychiatry · doi:10.1007/s40596-022-01732-y · Cited by 1
“Diet modification programs have been shown to improve symptoms of depression [8, 9] and bipolar disorder [10], suggesting the potential mental health benefit of such interventions [11].”
BackgroundStress and Disordered Eating Patterns
Tsofliou, F., Casey, C., & Hughes, C. (2023) · Springer eBooks · doi:10.1007/978-3-031-16691-4_3 · Cited by 1
Acute And Chronic Disease Diagnosis Using ML For Post Covid 19 Medical Issues
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“As we used several ml algorithms, such as the K-Fold Cross Validation approach, Random Forests, Vector Support Classifier, and Gaussian Bayesian Classifier, [14-15] we took the data of many individuals and forecasted their linked illness based on their symptoms.”
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Depression and Suicide in the “World’s Happiest Countries”
Fogel, B. S., & Jiang, X. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780190850074.003.0013 · Cited by 1
Badzińska, J., Żegleń, M., & Kryst, Ł. (2025) · American Journal of Human Biology · doi:10.1002/ajhb.70039 · Cited by 1
“Moreover, it is important to remember that diet can affect not only the physical health of adolescents but also the risk of mental health problems such as depression and anxiety disorders (Chen et al. 2023; Francis et al. 2019).”
Koo, H., Ishihara, K., Kanejima, Y., Nakatani, M., & Izawa, K. P. (2025) · Psychiatry International · doi:10.3390/psychiatryint6020062 · Cited by 1
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“” Traditional Chinese Medicine / Diet or supplement [70]“Participants in the Diet Change group received the diet intervention instructions from our registered dietician via a 13-min video, available for re-watching online as needed.”
Metadata
- Authors
- Francis, H. M., Stevenson, R. J., Chambers, J. R., Gupta, D., Newey, B., & Lim, C. K.
- Affiliations
- Macquarie University (AU)
- Corresponding author
- Francis, Heather M.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-10-09
- Volume
- 14
- Issue
- 10
- Pages
- e0222768
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6784975
- OpenAlex
- W2980066052
- Cited by
- 277
- References
- 39
- Citations by year
- 2026: 19 · 2025: 57 · 2024: 51 · 2023: 43 · 2022: 47 · 2021: 37 · 2020: 23
- FWCI
- 24.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Society for Mental Health Research (Project Grant 2016)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- depression, dietary intervention, young adults, depressive symptoms, dietary adherence, mood, self-efficacy, memory, healthy eating
- MeSH terms
- Adult, Depression, Diet, Female, Follow-Up Studies, Health Planning Guidelines, Humans, Male, Patient Compliance, Outcome Assessment, Health Care, Young Adult, Intention to Treat Analysis
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