Summary:
Anxiety and depression are common mental health conditions that often occur together. Their co-occurrence is associated with greater disease severity, increased treatment complexity, and poorer long-term outcomes. Given their high prevalence and impact, identifying modifiable risk factors is important for prevention and management. This is a cross-sectional study which investigated the relationship between dietary behaviour and anxiety, depression, and their co-occurrence among rural adults in China. Previous research suggests that overall dietary patterns, rather than individual foods, are more strongly associated with mental health outcomes. However, limited evidence exists on how dietary behaviour relates specifically to the co-occurrence of anxiety and depression. Rural populations may be at increased risk due to disparities in socioeconomic conditions, healthcare access, and nutrition. Diets in these settings are often less diverse and lower in nutrient-rich foods, which may contribute to poorer mental health outcomes. This study analysed data from a chronic disease and nutrition surveillance program. Dietary behaviour was assessed using a healthy diet score. Anxiety and depression symptoms were measured using validated screening tools, and statistical models were used to examine associations between diet and mental health outcomes. The findings showed that poorer dietary quality was associated with higher odds of anxiety, depression, and their co-occurrence. Individuals with the lowest diet scores had more than double the likelihood of experiencing these conditions compared to those with healthier diets. Similarly, participants with moderately healthy or unhealthy dietary patterns also had significantly increased risk across all outcomes. Overall, this study demonstrates that unhealthy dietary behaviour is associated with a higher prevalence of anxiety, depression, and comorbidity in rural Chinese populations. These findings suggest that improving overall dietary patterns may be an effective strategy to support mental health and reduce disease burden in these communities.
Abstract:
Background: Mental health issues pose a significant public health challenge. Anxiety and depression are among the most prevalent mental health problems. However, the association between dietary behavior and these mental health conditions among the rural population is unclear. This study examined the relationship between dietary behavior and the prevalence of anxiety, depression, and comorbidity among rural residents in China. Methods: This cross-sectional study used data from the Adult Chronic Disease and Nutrition Surveillance program in Pingnan. Dietary behavior was evaluated by healthy diet scores and dietary patterns. Two-Step Cluster Analysis (TCA) was employed to categorize the dietary patterns. Anxiety and depression symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Binary logistic regression models were conducted to explore the impacts of healthy diet scores and dietary patterns on anxiety, depression, and comorbidity. Results: Binary logistic regression results showed that rural residents with a healthy diet score of 0 and 1 had a significantly higher prevalence of anxiety (OR = 2.53, 95% CI = 1.29–4.96; OR = 2.31, 95% CI = 1.23–4.36), depression (OR = 2.65, 95% CI = 1.24–5.66; OR = 2.47, 95% CI = 1.20–5.05), and comorbidity (OR = 3.15, 95% CI = 1.27–7.84; OR = 2.42, 95% CI = 1.01–5.78). Individuals with a “moderately healthy pattern” and an “unhealthy pattern” also exhibited a significantly elevated prevalence of anxiety (OR = 1.67, 95% CI = 1.20–2.34; OR = 1.69, 95% CI = 1.14–2.50), depression (OR = 1.67, 95% CI = 1.17–2.39; OR = 1.61, 95% CI = 1.05–2.45), and comorbidity (OR = 1.88, 95% CI = 1.20–2.95; OR = 2.15, 95% CI = 1.29–3.57). Conclusions: Unhealthy dietary behavior is significantly associated with an increased prevalence of anxiety, depression, and comorbid conditions among rural residents in China. Promoting healthy dietary habits may help reduce the incidence and severity of anxiety and depression, thereby enhancing the overall mental health of rural communities.
Article Publication Date: 30/01/2026
DOI: 10.1186/s12889-026-26340-5
