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Background: Plant-based dietary pattern, a new scoring system, has had a favorable relationship with the risk of chronic diseases, however, the associations with mental health are long disputed. Thus, we examined the association between an overall plant-based diet (PDI), healthy plant-based diet (hPDI), and unhealthy plant-based diet (uPDI) and psychological disorders in adult Iranian patients., Methods: In this large cross-sectional study, 3,362 Iranian men and women were recruited. Dietary data were gathered using a validated and reliable Willett format food frequency questionnaire (FFQ). Plant-based dietary pattern scores were calculated based on the method of Satija et al. Psychological profile assessment was done using the validated hospital anxiety and depression scale (HADS) and the general health questionnaire (GHQ)., Results: A total number of 943, 448, and 760 participants who suffered from depression, anxiety, and psychological distress, respectively, were identified. In the multivariable-adjusted analysis, participants in the highest category of PDI and hPDI scores had lower odds of having depression and anxiety than those in the lowest category. This association was also found between hPDI and psychological distress (OR: 0.51, 95% CI: 0.38-0.68). In contrast, higher scores of uPDI was associated with increased odds of anxiety (OR: 1.60, 95% CI: 1.06-2.42) and psychological distress (OR: 1.38, 95% CI: 1.01-1.90)., Limitation: The cross-sectional study design., Conclusion: Our results indicated that greater adherence to the overall plant-based diet and healthy plant-based diet was inversely associated with psychological disorders, while following unhealthy plant-based diet increased the risk of anxiety and psychological distress., (Copyright © 2022. Published by Elsevier B.V.)

The present study was carried out to determine whether the dietary insulin index (DII) and dietary insulin load (DIL) are related to psychological disorders in a cross-sectional study among adults. A total of 3172 Iranian adults (age range of 18-55 years) were included. Data on dietary intakes were collected using a validated dish-based 106-item semi-quantitative FFQ. DII and DIL were calculated using food insulin index values published earlier. To assess depression and anxiety, an Iranian validated version of the Hospital Anxiety and Depression Scale was used. Furthermore, psychological distress was examined using the General Health Questionnaire. Among women, a significant positive association was seen; such that women in the highest quartile of DIL had higher odds of depression than those in the lowest quartile (OR 1·84; 95 % CI 1·14, 2·96). In terms of DII, in the fully adjusted model, women in the top quartile of DII were more likely to be depressed compared with those in the bottom quartile (OR 1·65; 95 % CI 1·05, 2·58). In conclusion, we found a significant positive association between DIL and DII and odds of depression among women, but not in men. However, such findings were not seen for anxiety and psychological distress.

Background: The purpose of this study was to explore the association of five factors personality traits, as predictor variables, with the anxiety and depression as joint dependent variables in an Iranian adult population., Subjects and Methods: A total of 3175 subjects living in Isfahan participated in this cross-sectional population-based study (SEPAHAN) and completed self-administered questionnaires about demographic, life style, gastrointestinal disorders, personality traits, social support, and psychological problems. Data was analyzed using bivariate multiple binary logistic regression in R Free statistical software., Results: The results indicated high scores of neuroticisms increase the risk of anxiety and depression after adjustment for the potential confounders in total sample (OR (95% CI): 1.22 (1.19-1.24) and 1.19 (1.17-1.21), respectively) as well as in both male and female. In contrast, joint inverse associations were found between anxiety and depression with high extraversion (OR (95% CI): 0.90 (0.88-0.92) and 0.91 (0.89-0.92), respectively), agreeableness (0.93 (0.91-0.96) and 0.94 (0.92-0.96) respectively) and conscientiousness scores (0.95 (0.93-0.97) and 0.95 (0.94-0.97) respectively) as well as in both male and female. Furthermore, higher scores of openness had significant inverse association with depression in male., Conclusion: The present study indicated that higher scores of neuroticism, however lower extraversion, conscientiousness and agreeableness scores are risk factors for both anxiety and depression in Iranian adult population. It is suggested to perform family studies or twin and genetic association studies with considering combinations of personality traits (personality styles), and also measuring personality traits at the facet level.

Background & Aims: Limited data are available on the association of inflammatory potential of the diet and odds of psychological disorders. We investigated the association between adherence to a pro-inflammatory diet, as measured by Dietary Inflammatory Index (DII), and odds of psychological disorders., Methods: In this cross-sectional study, dietary intakes of 3363 Iranian adult participants were collected using a validated Dish-based 106-item Semi-quantitative Food Frequency Questionnaire (DS-FFQ). DII score was calculated based on participants' dietary intakes obtained from DS-FFQ. The Iranian validated version of Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ) was used to assess psychological disorders. For depression and anxiety, scores of 8 or more on either subscale were considered as psychological disorders and scores of 0-7 were defined as "normal". In terms of psychological distress, the score of 4 or more was defined as psychological distress., Results: Overall, 28% (n = 943) of study participants had depression, 13.3% (n = 448) were affected by anxiety and 22.6% (n = 760) by psychological distress. After controlling for potential confounders, individuals in the highest quintile of DII score had higher scores of depression (6.56 ± 0.16 vs. 5.48 ± 0.16; P < 0.001), anxiety (3.85 ± 0.17 vs. 3.09 ± 0.17; P = 0.006), and psychological distress (2.42 ± 0.13 vs. 1.77 ± 0.13; P = 0.001), compared with those in the lowest quintile. Participants in the top quintile of DII score had greater odds of depression (OR: 1.84, 95% CI: 1.30-2.60), anxiety (OR: 1.69, 95% CI: 1.07-2.67), and psychological distress (OR: 1.72, 95% CI: 1.20-2.46) than those in the bottom quintile., Conclusions: We found that adherence to a pro-inflammatory diet was positively associated with psychological disorders., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objectives: Although several studies are available that link individual dietary antioxidants to the risk of psychological disorders, data about the association of dietary total antioxidant capacity (TAC) with depression and anxiety are scarce. This study was conducted to investigate the association between dietary TAC and odds of depression and anxiety among Iranian adults., Methods: In this cross-sectional study, the dietary intakes of 3297 apparently healthy adults in the Isfahan province of Iran were assessed using a validated food-frequency questionnaire. Dietary TAC was estimated using the ferric-reducing antioxidant power international databases. Depression and anxiety were assessed using a validated Persian translated version of the Hospital Anxiety and Depression Scale questionnaire. Scores of 0 to 7 in either subscales of the questionnaire were considered normal, and scores of ≥8 indicated the presence of depression or anxiety., Results: Overall, 943 study participants (28.6%) were depressed, and 448 participants (13.6%) had anxiety. After controlling for potential confounders, including the dietary intake of omega-3 fatty acids, we found that participants in the top quintile of the dietary TAC were 43% less likely to be depressed than those in the bottom category (odds ratio: 0.57; 95% confidence interval, 0.40-0.82; P trend  = .001). Regarding anxiety, we found an inverse significant association between dietary TAC and anxiety when comparing the extreme quintiles (odds ratio: 0.62; 95% confidence interval, 0.39-0.99; P trend  = .06)., Conclusions: We found an significant inverse association between dietary TAC and odds of depression and anxiety among adults. Further prospective studies are required to confirm these findings., (Copyright © 2018. Published by Elsevier Inc.)

Background & Aims: The association between diet and mental health disorders might be mediated by inflammatory properties of the diet. We evaluated the association between the dietary inflammatory index (DII) and the risk of a worsened mental health disorders profile., Methods: A total of 3363 Iranian adults were included in this cross-sectional study. A mental health disorders profile score was calculated using regression analysis, within the framework of factor analysis, based on anxiety, depression and psychological distress, with a higher scores indicating greater severity of mental problems. Dietary intakes were assessed using a validated dish-based food frequency questionnaire (DFQ). Twenty-seven macro- and micro-nutrients, onions, tea and caffeine were included in the calculation of DII. Each of them received a score based on their inflammatory ability, thus, a greater DII indicated a more pro-inflammatory diet. The odds of being in the highest tertile of mental health disorders profile across the tertiles of DII was assessed using multinomial logistic regression., Results: Either in the crude or fully-adjusted multinomial logistic regression models, participants in the lowest tertile of DII had a lower risk for being in the top tertile of mental health disorders profile (adjusted model: OR: 0.45; 95% CI: 0.33, 0.60; P trend<0.001). In a stratified analysis by sex, similar findings were observed in both genders, although there was only a trend for the associations to be significant in men (men: OR: 0.53; 95% CI: 0.31, 0.90; P trend = 0.070; women: OR: 0.40; 95% CI: 0.27, 0.58; P trend<0.0001)., Conclusions: Our findings suggest a direct association between the pro-inflammatory properties of the diet and an increased risk of higher mental health disorders profile scores. Prospective dietary intervention studies and observational prospective cohorts are required to confirm these findings., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Somatic syndrome is one of the remarkably prevalent issues in primary health care and subspecialty settings. We aimed to elucidate multidimensional associations between somatic symptoms with major mental problems and personality traits in the framework of the quantile regression model with a Bayesian approach., Methods: A total of 4763 employees at Isfahan University of Medical Sciences and Health Services in Isfahan province, Iran, filled out four validated questionnaires including Hospital Anxiety and Depression Scale (HADS), NEO Questionnaire, General Health Questionnaire (GHQ) and PHQ-15 for somatic symptom severity. In addition, Functional Gastrointestinal Disorders (FGIDs) were determined using Rome IV criteria. Exploratory Factor Analysis (EFA) and Bayesian regularized quantile regression with adaptive LASSO penalization were applied for reduced dimension of somatic symptoms and variable selection and parameter estimation, respectively., Results: The 25 major somatic symptoms were grouped into four factors including general, upper gastrointestinal, lower gastrointestinal and respiratory by EFA. Stress, depression, and anxiety had significant effects on all of the four extracted factors. The effect of anxiety in each four extracted factors was more than stress and depression. Neuroticism and agreeableness had significant effects on all of the four extracted factors, generally (p < 0.05)., Conclusions: Given the high prevalence of somatic symptoms and psychosomatic complaints in correlation with the diverse range of mental co-morbidities, developing more detailed diagnostic tools and methods is crucial; nonetheless, it seems that providing better interdisciplinary approaches in general medical practice is groundwork.

Background & Aims: Despite the growing evidence about dietary patterns, this study aimed at the association between patterns of nutrients intake and psychological disorders., Methods: In this cross-sectional study, diet and psychological factors including anxiety, depression, and general health (GHQ) were assessed through self-administered questionnaires in 3846 Iranian adults. Daily intakes of 57 nutrients and bioactive compounds were calculated. Nutrient patterns (NPs) were derived using factor analysis., Results: Three NPs were identified: 1) high in individual amino acids, cobalamin, zinc, phosphorus, saturated fatty acids, cholesterol and pantothenic acid named as "omnivore"; 2) high in thiamin, folate, selenium, iron, starch, maltose, betaine, calcium, riboflavin, and niacin; named as "grains and dairy". Mono-unsaturated fats, vitamin E and polyunsaturated fats were inversely associated with this pattern; 3) "fruits and vegetables" NP high in copper, vitamin C, glucose, fructose, potassium, dietary fiber, sucrose, vitamin A, magnesium and vitamin K. After adjustment for confounders, men in the top tertile of the omnivore NP had lower anxiety score than those in the bottom tertile (P = 0.04). Men in the highest tertile of the first NP were less likely to be depressed (OR = 0.50, 95%CI: 0.26-0.96; P-trend = 0.04). Women in the highest tertile of this pattern had lower GHQ scores than those in the bottom tertile (P = 0.01) and had lower odds of psychological distress (OR = 0.75, 95%CI: 0.57-0.99, P-trend = 0.0.04)., Conclusions: An "omnivore" like diet high in amino acids, cobalamin, zinc, phosphorus, saturated fat, cholesterol and pantothenic acid is associated with reduced psychological disorders. Prospective studies are recommended to confirm our results., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objectives: This study aims to find whether breakfast consumption is associated with human mental health., Study Design: This cross-sectional study was conducted to investigate the association between breakfast consumption and psychological disorders, including depression and anxiety, among Iranian adults., Methods: This cross-sectional study was conducted on 4378 general public adults in Isfahan, Iran. Breakfast consumption was assessed using a validated detailed dietary habits' questionnaire. Depression and anxiety were screened using an Iranian validated Hospital Anxiety and Depression Scale questionnaire. Psychological distress was examined by means of Iranian validated version of General Health Questionnaire (GHQ-12 items). Depression, anxiety, and psychological distress were defined based on standard criteria., Results: Overall, 13.95% (n = 611) of study participants had anxiety, 28.62% (n = 1253) were depressive, and 23.18% (n = 1015) had psychological distress. After controlling for potential confounding variables, participants with every day breakfast consumption had lower odds for depression (odds ratio [OR]: 0.49, 95% confidence interval [95% CI]: 0.36-0.66) compared with those with the least frequent intake of breakfast, even after further adjustment for body mass index [BMI] (OR: 0.47, 95% CI: 0.34-0.63). Frequent breakfast consumption was inversely associated with anxiety before (OR: 0.53, 95% CI: 0.37-0.76, P < 0.001) and after controlling for BMI (OR: 0.52, 95% CI: 0.36-0.75, P < 0.001). The same findings were obtained for psychological distress (OR: 0.46, 95% CI: 0.33-0.62, P < 0.001)., Conclusion: We found an inverse association between breakfast consumption and depression, anxiety, and psychological distress among Iranian adults. Further prospective studies are needed to confirm these findings., (Copyright © 2018. Published by Elsevier Ltd.)

The current study aimed to determine the prognostic values of personality traits for common psychological problems in a large sample of Iranian adult. In a large sample of healthy people (n = 4763) who lived in Isfahan province; the NEO-FFI was used to assess the personality traits; depression and anxiety were assessed using the "Hospital Anxiety and Depression Scale (HADS)" also stress was measured through Persian validated version of General Health Questionnaire (GHQ-12). Receiver Operating Characteristics Curve (ROC) analysis was used as main statistical method for data analysis. ROC analysis showed neuroticism was the best predictor for all psychological problems with highest area under the curve (AUC) (95% confidence interval) for stress, 0.837 (0.837-0.851), anxiety 0.861 (0.847-0.876) and depression 0.833 (0.820-0.846) (p < .001) and the corresponding cut-off points (sensitivity, specificity), were 21.5 (77%, 66%), 22.5 (81%, 77%) and 20.5 (77%, 74%), respectively. Other personality traits were significant protective factors for being affected with psychological problems (p < .001). Similar findings were observed separately in women and men. The present study showed that the neuroticism is significant risk factor for being affected with three psychological problems while other traits are significant protective factors. Personality traits are useful indices for screening psychological problems and an effective pathway toward prevention in general population., Competing Interests: All authors declare that they have no conflict of interests., (© Atlantis Press International B.V.)

Findings from clinical trials on the effect of Mg supplementation on depression and anxiety are not generalisable to the community owing to high-dose intervention in short-term periods. Limited observational data are available linking dietary intake of Mg and psychiatric disorders. We aimed to investigate the association between dietary intake of Mg and psychiatric disorders in a large cross-sectional study on Iranian adults. A total of 3172 Iranian adults (with an age range of 18-55 years) were included in this study. Data on dietary intakes were collected using a validated dish-based 106-item semi-quantitative FFQ. To assess depression and anxiety, an Iranian validated version of the Hospital Anxiety and Depression Scale was used. Furthermore, psychological distress was examined using the General Health Questionnaire. The mean age of men and women was 38·4 (sd 8·2) and 35·1 (sd 7·4) years, respectively. In unadjusted analyses, we found that higher dietary Mg intake was associated with lower odds of anxiety among women (OR 0·61; 95 % CI 0·41, 0·90), such that after taking potential confounders into account women in the highest quintile of Mg intake had a 39 % lower odds of anxiety compared with those in the lowest quintile (OR 0·61; 95 % CI 0·40, 0·93). Moreover, deficient Mg intake was positively associated with anxiety among all women (OR 1·80; 95 % CI 1·19, 2·72) and also normal-weight women (OR 1·73; 95 % CI 1·01, 2·95). In addition, a significant inverse association was found between dietary Mg intake and depression among normal-weight men (OR 0·45; 95 % CI 0·20, 0·99) and overweight women (OR 0·45; 95 % CI 0·24, 0·85). In conclusion, dietary intake of Mg was inversely associated with depression and anxiety. However, such findings were not seen for psychological distress.

Objective: The current study is aimed at investigating the association between stressful life events and psychological problems in a large sample of Iranian adults., Method: In a cross-sectional large-scale community-based study, 4763 Iranian adults, living in Isfahan, Iran, were investigated. Grouped outcomes latent factor regression on latent predictors was used for modeling the association of psychological problems (depression, anxiety, and psychological distress), measured by Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ-12), as the grouped outcomes, and stressful life events, measured by a self-administered stressful life events (SLEs) questionnaire, as the latent predictors., Results: The results showed that the personal stressors domain has significant positive association with psychological distress ( β = 0.19), anxiety ( β = 0.25), depression ( β = 0.15), and their collective profile score ( β = 0.20), with greater associations in females ( β = 0.28) than in males ( β = 0.13) (all P < 0.001). In addition, in the adjusted models, the regression coefficients for the association of social stressors domain and psychological problems profile score were 0.37, 0.35, and 0.46 in total sample, males, and females, respectively ( P < 0.001)., Conclusion: Results of our study indicated that different stressors, particularly those socioeconomic related, have an effective impact on psychological problems. It is important to consider the social and cultural background of a population for managing the stressors as an effective approach for preventing and reducing the destructive burden of psychological problems.

Earlier studies have shown a protective association between adherence to healthy eating guidelines and mental disorders in Western nations; however, data in this regard are limited from the understudied region of Middle East. We examined the association between adherence to healthy eating guidelines, as measured by Alternative Healthy Eating Index (AHEI)-2010, and prevalence of anxiety and depression in a large sample of Iranian adults. In this cross-sectional study, data on dietary intakes of 3363 adult participants were collected using a validated dish-based 106-item semi-quantitative FFQ. Adherence to healthy eating was quantified using AHEI-2010, as suggested by earlier publications. The Iranian validated version of Hospital Anxiety and Depression Scale was used to assess anxiety and depression in study participants. Data on other covariates were gathered using a pre-tested questionnaire. Overall, the prevalence of anxiety and depression was 15·2 % (males 10·8 % and females 18·3 %) and 30·0 % (males 22·9 % and females 35·1 %), respectively. After controlling for potential confounders, those in the top quartile of AHEI-2010 had a 49 % lower chance of anxiety (OR 0·51; 95 % CI 0·35, 0·72) and a 45 % lower odds of depression (OR 0·55; 95 % CI 0·42, 0·72), compared with those in the bottom quartile. Stratified analysis by sex revealed that women in the highest categories of AHEI-2010 had a 49 % lower odds of having anxiety and depression, after adjustment for confounders, but no significant association was found in men. In addition, among individuals who were 40 years old or younger, those with high adherence to AHEI-2010 were 58 and 51 % less likely to have anxiety and depression, compared with those with less adherence. Adherence to healthy eating was inversely associated with a lower chance of anxiety and depression in Iranian adults. Prospective studies are required to confirm these associations in Middle-Eastern populations.

Objective: Psychological disorders are highly prevalent worldwide. The present study aimed to investigate the relationship between major dietary patterns and prevalence of psychological disorders in a large sample of Iranian adults., Design: A cross-sectional study was done to identify dietary patterns derived from factor analysis. Dietary data were collected through the use of a validated dish-based semi-quantitative FFQ. Psychological health was examined by use of the Hospital Anxiety and Depression Scale and the General Health Questionnaire., Setting: The study was conducted in Isfahan, Iran, within the framework of the Study on Epidemiology of Psychological, Alimentary Health and Nutrition (SEPAHAN)., Subjects: Iranian adults (n 3846) aged 20-55 years., Results: After adjustment for potential confounders, greater adherence to the lacto-vegetarian dietary pattern was protectively associated with depression in women (OR=0·65; 95 % CI 0·46, 0·91). Normal-weight participants in the top quintile of this dietary pattern tended to have decreased odds of anxiety compared with those in the bottom quintile (OR=0·61; 95 % CI 0·38, 1·00). In addition, the traditional dietary pattern was associated with increased odds of depression (OR=1·42; 95 % CI 1·01, 1·99) and anxiety (OR=1·56; 95 % CI 1·00, 2·42) in women. Normal-weight participants in the highest quintile of the traditional dietary pattern had greater odds for anxiety (OR=1·89; 95 % CI 1·12, 3·08) compared with those in the lowest quintile. The Western dietary pattern was associated with increased odds of depression in men (OR=1·73; 95 % CI 1·07, 2·81) and anxiety in normal-weight participants (OR=2·05; 95 % CI 1·22, 3·46). There was a significant increasing trend in the odds of psychological distress across increasing quintiles of the fast food dietary pattern in women (P-trend=0·02)., Conclusions: Recommendation to increase the intake of fruits, citrus fruits, vegetables, tomato and low-fat dairy products and to reduce the intakes of snacks, high-fat dairy products, chocolate, carbonated drinks, sweets and desserts might be associated with lower chance of psychological disorders.

Background and Aims: Joint association of lifestyle-related factors and mental health has been less studied in earlier studies, especially in Middle Eastern countries. This study aimed to examine how combinations of several lifestyle-related factors related to depression and anxiety in a large group of middle-age Iranian population., Methods: In a cross-sectional study on 3363 Iranian adults, a healthy lifestyle score was constructed by the use of data from dietary intakes, physical activity, smoking status, psychological distress and obesity. A dish-based 106-item semi-quantitative validated food frequency questionnaire (FFQ), General Practice Physical Activity Questionnaire (GPPAQ), General Health Questionnaire (GHQ) and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. The Hospital Anxiety and Depression Scale (HADS) was applied to screen for anxiety and depression., Results: After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle were 95% less likely to be anxious (OR: 0.05; 95% CI: 0.01-0.27) and 96% less likely to be depressed (OR: 0.04; 95% CI: 0.01-0.15), compared with those with the lowest score. In addition, non-smokers had lower odds of anxiety (OR: 0.64; 95% CI: 0.47-0.88) and depression (OR: 0.62; 95% CI: 0.48-0.81) compared with smokers. Individuals with low levels of psychological distress had expectedly lower odds of anxiety (OR: 0.13; 95% CI: 0.10-0.16) and depression (OR: 0.10; 95% CI: 0.08-0.12) than those with high levels. Individuals with a healthy diet had 29% lower odds of depression (OR: 0.71; 95% CI: 0.59-0.87) than those with a non-healthy diet., Conclusion: We found evidence indicating that healthy lifestyle score was associated with lower odds of anxiety and depression in this group of Iranian adults. Healthy diet, psychological distress, and smoking status were independent predictors of mental disorders.

Cardiovascular diseases are regarded as one of the most disabling diseases of human beings around the world, particularly when psychological characteristics are taken into consideration. This study compared attachment styles, problem solving styles and sensitivity anxiety in cardiovascular diseases patients and normal Individuals. A total of 40 participants (20 diseased, 20 normal) were selected thought random cluster sampling procedure from among a population of cardiovascular diseases in the city of Ardabil. Data were collected using the attachment styles inventory (AAI), problem-solving styles questionnaire (PSSQ) and the anxiety sensitivity index (ASI); moreover, multivariate analysis of variance used for data analysis. These finding implied that among attachment styles, problem solving and sensitivity anxiety there existed differences in cardiovascular diseases patients and non-patients. Results showed that cardiovascular diseases patients used higher avoidance and ambivalence attachment than non-patients. Result also revealed that non-patients used higher safety attachment than cardiovascular disease patients and patients employed avoidant attachment style as well as ambivalence. Moreover, cardiovascular diseases patients had higher helplessness, problem solving control and avoidance style more than non-patients and the non-patients used higher creativity style, problem-solving confidence, avoidance style more than cardiovascular diseases patients. It was also found that cardiovascular diseases patients used higher physical, cognitive, social worries than non-patients. Overall, the finding indicated that attachment styles, problem solving styles and sensitivity anxiety were important components discriminating cardiovascular diseases patients from non-patients. The suggestion for further studies is about other variables in cardiovascular diseases to provide preventive strategies for these diseases