Associations between fruit and vegetable consumption and depressive symptoms: evidence from a national Canadian longitudinal survey.

BACKGROUND: Several cross-sectional studies have demonstrated associations between diet quality, including fruit and vegetable consumption, and mental health. However, research examining these associations longitudinally, while accounting for related lifestyle factors (eg, smoking, physical activity) is scarce. METHODS: This study used data from the National Population Health Survey (NPHS), a large, national longitudinal survey of Canadians. The sample included 8353 participants aged 18 and older. Every 2 years from 2002/2003 to 2010/2011, participants completed self-reports of daily fruit and vegetable consumption, physical activity, smoking and symptoms of depression and psychological distress. Using generalised estimating equations, we modelled the associations between fruit and vegetable consumption at each timepoint and depression at the next timepoint, adjusting for relevant covariates. RESULTS: Fruit and vegetable consumption at each cycle was inversely associated with next-cycle depression (ß=-0.03, 95% CI -0.05 to -0.01, p<0.01) and psychological distress (ß=-0.03, 95% CI -0.05 to -0.02, p<0.0001). However, once models were adjusted for other health-related factors, these associations were attenuated (ß=-0.01, 95% CI -0.04 to 0.02, p=0.55; ß=-0.00, 95% CI -0.03 to 0.02, p=0.78 for models predicting depression and distress, respectively). CONCLUSIONS: These findings suggest that relations between fruit and vegetable intake, other health-related behaviours and depression are complex. Behaviours such as smoking and physical activity may have a more important impact on depression than fruit and vegetable intake. Randomised control trials of diet are necessary to disentangle the effects of multiple health behaviours on mental health.

Time trends in symptoms of mental illness in children and adolescents in Canada.

BACKGROUND: Existing research and media reports convey conflicting impressions of trends in the prevalence of mental illness. We sought to investigate trends in the prevalence of symptoms of mental illness in a large population-based cohort of Canadian children and adolescents. METHODS: We obtained population-based data from the National Longitudinal Survey of Children and Youth. Every 2 years, participants completed self-reported measures of mental illness indicators, including conduct disorder, hyperactivity, indirect aggression, suicidal behaviour, and depression and anxiety. We analyzed trends in mean scores over time using linear regression. RESULTS: We evaluated 11 725 participants aged 10-11 years from cycles 1 (1994/95) through 6 (2004/05), 10 574 aged 12-13 years from cycles 2 (1996/97) through 7 (2006/07), and 9835 aged 14-15 years from cycles 3 (1998/99) through 8 (2008/09). The distribution of scores on depression and anxiety, conduct and indirect aggression scales remained stable or showed small decreases over time for participants of all ages. The mean hyperactivity score increased over time in participants aged 10-11 years (change per 2-year cycle: 0.16, 95% CI 0.02 to 0.12) and those aged 12-13 years (0.13, 95% CI 0.09 to 0.18). Over time, fewer participants aged 12-13 years (0.40% per cycle, 95% CI -0.78 to -0.07) and aged 14-15 years (0.56% per cycle, 95% CI -0.91 to -0.23) reported attempting suicide in the previous 12 months. INTERPRETATION: With the exception of hyperactivity, the prevalence of symptoms of mental illness in Canadian children and adolescents has remained relatively stable from 1994/95 to 2008/09. Conflicting reports of escalating rates of mental illness in Canada may be explained by differing methodologies between studies, an increase in treatment-seeking behaviour, or changes in diagnostic criteria or practices.

Protective factors against depression during the transition from adolescence to adulthood: findings from a national Canadian cohort.

OBJECTIVE: This study sought to identify factors protective against the onset or recurrence of depression in early adulthood, and to describe their interactions with stressors during this transitional period. METHODS: 1137 members of Canada's National Population Health Survey were followed from ages 12 to 17 in 1994/95 and contacted every two years until 2008/09. Protective factors measured at age 16/17 included social support, physical activity, mastery, self-esteem, and education level. General linear mixed models were used to examine the relationship between the protective factors and five assessments of depression, including interactions between protective factors and four types of stress: stressful life events, and work, financial, and personal stress. RESULTS: High mastery in adolescence had a significant protective effect against depression in early adulthood. Participants with high social support in adolescence were significantly less likely to become depressed after experiencing work or financial stress, compared to those with low social support. Those who were physically active in adolescence were less likely to become depressed after experiencing work stress, and higher overall education level reduced depression risk following personal stress or major life events. CONCLUSION: Social support and physical activity may be ideal targets for school-based depression interventions during a potentially stressful transitional period.

Diet quality and feelings of worry, sadness or unhappiness in Canadian children.

OBJECTIVE: To examine the association between diet quality and feelings of worry, sadness or unhappiness in Canadian children. METHODS: Responses to the Harvard Food Frequency Questionnaire of 6,528 grade 5 students were used to calculate a composite score of diet quality, and its components: variety, adequacy, moderation and balance. Responses to the question on "feelings of worry, sadness or unhappiness" from the EuroQoL 5 Dimension questions for Youth (EQ-5D-Y), a validated Health Related Quality of Life questionnaire, constitute the outcome of interest. Multilevel logistic regression methods were used to examine the association between diet quality and feelings of worry, sadness or unhappiness. All analyses were adjusted for gender, household income, parental education, energy intake, weight status, physical activity level, geographic area and year of data collection. RESULTS: Diet quality was inversely associated with children's feelings of worried, sad or unhappy (Odds ratio (95% confidence interval): 0.90 (0.85-0.97)). Dietary variety and dietary adequacy were also statistically significantly associated with lower odds of feeling worried, sad or unhappy. When the results were stratified by gender, the effect of diet on feeling worried, sad or unhappy was more pronounced in girls than boys. CONCLUSION: These findings suggest that diet quality plays a role in feelings of worry, sadness or unhappiness and complement other studies that have suggested the link between diet and mental health. We recommend consideration of diet quality in public health strategies that aim to reduce the burden of poor mental health in children and youth.

The association between fruit and vegetable consumption and mental health disorders: evidence from five waves of a national survey of Canadians.

OBJECTIVE: The objective of this study was to examine the association between fruit and vegetable intake (FVI) and mental health disorders. METHOD: This study used data from the Canadian Community Health Survey (CCHS), a repeated cross-sectional study of Canadians with five waves between 2000 until 2009 (n=296,121 aged 12 years or older). FVI was assessed based on frequency of consumption. The primary outcome was a major depressive episode over the previous 12 months. Logistic regression models adjusted for age, gender, household income, education, physical activity, chronic illness and smoking. RESULTS: In the first wave, greater FVI was significantly associated with lower odds of depression (OR: 0.85 95% CI:0.78-0.92). A combined estimate of all 5 waves demonstrated similar results (OR: 0.72; 95% CI: 0.71-0.75). Relative to those with the lowest FVI, those with the greatest FVI also had significantly lower odds of suffering from distress (OR: 0.87 95% CI: 0.78-0.98). These results were consistent across other waves. Perceived poor mental health status and previous diagnosis of a mood disorder and anxiety disorder also demonstrated statistically significant inverse associations with FVI (all p<0.05). CONCLUSION: These findings suggest a potentially important role of a healthy diet in the prevention of depression and anxiety.

Diet quality and mental health in subsequent years among Canadian youth.

OBJECTIVE: To examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents. DESIGN: A prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians' diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder. SETTING: The Canadian province of Nova Scotia. SUBJECTS: A provincially representative sample of grade 5 students (age 10-11 years). RESULTS: Diet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1.09; 95 % CI 0.73, 1.63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0.45; 95 % CI 0.25, 0.82). CONCLUSIONS: These findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.

Closing the osteoporosis care gap in hip fracture patients: an opportunity to decrease recurrent fractures and hospital admissions.

Background. Falls and hip fractures are an increasing health threat to older people who often never return to independent living. This study examines the management of bone health in an acute care setting following a hip fracture in patients over age 65. Methods. Retrospective chart review of all patients admitted to a tertiary health facility who suffered a recent hip fracture. Results. 420 charts of patients admitted over the course of a year (May 1, 2007-April 31, 2008) were reviewed. Thirty-seven percent of patients were supplemented with calcium on discharge, and 36% were supplemented with vitamin D on discharge. Thirty-one percent were discharged on a bisphosphonate. Conclusion. A significant care gap still exists in how osteoporosis is addressed despite guidelines on optimal management. A call to action is required by use of multifaceted approaches to bridge the gap, ensuring that fracture risk is minimized for the aging population.