Perceptions of university students on nutrition as a useful tool to manage anxiety and depression levels

Yıl 2023, , 45 - 56, 21.07.2023

Maria Paula Junqueıra-goncalves Mahmut Genç Seda Genç , Anne Majumdar

https://doi.org/10.56833/gidaveyem.1322441

Öz

Objective: Mental health problems among university students are an emergent public health issue and prevention is crucial. Dietary interventions are currently being investigated as additional treatment options for mental illness. This work aimed (i) to measure and correlate the general status of physical-mental health and diet habits of undergraduate students (n=164, 96 females and 68 males) from different universities, in England and Türkiye; (ii) to develop a specific questionnaire to measure their knowledge on nutrition for mental health (as only general nutrition knowledge questionnaires were available), and (iii) to identify barriers for healthier food choices and sustainable behavioural changes.

Materials and methods: The study was based on a cross-sectional survey. Undergraduate students were invited by email and their participation was voluntary and anonymous. Values were expressed as means and standard deviation. A significance level of 0.05 was set.

Discussion and conclusion: The results showed that more than 1/3 presented a medium to a high level of somatization symptoms while more than 1/4 presented a moderate to severe level of anxiety and depression. Moreover, results showed a significant negative correlation between nutritional knowledge with physical status, anxiety and depression level and a significant positive correlation with adherence to the Mediterranean diet. Cost, time, convenience and no healthy options on campus canteens/restaurants were the main reported barriers against a healthier diet. Most of the students showed poor nutritional knowledge on how nutrition may impact mental health, but a high interest in learning about nutrition to improve their physical and mental health. Nutrition education and the support of a nutritional team may be alternative tools at the universities to help students manage their anxiety/depression, general health status and academic performance.

Anahtar Kelimeler

nutrition, mental health, anxiety, depression, nutritional knowledge, university students

Üniversite öğrencilerinin kaygı ve depresyon düzeylerini yönetmek için yararlı bir araç olan beslenmeye ilişkin algıları

Öz

Amaç: Üniversite öğrencilerinde görülen mental sağlık sorunları acil çözüme kavuşması gereken bir halk sağlığı sorunu olup, bu sorunun önlenmesi büyük önem arz etmektedir. Günümüzde diyet uygulamalarının mental sağlığı iyileştirme çalışmaları ek tedavi seçeneği olarak araştırılmaktadır. Bu çalışma ile (i) İngiltere ve Türkiye’de bulunan farklı üniversitelerde eğitim gören lisans öğrencilerinin (n=164, 96 kadın ve 68 erkek) beden-mental sağlığı ve beslenme alışkanlıklarının genel durumunu ölçmek ve ilişkilendirmek; (ii) mental sağlık için beslenme konusundaki bilgilerini ölçmek amacıyla özel bir anket geliştirmek (yalnızca genel beslenme bilgisi anketleri mevcut olduğundan) ve (iii) kesitsel bir anket kullanılarak daha sağlıklı gıda seçimleri ve sürdürülebilir davranış değişikliklerinin önündeki engelleri belirlemek amaçlanmıştır.

Materyal ve yöntem: Çalışma, kesitsel bir araştırma olarak yapılandırılmış olup, lisans öğrencileri e-posta ile çalışmaya davet edilmiş, katılımları gönüllük esasına göre isimleri gizli tutulmuştur. Çalışmada değerler ortalama ve standart sapma olarak ifade edilmiş ve anlamlılık düzeyi 0,05 olarak belirlenmiştir.

Tartışma ve sonuç: Çalışmanın sonuçları, öğrencilerin 1/4’ten fazlasının orta ile şiddetli düzeyde anksiyete ve depresyon, 1/3’ten fazlasının ise orta ile yüksek düzeyde somatizasyon belirtileri olduğunu göstermiştir. Ayrıca, beslenme bilgisi ile fiziksel durum, anksiyete ve depresyon düzeyi arasında anlamlı bir negatif korelasyon, beslenme bilgisi ile Akdeniz diyetine bağlılık arasında ise anlamlı bir pozitif korelasyon olduğunu göstermiştir. Daha sağlıklı beslenmenin önündeki başlıca engeller maliyet, zaman, kolaylık ve kampüs kantinlerinde/restoranlarında sağlıklı seçeneklerin olmaması olarak belirlenmiştir. Öğrencilerin çoğunun beslenmenin mental sağlık üzerindeki etkisi konusunda yetersiz bilgiye sahip olduğu, ancak fiziksel ve mental sağlıklarını iyileştirmek için beslenmeyi öğrenmeye büyük ilgi duydukları görülmüştür. Beslenme eğitimi ve bir beslenme ekibinin desteği, üniversitelerde öğrencilerin kaygı/depresyon, genel sağlık durumu ve akademik performanslarını yönetmelerine yardımcı olacak alternatif araçlar olabileceği değerlendirilmiştir.

Anahtar Kelimeler

beslenme, mental sağlık, anksiyete, depresyon, beslenme bilgisi, üniversite öğrencileri

Kaynakça

• Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066X.55.5.469
• Arslan, G., Ayranci, U., Unsal, A., Arslantas, D. (2009). Prevalence of depression, its correlates among students, and its effect on health-related quality of life in a Turkish university. Upsala Journal of Medical Sciences, 114(3), 170–177. https://doi.org/10.1080/03009730903174339
• Bayram, N., and Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology, 43(8), 667–672. https://doi.org/10.1007/s00127-008-0345-x
• Carney, R., Firth, J., Pedley, R., Law, H., Parker, S., Lovelld, K. (2021). The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis. Gen Hosp Psychiatry. May-Jun; 70: 80–97.
• Dahlin, M., Nilsson, C., Stotzer, E., Runeson, B. (2011). Mental distress, alcohol use and help-seeking among medical and business students: A cross-sectional comparative study. BMC Medical Education, 11(1), 1–8. https://doi.org/10.1186/1472-6920-11-92
• DALYs GBD (2018), GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet; 392(10159):1859–922.
• El Ansari, W., Stock, C., Mikolajczyk, R. T. (2012). Relationships between food consumption and living arrangements among university students in four European countries - A cross-sectional study. Nutrition Journal, 11(1), 1–7. https://doi.org/10.1186/1475-2891-11-28
• El Ansari, W., Adetunji, H., Oskrochi, R. (2014). Food and mental health: Relationship between food and perceived stress and depressive symptoms among university students in the United Kingdom. Central European Journal of Public Health, 22(2), 90–97. https://doi.org/10.21101/cejph.a3941
• European General Data Regulation, https://commission.europa.eu/law/law-topic/data-protection/data-protection-eu_en.
• Genc, M., and Genc, S. (2019). Mediterranean Diet adherence in emerging adults in Izmir. British Food Journal, 121(3), 725–737. https://doi.org/10.1108/BFJ-07-2018-0470
• Guagliardo, V., Lions, C., Darmon, N., Verger, P. (2011). Eating at the university canteen. Associations with socioeconomic status and healthier self-reported eating habits in France. Appetite, 56(1), 90–95. https://doi.org/10.1016/j.appet.2010.11.142
• Ha, E. J., and Caine-Bish, N. (2009). Effect of Nutrition Intervention Using a General Nutrition Course for Promoting Fruit and Vegetable Consumption among College Students. Journal of Nutrition Education and Behavior, 41(2), 103–109. https://doi.org/10.1016/j.jneb.2008.07.001
• Hilger, J., Loerbroks, A., Diehl, K. (2017). Eating behaviour of university students in Germany: Dietary intake, barriers to healthy eating and changes in eating behaviour since the time of matriculation. Appetite, 109, 100–107. https://doi.org/10.1016/j.appet.2016.11.016
• Hubble, S., and Bolton, P. (2020). Support for students with mental health issues in higher education in England. Available: https://commonslibrary.parliament.uk/
• Kaplan, B. J., Rucklidge, J. J., Romijn, A., McLeod, K. (2015). The emerging field of nutritional mental health: Inflammation, the microbiome, oxidative stress, and mitochondrial function. In Clinical Psychological Science (Vol. 3, Issue 6, pp. 964–980). https://doi.org/10.1177/2167702614555413
• Khan, S., Alam Khan, R. (2016). Healthy Diet a Tool to Reduce Anxiety and Depression. Journal of Depression and Anxiety, 05(02). https://doi.org/10.4172/2167-1044.1000220
• Kıvrak, Y., Kokaçya, M. H., Sevim, E., Çöpoğlu, Ü. S. (2016). Depressive symptom prevalence and risk factors in eastern Turkish university students. Journal of Clinical and Analytical Medicine, 16(7), 440–444.
• Kroenke, K., Spitzer, R. L., Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
• Kroenke, K., Spitzer, R. L., Williams, J. B. W. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64(2), 258–266. https://doi.org/10.1097/00006842-200203000-00008
• Kwan, M. Y., Faulkner, G. E., Arbour-Nicitopoulos, K. P., Cairney, J. (2013). Prevalence of health-risk behaviours among Canadian post-secondary students: Descriptive results from the National College Health Assessment. BMC Public Health, 13(1), 1–6. https://doi.org/10.1186/1471-2458-13-548
• Lai, J. S., Hiles, S., Bisquera, A., Hure, A. J., McEvoy, M., Attia, J. (2014). A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. American Journal of Clinical Nutrition, 99(1), 181–197. https://doi.org/10.3945/ajcn.113.069880
• Lang, U. E., Beglinger, C., Schweinfurth, N., Walter, M., Borgwardt, S. (2015). Nutritional aspects of depression. In Cellular Physiology and Biochemistry (Vol. 37, Issue 3, pp. 1029–1043). https://doi.org/10.1159/000430229
• Libuda, L., Antel, J., Hebebrand, J., Föcker, M. (2017). Nutrition and mental diseases: Focus depressive disorders. Nervenarzt, 88(1), 87–101. https://doi.org/10.1007/s00115-016-0262-2
• Lin, L. P., and Dali, W. P. E. W. (2012). The impact of nutrition education interventions on the dietary habits of college students in developed nations: A brief review. In Malaysian Journal of Medical Sciences (Vol. 19, Issue 1, pp. 4–14).
• Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., Herzberg, P. Y. (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care, 46(3), 266–274. https://doi.org/10.1097/MLR.0b013e318160d093
• Marozoff S., Veugelers P.J., Dabravolskaj J., Eurich D.T., Ye M., Maximova K. (2020). Diet Quality and Health Service Utilization for Depression: A Prospective Investigation of Adults in Alberta’s Tomorrow Project. Nutrients. 12:2437. doi: 10.3390/nu12082437.
• Meegan, A. P., Perry, I. J., Phillips, C. M. (2017). The association between dietary quality and dietary guideline adherence with mental health outcomes in adults: A cross-sectional analysis. Nutrients, 9(3), 238. https://doi.org/10.3390/nu9030238
• Michels, K. B., Willett, W. C., Michels, K. B., Michels, K. B., Rosner, B. A., Bloom, B. R., Riccardi, P., Rosner, B. A. (2008). A Study of the Importance of Education and Cost Incentives on Individual Food Choices at the Harvard School of Public Health Cafeteria. Journal of the American College of Nutrition, 27(1), 6–11. https://doi.org/10.1080/07315724.2008.10719669
• Moncrieff, J. (2016). Misrepresenting harms in antidepressant trials. In BMJ (Online) (Vol. 352). https://doi.org/10.1136/bmj.i217
• Nani, M. O. (2016). Relationship between Nutrition Knowledge and food intake of College students. Master Dissertation. Kent State University.
• Nasir, J. A., and Tahir, M. H. (2017). Factors affecting nutritional attitudes among university adults. Pakistan Journal of Commerce and Social Sciences (PJCSS), 11(2), 644–652.
• O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., Berk, M., Jacka, F. N. (2014). Relationship between diet and mental health in children and adolescents: A systematic review. In American Journal of Public Health (Vol. 104, Issue 10, pp. e31–e42). American Public Health Association. https://doi.org/10.2105/AJPH.2014.302110
• Oztasan, N., Ozyrek, P., Kilic, A. (2016). Factors Associated With Health-Related Quality of Life Among University Students in Türkiye. Materia Socio Medica, 28(3), 210. https://doi.org/10.5455/msm.2016.28.210-214
• Philippou, E., Middleton, N., Pistos, C., Andreou, E., Petrou, M. (2017). The impact of nutrition education on nutrition knowledge and adherence to the Mediterranean Diet in adolescent competitive swimmers. Journal of Science and Medicine in Sport, 20(4), 328–332. https://doi.org/10.1016/j.jsams.2016.08.023
• Popa, T. A., and Ladea, M. (2012). Nutrition and depression at the forefront of progress. Journal of Medicine and Life, 5(4), 414–419.
• Robertson, D., Kumbhare, D., Nolet, P., Srbely, J., Newton, G. (2017). Associations between low back pain and depression and somatization in a Canadian emerging adult population. Journal of the Canadian Chiropractic Association, 61(2), 96–105.
• Ross, J. (2003). The mood cure. Total Health, 25(2), 21–23.
• Sakamaki, R., Toyama, K., Amamoto, R., Liu, C. J., Shinfuku, N. (2005). Nutritional knowledge, food habits and health attitude of Chinese university students–a cross sectional study. Nutrition Journal, 4 (1), 1–5.
• Sánchez-Villegas, A., Delgado-Rodríguez, M., Alonso, A., Schlatter, J., Lahortiga, F., Serra-Majem, L., Martínez-González, M. A. (2009). Association of the Mediterranean dietary pattern with the incidence of depression: The Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Archives of General Psychiatry, 66(10), 1090–1098. https://doi.org/10.1001/archgenpsychiatry.2009.129
• Schröder, H., Fitó, M., Estruch, R., Martínez-González, M. A., Corella, D., Salas-Salvadó, J., Lamuela-Raventós, R., Ros, E., Salaverría, I., Fiol, M., Lapetra, J., Vinyoles, E., Gómez-Gracia, E., Lahoz, C., Serra-Majem, L., Pintó, X., Ruiz-Gutierrez, V., Covas, M. I. (2011). A Short screener is valid for assessing mediterranean diet adherence among older Spanish men and women. Journal of Nutrition, 141(6), 1140–1145. https://doi.org/10.3945/jn.110.135566
• Scott, T. (2011). The antianxiety food solution: How the foods you eat can help, you calm your anxious mind, improve your mood, and end cravings. New Harbinger Publications.
• Thorley, C. (2017). Not By Degrees: Not by degrees: Improving student mental health in the UK’s universities. In Institute for Public Policy Research.
• Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579–592. https://doi.org/https://doi.org/10.1037/a0021769
• World Health Organization (2017). WHO | Depression and Other Common Mental Disorders, Global Health Estimates. In WHO. World Health Organization.
• World Health Organization. (2018). Management of physical health conditions in adults with severe mental disorders: WHO guidelines.
• Winzer, R., Lindberg, L., Guldbrandsson, K., Sidorchuk, A. (2018). Effects of mental health interventions for students in higher education are sustainable over time: A systematic review and meta-analysis of randomized controlled trials. PeerJ, 2018(4), e4598. https://doi.org/10.7717/peerj.4598
• Worsley, A. (2002). Nutrition knowledge and food consumption: can nutrition knowledge change food behaviour? In Asia Pacific journal of clinical nutrition: Vol. 11 Suppl 3 (pp. S579–S585). John Wiley and Sons, Ltd. https://doi.org/10.1046/j.1440-6047.11.supp3.7.x
• Yahia, N., Wang, D., Rapley, M., Dey, R. (2016). Assessment of weight status, dietary habits and beliefs, physical activity, and nutritional knowledge among university students. In Perspectives in Public Health (Vol. 136, Issue 4, pp. 231–244). SAGE PublicationsSage UK: London, England. https://doi.org/10.1177/1757913915609945
• Yusoff, M.S.B., Abdul Rahim, A.F., Baba, A.A., Ismail, S.B., Mat Pa, M.N., Esa, A.R. Prevalence and associated factors of stress, anxiety, and depression among prospective medical students. Asian J Psychiatr. 2013 Apr; 6 (2):128–33.