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Accepted manuscript

Environmental co-benefits of a Mediterranean-style dietary intervention for reducing depressive symptoms in adults: Results from the CALM randomised controlled trial

Published online by Cambridge University Press:  18 July 2025

Megan Turner*
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia Deakin University, School of Psychology, 75 Pigdons Road, Waurn Ponds, 3216, Victoria, Australia
Deborah N. Ashtree
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Melissa M. Lane
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Kim Anastasiou
Affiliation:
Stretton Health Equity, Stretton Institute, School of Social Sciences, University of Adelaide, Adelaide, 5000, South Australia, Australia Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria 3220, Australia,
Michalis Hadjikakou
Affiliation:
Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Melbourne, Victoria, Australia.
Samantha L. Dawson
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Mark Lawrence
Affiliation:
Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria 3220, Australia,
Laura Jennings
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Ozge Geyik
Affiliation:
Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Melbourne, Victoria, Australia.
Felice Jacka
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Vincent L. Versace
Affiliation:
Deakin Rural Health, Deakin University, Princes Hwy, Warrnambool, Victoria, Australia GeoHealth Labaratory, Department of Population Health, Dasman Diabetes Institute, Kuwait
Mary Lou Chatterton
Affiliation:
School of Public Health and Preventative Medicine, Health Economics Group, Monash University, Melbourne, Victoria, Australia
Pilvikki Absetz
Affiliation:
Tampere University, Health Sciences, Faculty of Social Sciences, Kauppi Campus, Finland
Marita Bryan
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Barbara Brayner
Affiliation:
Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria 3220, Australia,
Sophie Mahoney
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Dean Saunders
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Tayla John
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia Barwon Health MHDAS, 118 Moorabool Street, Geelong, Victoria, 3220, Australia
Lauren M. Young
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
Adrienne O’Neil
Affiliation:
Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
*
Corresponding author: Megan Turner, Deakin University, School of Psychology, 76 Pigdons Road, Waurn Ponds, Victoria, Australia, 3216. Email: megan.turner@deakin.edu.au, Tel: +61 5227 2267
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Abstract

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This study explored whether lifestyle therapy that promoted adherence to a Mediterranean-style diet as a treatment for depression led to environmental co-benefits. Participants (N = 75 complete case) were Australian adults in the Curbing Anxiety and Depression using Lifestyle Medicine (CALM) non-inferiority, randomised controlled trial, which showed that lifestyle therapy was non-inferior to psychotherapy in reducing depressive symptoms, when delivered in group format via video conferencing over an 8-week treatment period. In this secondary analysis, we hypothesised that the lifestyle arm would be superior to the psychotherapy arm in reducing environmental impact of self-reported diet over time. Dietary intake derived from Food Frequency Questionnaires at baseline and 8 weeks were transformed into environmental impact scores by calculating Global Warming Potential (GWP)*. GWP* was calculated for total dietary intake and distinct food groups (Australian Dietary Guidelines [ADG] and NOVA classifications). Within-arm changes in GWP* over time were calculated using median difference. Neither arm showed significant changes. Between-arm differences in percentage change in GWP* scores over time were analysed using Generalised Estimating Equations (GEE) models. No between-arm difference for total GWP* score was found (β=11.06 [-7.04 29.15]). When examining distinct food groups, results were mixed. These novel findings contribute to the sparse evidence base that has measured the environmental impact of diets in a clinical trial context. Whilst lifestyle therapy that reduced depressive symptoms did not have clear environmental benefits relative to psychotherapy, nutritional counselling that focuses on the environmental impact of food choices may drive more pronounced planetary co-benefits.

Information

Type
Research Article
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society