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. 2025 May 30;25(1):556.
doi: 10.1186/s12888-025-06987-x.

Association of planetary health diet index with depression and mortality in the United States

Ying Lan  1 , Lvlin Chen  1 , Zhimei Lin  2 , Haoxian Tang  3   4 , Xuan Zhang  5   6
Affiliations

Association of planetary health diet index with depression and mortality in the United States

Ying Lan et al. BMC Psychiatry. .

Abstract

Background: Given the changes in global environmental conditions and dietary patterns, understanding the potential impact of dietary factors on the risk of depression is crucial. The Planetary Health Diet Index (PHDI) is a dietary scoring system that integrates human health and environmental sustainability. This study aims to evaluate the association between the PHDI, the risk of depression, and mortality.

Methods: Data from the National Health and Nutrition Examination Survey 2005-2018. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9), with a score ≥ 10 indicating depression. PHDI calculated from 14 self-reported dietary groups, ranges from 0 to 140. Multivariable weight logistic and linear regression explored the association of PHDI with depression and total PHQ-9 score. Cox proportional hazards regression examined PHDI associations with mortality. Additional analyses included restricted cubic spline (RCS), threshold analyses, subgroup analyses, and multiple imputation.

Results: Adjusting for confounding variables, each 10-point increase in PHDI was associated with an 11% lower risk of depression (OR = 0.89, 95% CI = 0.84, 0.94), 0.13 score of total PHQ (β=-0.13, 95% CI=-0.18, -0.08), and 17% of all-cause mortality (HR = 0.83, 95% CI = 0.73, 0.95). RCS indicated an inverse L-shaped association between PHDI and depression, and threshold effects analyses showed that the above associations were more significant in those with PHDI ≥ 76.01.

Conclusions: Adherence to the PHDI dietary pattern is associated with a reduced risk of both depression and all-cause mortality. PHDI may provide dietary guidance for the early prevention and intervention of depression.

Keywords: Depression; Mortality; NHANES; PHDI.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: NHANES is carried out by the Centers for Disease Control and Prevention (CDC) in collaboration with the National Center for Health Statistics (NCHS). The NHANES study protocol underwent review and approval by the NCHS Research Ethics Review Committee. Written informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart for Screening the U.S. Participants in NHANES 2005–2018
Fig. 2
Fig. 2
Association between PHDI and depression of the U.S. participants in NHANES 2005–2018 by RCS. Dashed vertical lines represent inflection points of 76.01 scores. Model was adjusted for age, sex, race/ethnicity, marital status, education, PIR, smoking, drinking, physical activity, BMI, and uric acid. Abbreviations: BMI, body mass index; CI, Confidence interval; NHANES, National Health and Nutrition Examination Survey; OR, Odd Ratio; PHDI, Planetary Health Diet Index; PHQ-9, Patient Health Questionnaire-9; PIR, poverty income ratio; RCS, restricted cubic spline
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