Does depressive and anxiety symptoms associate with the diet quality of university students? An exploratory study during the COVID-19 pandemic in India

Background: This study examines the association of depressive and anxiety symptoms on diet quality while controlling for different demographic and other health and lifestyle factors. Methods: This cross-sectional study was carried out between April 2021 to June 2021 among a total of 440 (unweighted) university students. Diet quality was assessed using a 10-item mini-dietary assessment index tool. Depressive and anxiety symptoms of participants were measured using the validated Patient Health Questionnaire-9 (PHQ-9), and Generalized anxiety disorder (GAD-7) scale, respectively. Multivariable logistic regression and mediation analyses were performed. Results: In this study, 61.1% (95% CI: 56.6% to 65.7%) of university students’ diet quality was good during the COVID-19 pandemic. Being a post-graduate student, an urban resident, having no depressive (AOR = 2.15, 95% CI: 1.20 to 3.84) and anxiety symptoms (AOR = 1.96, 95% CI: 1.07 to 3.59), no changes or better appetite, and no changes in sleep duration were significantly associated with good diet quality among our study participants. Both depressive and anxiety symptoms had a direct and indirect effect on diet quality while mediated each other.Limitations: The causal conclusion cannot be drawn due to the cross-sectional design of this study. All data were self-reported that may cause social desirability and recall bias. Conclusions: Depressive and anxiety symptoms during COVID-19 had a significant effect on diet quality of university students. Future public health policies need to be focused on improving the mental health and well-being of students particularly during pandemic situations to enhance their diet quality.