Abstract
BACKGROUND: The Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diet are recognized for their cardiometabolic and preventive health benefits. However, the psychological and environmental determinants of adherence to these dietary patterns remain underexplored. The present study examined the direct and indirect effects of eco-anxiety, eco-awareness, and psychological distress on adherence to these healthy and sustainable diets. METHODS: A cross-sectional online survey was conducted among 1,028 Turkish adults aged 18-65 years. Data were collected using validated instruments, including the Mediterranean Diet Adherence Screener (MEDAS), DASH-Questionnaire (DASH-Q), Depression Anxiety Stress Scale-21 (DASS-21), Hogg Eco-Anxiety Scale (HEAS), and the Awareness Scale for Reducing Ecological Footprint (ASREF). Statistical analyses included correlation tests, linear regression, and mediation models (PROCESS macro). RESULTS: Linear regression analyses indicated that eco-anxiety significantly predicted higher adherence to both MEDAS [B = 0.329, 95% CI (0.101-0.557)] and DASH-Q [B = 1.409, 95% CI (0.234-2.585)], while eco-awareness predicted only DASH-Q [B = 2.289, 95% CI (1.719-2.859)]. Psychological models revealed that eco-anxiety strongly predicted depression, anxiety, and stress. Conversely, higher MEDAS [B = -0.157, 95% CI (0.279-0.034)] and DASH-Q scores [B = -0.027, 95% CI (0.051-0.003)] were associated with lower depression, while both also predicted lower anxiety. Mediation analyses confirmed significant negative indirect effects of depression and anxiety in the association between eco-anxiety and both MEDAS and DASH-Q, while stress mediated only the relationship between eco-anxiety and MEDAS. Notably, in all models the direct paths from eco-anxiety to dietary adherence remained positive. CONCLUSION: The results indicate a potential dual pattern in how eco-anxiety relates to dietary adherence. While eco-anxiety shows a positive association with adherence to healthy and sustainable diets, its connection with psychological distress is associated with lower adherence. Although these findings do not imply causality, they underscore the importance of considering both environmental concerns and psychological distress when examining determinants of dietary adherence.