Abstract
BACKGROUND: This study investigates the links between dietary diversity, food insecurity and mental health (depression and anxiety) in adolescents from rural Pakistan. Adolescence is a critical time for developing mental health disorders, yet limited research exists on these issues in low- and middle-income countries (LMICs). METHODS: The study included 1,396 adolescents (ages 9-15) and assessed their mental health, nutrition and maternal well-being. Depression and anxiety were measured using standardized questionnaires, while dietary diversity and food insecurity were evaluated through household assessments. Incidence rate ratios assessed the relationship between nutrition and mental health. RESULTS: Results showed that 8.1% of boys and 10.2% of girls experienced depression, with anxiety rates ranging from 5.8% to 39.1%. Adolescents from households with higher dietary diversity had lower symptoms of depression and anxiety (IRRs:0.91-0.96), while those with higher food insecurity had increased symptoms (IRRs:1.24-1.86). Folate deficiency was associated with depressive symptoms, particularly in boys. Maternal mental health was observed to mediate the relationship between food insecurity and adolescent depression and anxiety. CONCLUSIONS: The study highlights that improving maternal mental health and addressing nutritional deficiencies, particularly folate, may benefit adolescent well-being. Further research in other LMICs is needed to explore these associations and their mechanisms.