Food for Mind - Intervention in the Treatment of Depression

Aims. The main aim of the study is to explore whether Food for Mind - Group-based behavioral nutrition intervention alleviates depression symptoms. Furthermore, we aim to investigate, whether the intervention improves the quality of diet, eating habits, quality of life, ability to work and to study its cost-effectiveness. In collaboration with 11 public and private health care service providers in cities of Kuopio and Siilinjärvi in Northern Savo, Finland. Participants. The total number of subjects will be 144 based on power calculations. The calculation is based on the clinical decline of seven points assessed by the Center for Epidemiologic Studies Depression (CES-D) Scale. Participants sign an informed consent form to participate Food for Mind - intervention. Study design. In this randomized controlled clinical trial subjects are randomized into two parallel groups: Food for Mind -behavioral nutrition intervention group (n=72) and Group to bring Good Mood -control group (n=72). The intervention consists of behavioral nutrition counselling (5 times 1½ h and 1 time 3 h) and the control group (befriending group) (n=72) (5 times 1½ h and 1 time 3 h). Thus, in the befriending group the same visit schedule and length without any nutrition counselling is used. The befriending group consists of discussion of neutral topics, like hobbies, music, sports, and doing together. Both groups continue to have their normal depression care in the health care. Enrollment and treatment will take about four years, and follow-up will last about one year. The Northern Savo Hospital District Committee on Research Ethics gave its consent to the study protocol. Methods. All questionnaires are validated. CES-D -depression scale, Seasonal Pattern Assessment Questionnaire, The Diet Quality Index (IDQ), Diet frequency -questionnaire, Eating competence -questionnaire (ecSI 2.0), The Three Factor Eating Questionnaire, Ability to work and function -questionnaires, Assessment of Quality of Life (AQoL)-8D (8 dimensions) -questionnaire, Treatment expectancy -questionnaire, Acceptability -questioinnaire. In addition, body composition measurement and cost-effectiveness analyses to evaluate the health outcomes in relation to resource utilization and costs in Food for Mind -intervention.

Food for Mind -intervention group - topics of small group meetings Getting to know each other and forming a group. Overall quality of diet and meal rhythm, shifting thoughts to changing of wishes. Nutrition and depression based on the evidence based studies Mindful Eating - practical Food for Mind cooking class and eating meal together applying mindful eating Food for Mind - getting to know a selection of Food for Mind -food items available in the grocery store. Tools for the future: discovering and ensuring your own tools for success to put into action. Participants in the Food for Mind -intervention group will get for every group meeting optional home exercises consisting of observing their own food habits and bringing "food for mind" items on their meal plan. As a social support, participants can share their own experiences and findings via WhatsApp (Whats Application) messenger -mobile application. The WhatsApp messenger-mobile application is used during the intervention and ten months after it. The behavioral nutrition counselling is theory-based, i.e. solution focused theory (SFT) and self -determination theory. SFT places responsibility for change in the hands of subjects by using empowering language and recognizing them as skilled in matters of self-care. Subjects have strengths, resources, and coping skills that drive change while generating optimism and hope. Use of basic counseling skills, such as attending and listening, genuineness, empathy, positive regard and reflection, provide the foundation upon which SFT is practised.

Behavioral nutrition counselling and peer support, delivered in small groups. Includes six sessions extending over 8 weeks, with participatory activities facilitated by a nutrition therapist.

Social activation and peer support, delivered in small groups. Includes six sessions extending over 8 weeks, with participatory activities facilitated by group leader.

Depressive symptomatology measured with the Center for Epidemiologic Studies (CES-D) scale at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group. The scale has 20 items and measures symptoms of depression. Each item is scored from 0 (zero) to 3 points. The total score ranges from 0 (zero) to 60 points.Higher values of the total score represent a worse outcome.Four of the items (#4, #8, #12, #16) are reversed before calculating the total score. The total score is calculated as follows: the answers to the items are summed, the sum is divided by the number of scored items, and this value is multiplied by 20. If the answers are missing to more than five items, the total score will not be calculated.

The Diet Quality measured with the Diet Quality Index (IDQ) at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

The Diet Frequency measured with the Diet frequency -questionnaire at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

Eating Competence measured with the Eating competence -questionnaire (ecSI 2.0) at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

Eating Behavior measured with The Three Factor Eating Questionnaire at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

Ability to Work and Function measured with the Ability to work and function -questionnaires at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

The Quality of Life measured with the AQoL-8D -questionnaire at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

Body weight measured by body composition analyzer (InBody720) at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

Fat mass measured by body composition analyzer (InBody720) at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

Fat free mass measured by body composition analyzer (InBody720) at eight weeks, 6 months and 12 months after patient recruitment compared to the social support befriending group.

Inclusion Criteria: Age 20 - 65 years Customer Relationship of Kuopio Psychiatric Center or City of Kuopio: Individually tailored treatment and rehabilitation plan ICD-10 (International Classification of Diseases 10th Revision): Depression Diagnosis (F32-F33, F34.1) The treatment (medication and / or psychotherapy) has continued unchanged for at least 2 weeks time before randomization Willingness to participate in group-based intervention for 8 weeks: 6 group sessions (5 x 1½h and 1 x 3h) Exclusion Criteria: General illness that is clinically unstable and which can be aggravated by intervention Pregnancy Severe food allergy, intolerance or food aversion Participation at the same time, such as other nutrition or exercise intervention Primary diagnosis include personality disorder, severe eating disorder and / or substance abuse.

Roponen J, Ruusunen A, Absetz P, Partonen T, Kuvaja-Kollner V, Hujo M, Nuutinen O. Nutrition-focused group intervention with a strength-based counseling approach for people with clinical depression: a study protocol for the Food for Mind randomized controlled trial. Trials. 2021 May 17;22(1):344. doi: 10.1186/s13063-021-05279-5.