**Background:** The Mediterranean diet (MD), first described by Ancel Keys in the 1960s, is a dietary pattern rich in fruits, vegetables, whole grains, legumes, fish, and nuts, and limited in processed foods, red meats, refined grains, and added sugars. While MD is well-established for reducing cardiovascular disease, diabetes, hypertension, and obesity, growing evidence suggests benefits for mental health as well. Prior studies have reported inverse relationships between MD adherence and depression, including data from 49,261 Swedish women. Depression affects approximately 7% of U.S. adults (19.4 million), and is a leading cause of disability. The authors hypothesized that higher adherence to MD would be correlated with lower levels of anxiety and depression.
**Methods:** The study was approved by the IRB at Nova Southeastern University (IRB #2022-277, approved June 20, 2022). Participants over age 18 were recruited via bulletins at South Florida fitness clubs and on Facebook and Instagram. Inclusion criteria required participants to be at least 18 years old, proficient in English, have access to a computer or mobile device, and provide implied consent. Exclusion criteria included being under 18, not proficient in English, lacking electronic device access, or not providing consent. A total of 117 anonymous responses were collected via REDCap; 17 were excluded for incompletion, yielding a final sample of 100 participants. The online survey comprised four sections: demographics, the 14-item Questionnaire of Mediterranean Diet Adherence (each item worth 1 point, higher scores = greater adherence), the Generalized Anxiety Disorder-7 (GAD-7; 7 items, 0–21 scale, higher scores = greater anxiety), and Beck's Depression Inventory (BDI; 21 items, 0–63 scale, higher scores = greater depression). Spearman's rank correlation coefficient was used to assess associations between MD adherence and anxiety, and MD adherence and depression.
**Key Results:** The sample included 100 participants aged 19–77 (mean 37 years), with 61% women and 31% men. Demographics were 79% White, 10% Hispanic, 5% two or more races, 3% Asian, 2% African American or Black, and 1% Other. Spearman's correlation analysis revealed a significant negative correlation between MD adherence and depression (rs = -0.369, t = 3.93, df = 98, p = 0.0001) and between MD adherence and anxiety (rs = -0.234, t = 2.38, df = 98, p = 0.0191). Both p-values were below the 0.05 threshold for statistical significance. The association was stronger for depression than for anxiety. Scatter plots of raw scores showed a general negative relationship for both outcomes.
**Clinical Implications:** The findings support the hypothesis that higher adherence to the Mediterranean diet is associated with lower levels of anxiety and depression, with the strongest effect observed for depression. The authors suggest that diet may influence mental well-being through mechanisms such as inflammation and the gut-brain axis. Given that women comprised 61% of the sample and are known to have higher prevalence of anxiety and depression (potentially due to hormonal fluctuations), the results may be particularly relevant to this demographic. The authors recommend that healthcare professionals consider diet when evaluating patients' lifestyle and well-being, and that tools such as food diaries may help patients identify dietary patterns that affect mood. Limitations include a small, non-diverse sample (79% White, 61% women), potential self-report bias, and lack of adjustment for confounders such as physical activity, medication use, alcohol, tobacco, and sleep. Future studies should incorporate these variables and more diverse populations.