Association between dietary self-care adherence and depression among adults living with type 2 diabetes mellitus in Ghana: a cross-sectional study

Introduction: Dietary recommendation plays a quintessential role in diabetes self-management. Persons living with diabetes (PLWD) are expected to consume diets rich in whole grains, fruits, vegetables, legumes and nuts, while limiting alcohol consumption, refined grains, red and processed meats, and low sugar-sweetened beverages. However, the following questions remain: (a) What is the association between dietary adherence and depression among persons living with diabetes in Ghana? (b) Do adherence to a general diet and specific diet recommendations have the same association with depression? To address these questions, we examined the association between dietary self-care adherence and depression among PLWD in Ghana. Methods: This cross-sectional study was conducted in the Ashanti region of Ghana. The study involved 398 PLWD. Bivariable and multivariable logistic regression models were performed to assess the association between dietary adherence and depression. The results of the multivariable logistic regression were presented in adjusted odds ratio (AOR) with the corresponding 95% confidence intervals (CIs). Statistical significance was set at < 0.05. Results: Overall, we estimated a depression prevalence of 38.7% among the participants. PLWD who had a high dietary self-care adherence were significantly less likely to experience depression (COR = 0.27; 95% CI: 0.11–0.66). This association remained statistically significant after adjusting for covariates (AOR = 0.28; 95% CI: 0.10–0.78). While a high general diet score was associated with lower odds of depression, it was statistically not significant. However, PLWD with a higher specific diet score were significantly less likely to experience depressive symptoms (AOR = 0.80; 95% CI: 0.73–0.88). Conclusion: The significant inverse association between adherence to specific diets and depression points to an area that clinicians and public health authorities must prioritise. Our findings suggest that encouraging PLWD to adhere to specific diet recommendations (e.g., fruit and vegetable consumption, practicing carbohydrate spacing, and consuming low-fat diets) could help reduce the risk of depression. Hence, clinicians must emphasise the mental health benefits of adhering to dietary recommendations during their dietary counselling sessions with PLWD.