Public Health Nutrition: 18(3), 546–553 doi:10.

1017/S1368980014000561

Unsaturated fat intakes and mental health outcomes in young

women from the Australian Longitudinal Study on Women’s Heath
Clare Daley1, Amanda Patterson1, David Sibbritt2 and Lesley MacDonald-Wicks1,*
1
Nutrition and Dietetics, School of Health Sciences, University of Newcastle, Hunter Building, University Drive,
Callaghan, NSW 2308, Australia: 2Faculty of Health, University of Technology, Sydney, Sydney, New South Wales,
Australia

Submitted 4 February 2013: Final revision received 13 December 2013: Accepted 2 January 2014: First published online 9 April 2014

Abstract
Objective: To determine if associations exist between a range of unsaturated fatty
acid intakes and mental health outcomes.
Design: Cross-sectional data analysis of the Australian Longitudinal Study on
Women’s Health (ALSWH) Young Cohort Survey 3 that included the validated
seventy-four-item Dietary Questionnaire for Epidemiological Studies FFQ,
validated mental health scales and self-report questions on depression and
anxiety.
Setting: Australia, 2003.
Subjects: A nationally representative sample of young Australian women (25–30
years) from ALSWH. The 7635 women with plausible energy intakes (>4·5 but
< 20·0 MJ/d) were included in the analyses.
Results: Adjusted logistic regression analyses found statistically significant
associations between higher intakes of α-linolenic acid and decreased likelihood
of depressive symptoms indicated by the ten-item Center for Epidemiological
Studies Depression Scale (CESD-10; OR = 0·77; 95 % CI 0·60, 0·99; P = 0·040) and
the Short Form Health Survey (SF-36) mental health subscale (OR = 0·73 95 % CI
0·56, 0·96; P = 0·024). Furthermore, higher intakes of n-6 fatty acids (OR = 0·96,
95 % CI 0·93, 0·99; P = 0·019) and linoleic acid (OR = 0·96, 95 % CI 0·93, 0·99;
P = 0·020) were associated with decreased likelihood of self-reported diagnosed
anxiety and higher intakes of n-9 fatty acids (OR = 1·02, 95 % CI 1·00, 1·04;
P = 0·041) and oleic acid (OR = 1·02, 95 % CI 1·00, 1·05; P = 0·046) were associated
with increased likelihood of self-reported diagnosed anxiety.
Keywords
Conclusions:: Increased intakes of α-linolenic acid were associated with a reduced
Unsaturated fatty acids
likelihood of depressive symptoms, increased intakes of n-6 fatty acids and FFQ
linoleic acid were associated with a reduced likelihood of self-reported anxiety, Women
and increased intakes of n-9 fatty acids and oleic acid were associated with an Depression
increased likelihood of anxiety. Additional studies are needed to further elucidate Anxiety
associations between unsaturated fatty acids and depression and anxiety. Mental health

In recent years there has been an increase in the inci- The n-3, n-6 and n-9 FA are collectively referred to
dence of mental illnesses, with depression now being the as unsaturated fats. Unsaturated FA are found in high
leading cause of disability worldwide(1–3). According to concentrations in cell membranes and are thought to
the 2007 National Survey of Mental Health and Wellbeing, influence membrane fluidity and thus cell signalling,
approximately 45 % of the Australian population have neurotransmitter release and receptor sensitivity(10–13).
experienced a mental illness in their lifetime and the Therefore higher concentrations of unsaturated FA in
incidence is increasing by approximately 20 000 cases neural membranes are thought to improve the commu-
per annum(2). Women, in particular young women, were nication between brain neurons and the transport of
found to be more likely to experience anxiety and neurotransmitters such as dopamine and serotonin, and
depression, the most common forms of mental illness(2). thus play a role in mental health(10,12). The focus of past
The rise in mental illnesses has correlated with changes research has been primarily on n-3 FA due to the parti-
in dietary intake in Western countries, in particular cularly high concentration of long-chain (LC) n-3 FA found
a decreased consumption of n-3 fatty acids (FA) and in the brain and nervous system tissues(9–11).
concomitant increases in intakes of n-6 and most likely The majority of experimental studies investigating the
n-9 FA(4–8). potential therapeutic effect of n-3 FA on pre-existing

*Corresponding author: Email [email protected] © The Authors 2014

Unsaturated fat intake and mental health 547
mental health issues have often used supplementation Overall, the association between LC n-3 FA and depres-
rather than a dietary source. The role of n-3 FA in the pre- sion is still unclear. In addition, despite being metabolically
vention of mental health issues in observational studies to plausible, few studies exist that investigate a range of
date has yielded mixed results(12). These studies commonly different FA in relation to depression and anxiety. The
measure dietary sources of n-3 FA using fish consumption present study aimed to assess whether a range of dietary
as a proxy measure, rather than individual n-3 FA, thereby unsaturated FA are associated with mental health status
excluding n-3 FA derived from non-fish sources. There are in a cross-sectional analysis of data from the Australian
conflicting results about gender-specific differences in the Longitudinal Study on Women’s Health (ALSWH) Young
association of n-3 FA and mental health. Also, the literature Cohort Survey 3 (2003).
suffers as a variety of measures of mental health outcomes
have been used, making direct comparison of the evidence
base difficult. A longitudinal study by Yanfeng et al. (2011) Methods
found that among 5068 adults, infrequent fish consumption
was a risk factor for severely depressed mood in men, but Study sample
not in women, measured using the ten-item Center for The ALSWH is a population-based prospective longitudinal
Epidemiological Studies Depression Scale (CESD-10)(13). study funded by the Commonwealth Department of Health
However, a longitudinal cohort study of 3317 African- and Ageing. The study commenced in 1996 and was estab-
American and Caucasian young adults by Colangelo et al. lished to investigate the changes in the health of Australian
(2009) found that fish intake and intakes of EPA, DHA and women by distributing self-reported questionnaires over a
EPA + DHA were all significantly related to depressive 20-year period(21). Approximately 45 000 women were
symptoms, measured using the CESD-10, in women only(14). recruited by random selection from the Australian Medi-
Additionally Tanskanen et al. (2001) found that infrequent care database, which includes all permanent residents of
fish consumption was significantly associated with depres- Australia(21). Women from three age groups were selected
sive symptoms measured using the Beck Depression (‘younger’ women aged 8–23 years, ‘mid-age’ women
Inventory scale among both genders, but especially in aged 45–50 years, ‘older’ women aged 70–75 years)(21).
women, in a cross-sectional study of 3204 Finnish adults(15). Women living in rural or remote areas were over-sampled
In contrast, a population-based study of 2416 New Zealand to ensure adequate numbers for statistical analysis(21). The
adults that measured EPA and DHA in serum phospholipids respondents have been shown to be broadly representa-
found inconsistent associations between the LC n-3 FA and tive of the national population of women in the target age
mental well-being measured using the Short Form Health groups, with a slight over-representation of Australian-
Survey questionnaire (SF-36)(16). born, better-educated non-smoking women(21,22).
There has been far less focus on anxiety than depression The present study is a cross-sectional data analysis of
in relation to n-3 FA intakes in the research literature, the Young Cohort Survey 3, which was distributed in 2003
despite the probability that mood and anxiety disorders are when the participants were aged 25–30 years. At baseline
mechanistically related(17). One prospective cohort study of (survey 1 in 1996) 14 247 women aged 18–23 years par-
7903 university graduates showed that dietary n-3 fat intake ticipated(23). At survey 3 in 2003, 9067 women responded to
provided a potential benefit to total mental disorders the survey (retention rate of 64 %); however, this response
(anxiety, depression, stress) at baseline(18). However, the rate compares well with other surveys of this highly mobile
study also found that participants who had a high fish age group(21,24). Survey 3 included an FFQ and questions
consumption at baseline, which had then increased further that explore factors influencing the health of Australian
by the 2-year follow-up, was then associated with an women(24).
increased risk of mental disorders(18). The ALSWH has been approved by the Human Research
The majority of the literature to date focuses on the Ethics Committees of the University of Newcastle and the
association between n-3 FA and mental health, in parti- University of Queensland.
cular depression; however, there are a few studies investi-
gating n-6 and n-9 FA in relation to mental health. A Fatty acid measures
prospective cohort study of 4856 adults aged 25–74 years The Dietary Questionnaire for Epidemiological Studies
by Wolfe et al. (2009) found that increased intake of oleic (DQES) version 2, developed by the Cancer Council Victoria,
acid (OA; 18: 1n-9) was associated with a reduced risk of is a seventy-four-item FFQ that assesses usual dietary
severe depressed mood in women, while an increased intake for the previous 12 months, but does not include
intake of linoleic acid (LA; 18: 2n-6) was associated with questions on vitamin or mineral supplement use(25). This
an increased risk of severe depressed mood in men(19). FFQ has previously been validated in a cohort of young to
Furthermore Yary and Aazami (2011) found an inverse middle-aged Australian women(26).
association between total PUFA intake and depressive All FA intakes were estimated from the analysis of the
symptoms among 402 Iranian postgraduate students in FFQ responses, using the NUTTAB95 and Royal Melbourne
Malaysia(20). Institute of Technology FA databases that have been shown
548 C Daley et al.
(25–27)
to give accurate indications of intake levels . The n-9 First, unadjusted logistic regression analyses were con-
FA are MUFA that are synthesised in the body, but can also ducted using all unsaturated FA listed above as continuous
be obtained from dietary sources such as olive, rapeseed variables. Each FA value was compared with each catego-
and peanut oils(11). The main n-9 FA is OA (18: 1n-9). The rical outcome variable; self-reported diagnosed depression,
n-3 and n-6 FA are PUFA. The main n-6 FA, LA (18: 2n-6), is self-reported diagnosed anxiety, CESD-10 (cut-off point ≥10)
an essential FA found primarily in seed oils(11). The essential and SF-36 MH subscale (cut-off point ≤52).
n-3 FA is α-linolenic acid (ALA; 18: 3n-3) found in plant- Adjusted analyses were then conducted using logistic
based foods such as rapeseed, linseed and walnuts(11). ALA regression models. The association was reported after the
can be converted within the body into the LC n-3 FA, EPA following confounders were adjusted for after consideration
(20: 5n-3), docosapentaenoic acid (DPA; 22: 5n-3) and DHA of their potential influence on mental health outcomes:
(22: 6n-3); evidence suggests that 9 % of ALA is converted BMI(37) (<18·5 kg/m2 underweight, 18·5–24·99 kg/m2 normal
to LC n-3 FA in women(11,27). The LC n-3 FA are mostly weight, 25·0–29·99 kg/m2 overweight, ≥ 30·0 kg/m2 obese);
found in oily fish, seafood and in red meats (especially DPA) energy intake (kJ); physical activity categorised in total
in the Australian diet(28). metabolic equivalent (MET) minutes(38) (<40 none, 40–600
Unsaturated FA variables used in the present analysis low, 600–1200 moderate, >1200 high); whether they had
included: (i) individual n-3 FA intakes (ALA, EPA, DPA, been diagnosed with/treated for any of seventeen medical
DHA); (ii) total n-3 FA intake; (iii) total LC n-3 FA acid intake conditions in the previous 3 years such as type 2 diabetes,
(EPA + DPA + DHA); (iv) total n-6 FA intake; (v) intake of heart disease, postnatal depression, anxiety, a sexually
the individual n-6 FA, LA; (vi) total n-9 FA intake; and transmitted infection, hepatitis B or C or cancer (anxiety and
(vii) intake of the individual n-9 FA, OA. depression conditions were excluded from this count in
models as appropriate); whether they had experienced any
Mental health outcome measures of twenty-one symptoms ‘often’, such as severe tiredness,
The CESD-10 tool was used to measure depressive symp- leaking urine, back pain and skin problems (anxiety and
toms experienced ‘during the last week’. CESD-10 has good depression symptoms were excluded from this count in
internal consistency and validity and was specifically models as appropriate); alcohol status (low risk, non-drinker,
designed to identify depressive symptoms by self-report in rare drinker, risky/high risk drinker); highest qualification
non-clinical population research(29). Responses are con- completed (high school, trade/apprenticeship/certificate/
verted to a score out of 30, where higher scores indicate diploma, university degree or higher); pattern of drug use
increased depressive symptomatology. Scores ≥10 were (no use of any drugs in the last 12 months/ever, only used
used to indicate depression(30). marijuana in last 12 months, used multiple/single drug other
The five-item mental health (MH) subscale of the Medical than marijuana in last 12 months); smoking status (never
Outcomes Study SF-36 specifically targets depression and smoked, ex-smoker, >10/d, 10–19/d, ≥20/d); pregnancy
anxiety experienced ‘during the past 4 weeks’(31). Respon- status (yes/no, ‘don’t know’ was replaced with missing);
ses are converted to a score out of 100, with higher scores experienced any kind of abuse in last 3 years (yes/no);
indicating better mental health. The scales of the SF-36 have area of residence (major city, inner regional, outer regio-
high internal consistency and have been tested extensively nal, remote/very remote); ability to manage on income
for reliability and validity with adults of all ages(32). The MH (impossible/difficult all the time, difficult some of the time,
subscale was used as it is highly correlated with other not too bad, easy); marital status (never married, married/
measures of depression and is a validated screening tool for de facto, separated/divorced/widowed); whether they had
depression, at a cut-off point of ≤52(33–35). experienced any of twenty-eight major life events in the
Participants were asked if they had been diagnosed with last 12 months (e.g. major personal injury, illness, surgery,
or treated for depression or anxiety (self-reported data) in having a child with a serious disability or illness, divorce/
the last 3 years (yes/no). The responses to these items separation, becoming a sole parent, death of partner/close
were both also used as separate mental health outcome family member, loss of job, natural disaster, involvement
variables in the present analysis. in a serious accident, sexual abuse, legal troubles). Addi-
tionally, participants taking antidepressant medications
Statistical analysis were also adjusted for in the analyses involving CESD-10
All analyses were performed using the JMP statistical soft- and SF-36 MH subscale. P values of < 0·05 were con-
ware package (version 9·0, 2010). To improve the validity sidered statistically significant and odds ratios and their
of the dietary analyses, women with reported daily 95 % confidence intervals were calculated.
energy intakes <4·5 or >20·0 MJ/d were excluded (n 1432)
as energy values outside this range were considered bio-
logically improbable and indicative of misreporting(36). Results
Therefore a total of 7635 women were included in the
analysis. Logistic regression analyses were conducted as In survey 3, 9067 women completed and returned the
the outcome variables are binary. questionnaire. Of these, 1432 (15·8 %) were excluded as they
Unsaturated fat intake and mental health 549
Table 1 Mean intakes of fatty acids in the young cohort of women aged 25–30 years (n 7635) from the Australian Longitudinal Study on
Women’s Health (ALSWH) compared with the mean intakes derived from the 1995 Australian National Nutrition Survey (NNS; n 10 851)(39)
and the Australian Nutrient Reference Value (NRV) recommendations(11)

ALSWH (n 7635) 1995 NNS (n 10 851)

(mean intake, Australian adults Australian NRV recommendations
Mean SD aged 19+ years) (AI, women aged 19+ years)
Total n-3 (g) 1·43 0·66 1·36 –
ALA (g) 1·05 0·45 1·17 0·80
EPA (g) 0·11 0·13 – –
DPA (g) 0·04 0·04 – –
DHA (g) 0·24 0·25 – –
LC n-3 (g) 0·39 0·41 0·19 0·09
Total n-6 (g) 8·73 4·09 10·85 8·00
LA (g) 8·63 4·06 10·80 –
Total n-9 (g) 28·79 11·99 20·31 –
OA (g) 25·63 10·78 – –

AI, Adequate Intake; ALA, α-linolenic acid; DPA, docosapentaenoic acid; LC, long chain; LA, linoleic acid; OA, oleic acid.

Table 2 Mean intakes of fatty acids categorised by mental health status in young women aged 25–30 years (n 7635) from the Australian
Longitudinal Study on Women’s Health

Symptoms of depression

Self-reported depression Self-reported anxiety (CESD-10 ≥ 10) (SF-36 MH subscale ≤ 52)

Yes No Yes No Yes No Yes No

(n 927) (n 6590) (n 452) (n 7065) (n 1949) (n 5570) (n 1310) (n 6311)

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

Total n-3 (g) 1·47 0·63 1·43 0·66 1·49 0·68 1·43 0·66 1·51 0·75 1·41 0·64 1·49 0·70 1·42 0·65
ALA (g) 1·09 0·46 1·04 0·44 1·09 0·47 1·04 0·44 1·12 0·49 1·02 0·43 1·11 0·50 1·03 0·43
EPA (g) 0·11 0·12 0·11 0·13 0·12 0·13 0·11 0·13 0·11 0·15 0·11 0·12 0·11 0·13 0·11 0·13
DPA (g) 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04 0·04
DHA (g) 0·23 0·23 0·24 0·25 0·25 0·25 0·23 0·25 0·24 0·29 0·23 0·25 0·23 0·25 0·24 0·25
LC n-3 (g) 0·38 0·38 0·39 0·41 0·41 0·42 0·38 0·41 0·39 0·48 0·38 0·40 0·38 0·41 0·39 0·41
Total n-6 (g) 9·09 4·37 8·66 4·03 9·22 4·21 8·68 4·07 9·14 4·24 8·57 4·01 9·10 4·37 8·65 4·02
LA (g) 8·99 4·35 8·57 4·01 9·12 4·18 8·57 4·04 9·04 4·22 8·47 3·98 9·00 4·34 8·55 4·00
Total n-9 (g) 29·72 12·76 28·61 11·83 29·27 12·37 28·72 11·93 30·7 13·60 28·09 11·27 30·32 13·57 28·46 11·62
OA (g) 26·52 11·56 25·46 10·62 26·08 11·13 25·56 10·73 27·34 12·24 24·99 10·13 27·01 12·20 25·32 10·44

CESD-10, ten-item Center for Epidemiological Studies Depression Scale; SF-36 MH subscale, Medical Outcomes Study Short Form Health Survey mental
health subscale; ALA, α-linolenic acid; DPA, docosapentaenoic acid; LC, long chain; LA, linoleic acid; OA, oleic acid.

had implausible energy intakes of <4·5 or >20·0 MJ/d(36). was 12·1 % (n 927) and anxiety was 5·9 % (n 452). The
Overall, 7635 young Australian women between the ages of number experiencing symptoms of depression in the pre-
25 and 30 years were included in the analyses. The mean vious week, indicated by the CESD-10 screening tool, was
energy intake for this population was 7526 (SD 2389) kJ/d, 25·5 % (n 1949). The SF-36 MH subscale, which considers
51 % were of a healthy weight and 52 % were moderately- the previous 4 weeks, identified 17·2 % (n 1310) with risk of
highly active. In terms of education, 43 % had a university depressive symptoms.
degree or higher, 55 % lived in a major city and 76 % had Table 4 shows the results of the adjusted logistic
never smoked or were an ex-smoker. regression analyses between dietary intake of unsaturated
Mean FA intakes for the ALSWH young women are FA and mental health outcomes. There were no statistically
presented in Table 1. The 1995 National Nutrition Survey significant associations between self-reported diagnosed
data on FA intakes(39) (for Australian adults) and the Nutrient depression and the intake of any of the unsaturated FA.
Reference Value recommendations(11) (for women 19+ There was a statistically significant association between the
years) are also presented here for comparison (Table 1). individual n-3 FA, ALA, and the CESD-10 score (OR = 0·77;
Unadjusted mean intakes of each explanatory FA variable 95 % CI 0·60, 0·99; P = 0·040; Table 4). Additionally, there
for each categorisation of the mental health outcomes are was a statistically significant association between increased
shown in Table 2. ALA and the SF-36 MH subscale (OR = 0·73; 95 % CI 0·56,
The prevalence of mental health outcomes is presented 0·96; P = 0·024). There was also a statistically significant
in Table 3. In the previous 3 years in this cohort, the pre- association between higher intakes of total n-6 FA and LA
valence of self-reported diagnosed or treated depression and decreases in self-reported diagnosed anxiety, although
550 C Daley et al.
Table 3 Mental health outcomes in the young cohort of women aged 25–30 years (n 7635) from the Australian Longitudinal Study on
Women’s Health

Yes No Missing

n % n % n %
Self-reported diagnosed depression 927 12·1 6590 86·3 118 1·6
Self-reported diagnosed anxiety 452 5·9 7065 92·5 118 1·6
CESD-10 ≥ 10 1949 25·5 5570 72·9 116 1·6
SF-36 MH subscale ≤ 52 1310 17·2 6311 82·7 14 0·1

CESD-10, ten-item Center for Epidemiological Studies Depression Scale; SF-36 MH subscale, Medical Outcomes Study Short Form Health Survey mental
health subscale.

Table 4 Adjusted logistic regression results between dietary intake of unsaturated fatty acids and mental health outcomes in the young
cohort of women aged 25–30 years (n 7635) from the Australian Longitudinal Study on Women’s Health
Symptoms of depression

Self-reported depression Self-reported anxiety CESD-10 ≥10 SF-36 MH subscale ≤52

OR 95 % CI P value OR 95 % CI P value OR 95 % CI P value OR 95 % CI P value

Total n-3 (g) 1·05 0·87, 1·26 0·637 0·93 0·74, 1·19 0·564 0·98 0·85, 1·14 0·128 0·96 0·82, 1·16 0·629
ALA (g) 0·90 0·66, 1·24 0·519 0·98 0·65, 1·49 0·928 0·77 0·60, 0·99 0·040* 0·73 0·56, 0·96 0·024*
EPA (g) 1·38 0·68, 2·89 0·379 0·78 0·34, 1·90 0·564 1·31 0·75, 2·34 0·353 1·29 0·69, 2·49 0·433
DPA (g) 6·97 0·58, 93·3 0·134 0·41 0·02, 9·14 0·562 3·35 0·45, 25·89 0·241 3·43 0·37, 34·16 0·285
DHA (g) 1·21 0·84, 1·77 0·326 0·87 0·57, 1·37 0·535 1·20 0·89, 1·61 0·234 1·21 0·87, 1·70 0·262
LC n-3 (g) 1·12 0·90, 1·41 0·316 0·92 0·71, 1·22 0·544 1·11 0·93, 1·33 0·265 1·11 0·91, 1·36 0·308
Total n-6 (g) 0·98 0·95, 1·00 0·091 0·96 0·93, 0·99 0·019* 0·99 0·97, 1·02 0·597 0·99 0·97, 1·01 0·443
LA (g) 0·98 0·95, 1·00 0·093 0·96 0·93, 0·99 0·020* 0·99 0·97, 1·02 0·603 0·99 0·97, 0·99 0·444
Total n- 9 (g) 1·00 0·98, 1·02 0·917 1·02 1·00, 1·04 0·041* 0·99 0·98, 1·01 0·287 1·00 0·99, 1·01 0·799
OA (g) 1·00 0·98, 1·01 0·523 1·02 1·00, 1·05 0·046* 0·99 0·98, 1·01 0·224 1·00 0·98, 1·01 0·790

CESD-10, ten-item Center for Epidemiological Studies Depression Scale; SF-36 MH subscale, Medical Outcomes Study Short Form Health Survey mental
health subscale; ALA, α-linolenic acid; DPA, docosapentaenoic acid; LC, long chain; LA, linoleic acid, OA, oleic acid.
Adjusted for BMI, energy intake, physical activity, chronic illnesses, alcohol intake, education, drug use, smoking status, pregnancy status, abuse, area of
residence, managing on income, marital status, major life events, symptoms, depression medications (for CESD-10 and SF-36 MH subscale only).
*Statistically significant (P < 0·05).

the effect was considerably smaller (OR = 0·96; 95 % CI authors’ knowledge, no one has previously shown an
0·93, 0·99 for both; P = 0·019 and P = 0·020, respectively). association between dietary intakes of ALA and reduced
Small, but statistically significant associations were also risk of depression using the SF-36 MH subscale and
found between self-reported diagnosed anxiety and intakes CESD-10 validated screening measures. Despite the signi-
of total n-9 FA (OR = 1·02; 95 % CI 1·00, 1·04; P = 0·041) and ficant relationship with the validated screening tools, our
OA (OR = 1·02; 95 % CI 1·00, 1·05; P = 0·046), although analyses showed no significant relationship between ALA
these were in the opposite direction. intake and self-reported diagnosed depression. This is
possibly due to the wording in the ALSWH survey, which
asked women to report if they had been ‘treated or diag-
Discussion nosed’ for depression in the ‘last 3 years’. This is a much
longer timeframe than for the FFQ, and therefore the
Despite the acknowledged metabolically plausible role outcome has really been measured before the exposure,
of unsaturated fats in mental health, the present study and it may be expected that anyone diagnosed and
appears to be the first to compare a range of unsaturated undertaking treatment for depression would not currently
FA derived from dietary intake data with various mental be experiencing depressive symptoms. However, the
health outcomes using a large nationally representative SF-36 and the CESD-10 ask about depressive symptoms
cohort of young women. experienced over the previous 4 weeks and 1 week,
Our findings demonstrated that women with higher respectively, which are within the timeframe for the FFQ.
consumptions of ALA were less likely to have depressive Contrary to much of the existing literature which shows
symptoms. A study by Panagiotakos et al. (2010) in 853 an inverse association between LC n-3 FA and/or fish
healthy adults from the province of Attica found that intake, there were no significant associations found
increases in plasma total PUFA, total MUFA, total n-3 FA, between the LC n-3 FA and the mental health outcomes in
DHA, EPA, LA and ALA were all associated with lower the present analyses(14,15,41). ALA is the primary n-3 FA
scores on Zung’s Self-rating Depression Scale(40). To the consumed in a Western diet, but it is generally believed
Unsaturated fat intake and mental health 551
(3,48)
that the conversion rate of ALA to the LC n-3 FA is very the study meaningful to the population of interest .
limited, at approximately 8 % in adults(27,42,43). However, Furthermore, having the data that enabled the study to be
there is recent evidence to suggest that ALA may be more designed to include numerous markers of mental health
efficiently converted to LC n-3 FA in women, in particular and both total and individual FA strengthen the study as this
women of reproductive age, as a result of a variation in allowed a unique and more comprehensive examination of
their metabolic capacity to meet the DHA demands of a the association between dietary FA intake and mental
fetus and neonate during pregnancy and lactation(42,44,45). health measures.
As the literature focuses primarily on fish consumption The findings are limited by a potential for measurement
as a marker of LC n-3 FA, there is little reported in the error associated with the use of a self-reported FFQ, with a
literature about ALA and depression in young women. It is reduced range of foods included in the dietary evaluation.
possible that the association with ALA but not with LC n-3 It should be noted however that all methods of dietary
is a result of the FFQ more effectively assessing ALA in the data collection have some form of measurement error.
diet compared with LC n-3, as the coverage of fish intake While this FFQ is a validated dietary intake tool for this
is limited. population, it has not been validated for FA intakes(26).
Our results also showed that women with higher However, data analysis was limited to plausible energy
consumptions of total n-6 FA or LA were less likely to ranges using a previously published method(36) and
have self-reported anxiety. The agreement between these average intakes of FA were within realistic ranges of
two explanatory variables is not surprising as for the national dietary averages(11,39). Participants may have
present analysis LA comprised approximately 98 % of total been taking supplementary sources of various FA (n-3 in
n-6 intake. To the authors’ knowledge, this is the first particular), which would impact the analyses, but this
comparison of dietary intake of n-6 FA and anxiety in information was not available from the ALSWH survey.
an observational study of a large cohort. There is some Data from the 1995 National Health Survey demonstrate
evidence for total dietary PUFA and decreases in anxiety in that over 9 % of the Australian population uses natural/
a study by Yehuda et al. (2005), which found that higher herbal medications (including fish-oil supplements), and
intakes of PUFA in a group of college students reduced women were almost twice as likely to use them than
previously elevated cortisol levels and improved sleep men(49). Finally, the cross-sectional study design means
quality, thereby reducing test anxiety(46). Similarly, a rando- that causal relationships and the direction of those rela-
mised control trial by Williams et al. (1992) found that indi- tionships cannot be determined; therefore longitudinal
viduals who exhibited more psychological stress had altered studies are needed to assess temporal associations.
proportions of total plasma esterified n-6 FA compared with The findings of the present study were unexpected as
their less stressed counterparts, although n-3 FA were found no associations were revealed between the LC n-3 FA and
in similar proportions in both groups(47). This suggests anxiety or depression. While most of the recent research
that stress-related metabolic processes may bypass n-3 FA has been conducted in this area, the present findings
pathways, and higher intakes of n-6 FA may prevent suggest that further studies are needed of all dietary
metabolism of n-3 FA within the body(47). unsaturated FA as they may be associated with these
The results of our study showed that young women with common and debilitating mental health issues.
lower consumptions of total n-9 FA or OA were less likely Overall, there is limited knowledge about the preventive
to have self-reported diagnosed anxiety. Again, for this potential of each type, source, dose or combination of
analysis, OA comprises 89 % of the total n-9 intake. The unsaturated FA and the mental health outcomes of depres-
authors are not aware of any studies that have previously sion and anxiety due to a limited literature(50). Further
investigated n-9 FA and anxiety; however, there has been well-designed, large cohort studies are needed that use
some research into the relationship between MUFA and comparable measures of mental health and validated tools
depression. Unlike the present analysis, the results of these to measure unsaturated FA to ensure consistency in results.
studies suggest that increased MUFA are associated with This in turn will strengthen the current evidence base to be
decreased risk of depression(19,40). While these studies were able to confidently confirm or refute an association.
not directly measuring anxiety, it is thought that depression
and anxiety are mechanistically related(17) and this justified
the current investigation. Conclusion
The strengths of the present study are the large
population-based sample, the ability to control for multiple The current study demonstrated that among a nationally
confounding variables, and the inclusion of validated diet- representative sample of young Australian women, an
ary intake and depression-screening tools in the analysis. increased intake of ALA but not other n-3 FA was asso-
The dietary intake data used in the study were plausible ciated with a decreased likelihood of experiencing
with regard to energy intake(36) and comparable with other depressive symptoms. Furthermore, increased intakes of
Australian data(3), and the outcome variables were not n-6 FA and LA and decreased intakes of n-9 FA and OA
dissimilar to similar population data, making the results of were associated with a decreased likelihood of having
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