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The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis

Lookup NU author(s): Dr Kirby Sainsbury, Dr Marta Marques



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


PurposeDepressive symptoms are common in patients with coeliac disease (CD) and may represent a barrier to gluten free diet (GFD) adherence. The aims of this meta-analysis were: (1) to synthesise the evidence on the relationship between depression or depressive symptoms and degree of adherence to a GFD in patients with CD who are already attempting a GFD (i.e., post-diagnosis and onset of GFD), and (2) to summarise the direction of causation of any observed relationship.MethodsA random effects meta-analysis of 8 cross-sectional studies (N = 1644) was conducted. Included studies measured self-reported depressive symptoms and GFD adherence using either a dietitian interview or validated self-report questionnaire that considered unintentional gluten consumption.ResultsThere was a moderate association between poorer GFD adherence and greater depressive symptoms (r = 0.398, 95% CI = 0.321–0.469), with marked heterogeneity in the effects (I2 = 66.8%). A sensitivity analysis excluding studies with a moderate/high (k = 1) or unclear risk of bias (k = 1) did not change the results.ConclusionThe low number of studies meeting inclusion criteria limits the strength of the conclusions. Available evidence suggests there is an association between poorer GFD adherence and self-reported depressive symptoms; however, studies using longitudinal and prospective designs, and reliable measures, particularly for adherence, are needed to confirm this association. The direction of causation between depression and adherence remains unclear.

Publication metadata

Author(s): Sainsbury K, Marques MM

Publication type: Article

Publication status: Published

Journal: Appetite

Year: 2018

Volume: 120

Pages: 578-588

Print publication date: 01/01/2018

Online publication date: 16/10/2017

Acceptance date: 11/10/2017

Date deposited: 19/10/2017

ISSN (print): 0195-6663

ISSN (electronic): 1095-8304

Publisher: Elsevier


DOI: 10.1016/j.appet.2017.10.017


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