Association Between Psychological Symptoms and Dietary Diversity Among Pregnant and Postpartum Women in Rural Areas of Western China

Objective
Psychological factors shaping maternal diet remain underexplored, particularly in rural contexts. This study examined the associations of psychological symptoms with maternal dietary diversity in rural Western China.

Methods
This cross-sectional study included 2430 women (847 pregnant, 1583 postpartum) selected through multi-stage random cluster sampling. Dietary diversity was assessed using the Woman's Dietary Diversity Score, which was categorized into tertiles. Depression, anxiety, and stress symptoms were measured and integrated into a standardized composite psychological index. Multinomial logistic regression examined associations between psychological symptoms and dietary diversity adjusting for relevant covariates.

Results
In the full sample, using the lowest dietary diversity score tertile as the reference group, depression symptom was associated with lower odds of being in the high dietary diversity group (relative risk ratio [RRR] = 0.71, 95% confidence interval [CI] 0.53–0.95). Anxiety and stress symptoms were associated with lower odds of being in both medium (anxiety: RRR = 0.74, 95% CI 0.58–0.95; stress: RRR = 0.64, 95% CI 0.46–0.89) and high (anxiety: RRR = 0.78, 95% CI 0.61–0.99; stress: RRR = 0.56, 95% CI 0.39–0.79) dietary diversity group. Higher composite index scores were consistently associated with lower odds of being in the medium (RRR = 0.86, 95% CI 0.78–0.95) and high (RRR = 0.83, 95% CI 0.75–0.93) dietary diversity group. Interaction analyses showed significant effects for depression, stress, and the composite psychological index (P for interaction <0.01), but not for anxiety (P for interaction = 0.954).

Conclusion
Psychological symptoms were inversely associated with maternal dietary diversity. Moreover, these associations varied by pregnancy status for depression, stress, and overall psychological distress. Findings support integrating psychological care into maternal nutrition programs in rural settings.