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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 20, 2018; 8(3): 88-96
Published online Sep 20, 2018. doi: 10.5498/wjp.v8.i3.88
Drinking plain water is associated with decreased risk of depression and anxiety in adults: Results from a large cross-sectional study
Fahimeh Haghighatdoost, Awat Feizi, Ahmad Esmaillzadeh, Nafiseh Rashidi-Pourfard, Ammar Hassanzadeh Keshteli, Hamid Roohafza, Payman Adibi
Fahimeh Haghighatdoost, Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Awat Feizi, Psychosomatic Research Center, Integrative Functional Gastrointestinal Research Center and Biostatistics and Epidemiology Department, School of Health Isfahan University of Medical Sciences, Hezarjarib, Isfahan 81746-73461, Iran
Ahmad Esmaillzadeh, Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran 14176-53761, Iran
Nafiseh Rashidi-Pourfard, Shahid Motahari Hospital, Fooladshahr, Isfahan 81746-73461, Iran
Ammar Hassanzadeh Keshteli, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AL 54321, Canada
Hamid Roohafza, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Payman Adibi, Integrative Functional Gastrointestinal Research Center and Gastroenterology Section, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Author contributions: Haghighatdoost F and Feizi A contributed to statistical analysis, data interpretation and manuscript drafting; Esmaillzadeh A contributed to SEPAHAN study concepts and design, data collection and drafting of the manuscript; Rashidi-Pourfard N contributed to statistical analysis, data interpretation and manuscript drafting; Keshteli AH, Roohafza H and Adibi P contributed to SEPAHAN study concepts and design, data collection and drafting of the manuscript; Feizi A supervised the current secondry study; all authors approved the final version of the manuscript.
Institutional review board statement: The study protocol was approved by the bioethics committee of Isfahan University of Medical Sciences (#189069, #189082, #189086).
Informed consent statement: All study participants provided an informed consent statement.
Conflict-of-interest statement: None of the authors had any personal or financial conflicts of interest.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Awat Feizi, PhD, Full Professor, Psychosomatic Research Center, Integrative Functional Gastrointestinal Research Center and Biostatistics and Epidemiology Department, School of Health Isfahan University of Medical Sciences, Hezarjarib, Isfahan 81746-73461, Iran. awat_feiz@hlth.mui.ac.ir
Telephone: +98-313-792 3250 Fax: +98-313-7923232
Received: February 14, 2018
Peer-review started: February 14, 2018
First decision: March 2, 2018
Revised: April 23, 2018
Accepted: June 9, 2018
Article in press: June 9, 2018
Published online: September 20, 2018
AIM
To investigate the relation between plain water drinking and risk of depression and anxiety among a large sample of Iranian adults.
METHODS
A total of 3327 Iranian general adults were included in this cross-sectional study. Validated Iranian version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Water consumption was assessed by asking about the number of glasses of water that consumed daily. Water consumption was categorized into < 2, 2-5, and ≥ 5 glasses of water/d.
RESULTS
In the crude model, the lowest level of water drinking (< 2 glasses/d) compared with reference group (≥ 5 glasses/d) doubled the risk of depression and anxiety (P < 0.0001). After adjusting potential confounders, this inverse link remained significant for depression (OR: 1.79; 95%CI: 1.32, 2.42; P < 0.0001), but not for anxiety (OR: 1.49; 95%CI: 0.98, 2.25; P = 0.109). In stratified analyses by sex, after controlling for potential confounders, water drinking < 2 glasses/d was associated with 73% and 54% increment in the risk of depression in men and women, respectively (P < 0.05), whilst no significant association was observed for anxiety either in men or in women.
CONCLUSION
We found inverse associations between plain water consumption and depression. Also, these findings showed a tended risky association, but not statistically significant, between lower levels of water consumption and anxiety. These findings warrant evaluation in prospective and clinical trials studies to establish the plausible role of water in mental health status.
Core tip: Evidence supports the relation between water consumption and health outcomes. Validated Iranian version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Water consumption was assessed by asking about the number of glasses of water that consumed daily. After adjusting potential confounders, an inverse link was observed between water and depression, but not for anxiety, though in the crude model both disorders were inversely related to water drinking. These findings warrant evaluation in prospective studies to establish the plausible role of water in mental health status.
