Plant-Based Diet Indices and Depression in University Students: The Nuts4Brain-Z Study

Background/Objectives: Evidence on the associations between adherence to different plant-based diet indices and depression in young adults remains limited. This study aimed to analyze the associations of overall, healthy, and unhealthy plant-based diet indices with depressive symptoms in university students. Methods: A cross-sectional study was conducted in 2023 with self-reported data from university students in Cuenca, Spain. Adherence to the overall plant-based diet index (PDI) and to the healthy (hPDI) and unhealthy (uPDI) plant-based diet indices were calculated using data from a 137-item food-frequency questionnaire. Mild-to-severe depression was defined as a Beck Depression Inventory II score > 13 points. Linear and logistic regression models were adjusted for sociodemographic and lifestyle-related confounders. Results: A total of 392 students (mean age: 20.9 ± 2.4 years; 70.4% female) were included. The prevalence of mild-to-severe depression was 36.0%. Higher hPDI and overall PDI scores were associated with lower depressive symptom scores, whereas uPDI scores showed a positive but non-significant association after full adjustment. In logistic regression analyses, high adherence to the hPDI was associated with lower odds of mild-to-severe depression (OR = 0.51; 95% CI: 0.28–0.95; p-for-trend = 0.030). In contrast, higher uPDI adherence was associated with greater odds of depression, although the association was attenuated after adjustment for lifestyle-related variables. Conclusions: Greater adherence to a healthy plant-based diet was associated with lower depressive symptoms and lower odds of mild-to-severe depression among university students. These findings highlight the importance of plant food quality, rather than plant-based diets per se, in relation to depression in young adults.