Background: Psychosocial stress and emotional coping are known to influence dietary behaviors, yet little is known about how these patterns vary across populations or interact with psychological food involvement and health engagement. This study investigates how stress-related eating, food involvement, and health engagement shape dietary behaviors and digestion-related quality of life (DQoL) across five European countries.
Methods: A cross-sectional survey was conducted with 2,324 adults from Denmark, Germany, Italy, Lithuania, and the Netherlands. Measures included Perceived Stress Scale, Salzburg Stress Eating Scale, Altarum Consumer Engagement Scale, Psychological Food Involvement Scale, and Digestion-Associated Quality of Life Questionnaire. Ad hoc items assessed comfort food consumption under stress and its perceived importance. ANOVA, Pearson correlations, and Chi-square tests assessed associations and cross-country differences.
Results: Perceived stress was strongly associated with poorer DQoL (r=0.510), while health engagement negatively correlated with stress (r=-0.115). Psychological food involvement was positively associated with both health engagement (r=0.368) and stress-eating (r=0.100). Higher health engagement was more common among women, older adults, and those with higher education. Individuals with greater food involvement were also more likely to value food as a stress-regulation tool. Cross-country comparisons revealed significant psychosocial and behavioral variation. Italians showed the highest engagement and food involvement levels (p<0.001) and reported the lowest intake of fast food and sweetened beverages, even under stress. In contrast, Danes reported low engagement and food involvement, and high habitual consumption of sugary snacks and drinks, particularly during stress. Germans and Lithuanians showed more reactive eating patterns, especially for fast food and alcohol. Dutch participants reported high fast-food intake but moderate stress-related eating changes.
Conclusion: The findings reveal psychosocial and cultural variability in stress-eating, health engagement, and food involvement across five European countries. These insights suggest the need for context-sensitive dietary interventions that account for both emotional drivers of eating and national patterns of health orientation.