Our study also has numerous strengths. We used standardized, a priori measures of diet quality and depression to test for a prospective association in AI communities-a population unique to the literature on this topic yet known to experience higher burdens of related health outcomes. The Strong Heart Family Study is a large, multi-tribal study of risk factors for cardiovascular disease in an underserved and rural population of AIs. We leveraged comprehensive **data** collected at each assessment to control for potential confounders, including psychosocial factors that have been difficult to control for in previous studies. We were also able to explore interactions by age and sex and impute missing values.