Food Insecurity and Mental Health

Systematic evidence and gap map of research linking food security and nutrition to mental health

Campus Food Pantry Use Is Linked to Better Health Among Public University Students

Prevalence of food insecurity in people with major depression, bipolar disorder, and schizophrenia and related psychoses: A systematic review and meta-analysis

Food insecurity and mental well-being in immigrants: A global analysis

Food insecurity and risk of depression among refugees and immigrants in South Africa

This 2021 literature review was undertaken to better understand how food insecurity relates to cognitive function or brain structure across the life course. The authors conducted systematic database searches on Google Scholar and PubMed for studies that used measures of food insecurities and cognitive function/brain structure in humans. In total, 17 studies met the inclusion criteria. Of these, 13 assessed general cognition, 10 included executive function, 8 measured verbal memory, and 4 evaluated visuospatial abilities. No studies examined brain structure. Most of the studies showed a link between higher food insecurity and poorer cognitive function across all stages of the life course, particularly for general cognition and executive function. Significant inverse associations were found between food insecurity and either general cognition or executive function among children and adults. Overall, these findings indicate that food insecurity is connected to lower cognitive function across the life course. Royer et al. suggest future research to investigate the effect of varying food security status on cognitive function and brain structures. This would hopefully allow the development of optimal food insecurity interventions and as a result enhance cognitive health. [NPID: cognition, food security, food insecurity, review, cognitive function]

Teasdale et al. (2021) conducted a review and meta-analysis to report the prevalence of food insecurity in people with severe mental illnesses. It is believed that these patients with major depression, bipolar disorder, or schizophrenia experience several risk factors that may predispose them to food insecurity. But there has been limited research done on the incidences and effects of food insecurity among this population. The review identified 29 unique datasets (including 31 publications related to food insecurity in severe mental illnesses). The average prevalence rate of severe mental illnesses among the studies was 40%. Compared to the general population/control group, people with severe mental illness were 2.71 times more likely to show food insecurity. The odds of people with severe mental illness demonstrating food insecurity were higher in high/high-middle income countries compared to low/low-middle income countries. The authors hypothesized that this is due to the general population of lower income countries having higher rates of food insecurity. In terms of diagnosed food insecurity, there were no differences in prevalence rates. Thus, healthcare professionals working with patients with severe mental illness should consider food insecurity. [NPID: food insecurity, severe mental illness, depression, bipolar disorder, schizophrenia]

This 2021 study aimed to understand the interaction between food insecurity and depression, anxiety, and stress during the COVID-19 pandemic among low-income adults in the United States. Between the 19th and 24th March 2020, a web-based survey was conducted to gather data on food security among low-income adults (those under the 250% Federal poverty line). More than one-third of the respondents screened positive for depression (33%), anxiety (39%), and stress (39%). There was a dose-dependent relationship between higher food insecurity and all the psychological distress outcomes and COVID-19-related worries. Moreover, adults with very low food security were more likely to test positive for depression, anxiety, and high perceived stress, when compared with food-secure individuals. In addition, very low food security was linked with increased concerns on COVID-19’s effects on health, income, and ability to keep providing for the family. This coronavirus pandemic is negatively affecting the mental health of low-income adults in the U.S., particularly those with food insecurity. This may result in greater disparities in mental health in the future. [NPID: COVID, coronavirus, pandemic, food, diet, food insecurity, depression, anxiety, stress, US, United States, Americans, low income, poor, poverty, health]

One of the aims of this 2019 study was to find out the prevalence of food insecurity, mental distress, and suicidal ideation among 1,142 individuals living in rural villages in Nigeria (n = 380), Uganda (n = 380) and Ghana (n = 382). The second objective was to examine how these 3 measures interact with one another. Food insecurity was determined based on the number of months in the previous year that the respondent's family were 'unable to eat two square meals per day'. The Kessler non-specific psychological distress scale (K6) indicated that 35.5%, 30.8%, and 30.4%, of participants from Nigeria, Uganda and Ghana, had moderate or severe mental distress, respectively. Moreover, suicidal ideation was reported by 29.7% of Nigerians, 21.3% of Ugandans, and 10.9% of Ghanians. There was no variation in mental distress between the men and the women of any of these countries. Less mental distress appeared to be related to being a farmer in Uganda and Ghana, but no other social factors were significantly associated with mental distress. Across the 3 study sites, risk of having suicidal thoughts was different too. Suicidal ideation was linked with food insecurity in Nigeria, female sex in Uganda, and advancing age in Uganda. Sweetland et al. have exposed the higher than previously thought prevalence of mental distress and suicidal ideation in 3 areas in Nigeria, Uganda, and Ghana. Further research is encouraged to better understand the social etiology of mental distress in these poverty-stricken countries in sub-Saharan Africa. [NPID: food insecurity, mental health, Nigeria, Uganda, Ghana, suicide, suicidal ideation, female, Africa]

To assess the relationship between poverty, depression, and food insecurity, Wu et al. (2018) designed this study to inspect family socioeconomic status (SES), maternal depression, and household food insecurity across children's first five years of life. Data were extracted from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a dataset nationally representative of all children born in the United States in 2001. Socioeconomic status was documented by the mother when their children were nine months, 24 months, four years, and at kindergarten entry, while ratings on maternal depressive symptoms were collected at nine months, four years, and kindergarten entry. The research found that family socioeconomic status was predictive of subsequent household food insecurity, which was in turn linked with maternal depressive symptoms further down the timeline. There was also evidence showing household food insecurity mediates the relationship between family socioeconomic status and maternal depressive signs. Household food insecurity may play a big role in the development of the mother’s depression, particularly in poorer families. This study highlights the importance of taking into account food insecurity in service provision to depressed mothers and their under-resourced family. [NPID: food insecurity, mental health, depression, poverty, maternal depression, socioeconomic status]

This 2019 review examined the literature available on the study of the association between food insecurity and depression, anxiety, and sleep disorders. A systematic search on 5 research libraries produced 57 studies that assessed the relationship between food insecurity and depression (n = 169,433), 13 on the link with anxiety and psychological distress (n = 91,957), and 8 studies on sleep disorders (n = 85,788). The meta-analyses performed revealed several correlations between food insecurity with increased risks of depression [odds ratio (OR) = 2.74], anxiety (OR = 2.41), and sleep disorders (OR = 1.80). These results were robust to covariates and population groups. Thus, food insecurity was strongly associated with risk of depression, anxiety, and sleep disorders, although Arenas et al. bring up the need for additional longitudinal studies that would improve understanding of effect sizes and causal relationships. [NPID: food insecurity, mental health, food insecurity, depression, anxiety, sleep disorders, psychological distress, sleep disorders]

Since there is very little research on the ways in which African Americans in public-sector mental health services cope with food insecurity, Myers et al. (2019) decided to analyze the qualitative data from a study on the prevalence and management of food insecurity among African Americans using public sector mental health services. Interviews were held with 21 participants to get their accounts on their everyday experiences with food insecurity and the strategies used to cope with it. High levels of food insecurity were reported. Coping strategies included sharing foods and cooking meals together. These methods appeared to reduce the negative aspect of living with high food insecurity and serious mental illnesses. As a result, Myers et al. concluded that provision of communal gardens and kitchens through public mental health services may help people cope with food insecurity and potentially reduce incidences of mental illness. [NPID: food insecurity, mental health, African Americans, mental illness]

In this 2021 study, surveys and interviews were carried out with 265 informal women workers in South Africa with the intention of analyzing work conditions and settings, food security and risk of depression among these working women with young children (0-3 years old). One-third of working women in South Africa are in informal work, which is believed to be linked with socioeconomic vulnerability. The types of works the participants had were domestic work or home-based work. Most were informal traders, but others included informal employees and own account workers. Many of the mothers (56.2%) earned between US$70-200 per month, meanwhile some earned less than $70/month and a few (14%) brought in over $200 per month. This study discovered that income was related with food insecurity among these women: detection of severe food insecurity was significantly higher among those with the lowest income relative to the highest earners. Many of the subjects experienced either mild (14.3%), moderate (27.2%), or severe (16%) food insecurity. Horwood et al. also found that women who received financial support from the baby’s father were more likely to be food insecure. Another significant relationship was identified between household food insecurity and depression risk. The risk of depression, according to Edinburgh Postnatal Depression Scores, was 8.3% among the sample. Similar rates were seen for postnatal women and mothers with older children. The calculated depression risk was low compared to previous estimates in South Africa, which suggests that these informal workers possess high resilience levels. But the women with low incomes and increased odds of food insecurity remain vulnerable, possibly leading to worsening of maternal health. Interventions that help enhance social protection, health service access, and ensure safe childcare in the workplace are encouraged. [NPID: food insecurity, mental health, South Africa, depression, income, low income, financial support]

This 2020 study evaluated whether food insecurity is associated with psychotropic medication use independent of depression and anxiety symptoms among HIV-positive women in the U.S. Few studies had previously examined the social-structural factors that may play a role in the use of psychotropic medication, which has increased in America. Using data from the national study Women's Interagency HIV Study (WIHS), Whittle et al. looked into interactions between food insecurity and the use of any psychotropic medications (including antidepressants, sedatives and antipsychotics). Two-thirds of the 905 women included were African American. Results showed a correlation between worse food insecurity with increased symptoms of depression and anxiety in a dose-response manner. In models unadjusted for depression and anxiety, marginal and low food security were linked with higher odds of using any psychotropic medication. There was a 1.93 times greater chance of using any psychotropics after adjusting for depression and anxiety symptoms. Very low food security was not found to be significantly related to psychotropic use but was significantly associated with less risk of antidepressant use. These complex results may signify the presence of barriers to mental health service access that people with very low food security face, and the higher psychotropic prescription rate for distress (likely to have arisen from social and structural factors) in those experiencing marginal food security with services access. [NPID: food insecurity, mental health, psychotropic medication, HIV, women, antidepressants, sedatives, anxiety, depression]

Bruening et al. (2017) conducted a systematic search for relevant literature on the longitudinal association between food insecurity and emotional well-being. The aim of this review was to determine the causal relationship between food insecurity and emotional health among US-based populations. Twelve out of the 4161 peer-reviewed articles met the inclusion criteria. Three of these studies analyzed the impact of emotional health on food insecurity, while five examined the effect of food insecurity on emotional well-being, and four studies investigated a bidirectional relationship. The majority of studies (83%) positively associated negative emotional well-being with food insecurity over time. Although additional studies are required, these observations suggest a bidirectional relationship whereby food insecurity raises the risk of poor emotional health, and poor emotional well-being elevates the risk of food insecurity. [NPID: food insecurity, mental health, emotional well-being, bidirectional relationship]

In this 2018 study, 227 women between 20-50 years old were assessed on their diet to calculate their adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (a diet rich in fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, and low in red and processed meats, sweetened beverages and sodium). The objective was to investigate the relationship between this adherence to the DASH diet with food security and weight status among female adults. While the overall prevalence of food insecurity was 33.9%, the majority of obese and overweight participants were food insecure. Also, greater adherence to the DASH diet was associated with less occurrence of obesity and overweight. In fact, after controlling for age and energy intake, those subjects in the highest tertile for adherence to the DASH diet were 66% less likely to be overweight or obese, compared to those in the lowest tertile. This significant relationship between DASH diet adherence tertile and overweight/obesity was indicated in both food secure and insecure women. To summarize, Tabibian et al. discovered that adherence to the DASH diet correlates is related with a reduced risk of overweight and obesity (based on BMI) in both food secure and insecure women. [NPID: food insecurity, mental health, DASH, hypertension, obesity, overweight]

Myers (2020) provides a review of the association between food insecurity (low quantity and/or quality of food intake) and psychological distress (depression and anxiety). The author comments on the studies published in the last 5 years that have positively associated food insecurity with multiple indicators of psychological distress. These include cross-sectional and longitudinal studies, those in which primary and secondary data were collected, and those that investigated populations in countries of varying income levels. There was a diverse portfolio of studied samples, including adults of all ages, college students, people with chronic disease, and parents. The conclusion was that food insecurity is interconnected with psychological distress, although there are several important gaps in the literature that future research ought to consider. The reviewers would welcome the development of interventions aimed at improving both food insecurity and psychological health at the same time. [NPID: food insecurity, mental health, quality of food, psychological distress, depression, anxiety, income levels, income, college students, chronic disease]

Since the poor health outcomes related to food insecurity may be more apparent in later life, Gyasi et al. (2020) analyzed the age and gender differences in the association between food insecurity with psychological disorders (PD) among older people in Ghana. The dataset was obtained from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study, which included 1,200 individuals aged ≥50 years. Thirty-six percent complained of hunger, while other signs of food insecurity were breakfast skipping (29% prevalence) and consuming the first meal of the day late (observed in 5%). After adjusting the analysis model, presence of food insecurity significantly correlated with higher scores in the psychological disorder assessment, compared to absence of food insecurity. Additionally, having the first meal of the day late was related with a higher risk of having psychological disorders. These relationships were moderated by age and gender - men and those 65 years and over were more likely to have PD compared to women and those in the 50-64 age group. These results demonstrate that food insecurity independently increases incidence of psychological disorders in older people, which hopefully informs public health and policy interventions that support mental health enhancement in the elderly. [NPID: food insecurity, mental health, psychological disorders, Ghana, breakfast, skipping breakfast, public health, elderly]

While food insecurity has been associated with depression, this 2019 study set out to examine its correlation with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD). The study applied data collected in the Women's Interagency HIV Study (WIHS), an American cohort study of 2553 women (71.6% African American/black) with/at risk of HIV. Questionnaires were administered every 6 months from April 2013 until March 2016. Current marginal, low, and very low food securities were discovered to be linked with higher GAD-7 scores (generalized anxiety disorder assessment), and with a significantly greater likelihood of screening positive for moderate-to-severe GAD. Furthermore, low and very low food security 6 months earlier was associated with generalized anxiety disorder outcomes at the present visit. Food security also showed similar dose-response relationships with the measures of perceived stress (PSS-10 score) and PTSD (PCL-C score). In fact, those with very low food security were 1.93 times likely to screen positive for PTSD. Whittle et al. have produced evidence connecting food insecurity with several poor mental health outcomes among women in the United States with or at risk of HIV. [NPID: food insecurity, mental health, GAD, anxiety, generalized anxiety disorder, HIV, stress, perceived stress, women]

Davison et al. (2015) applied data obtained from the 2007 Canadian Community Health Survey to examine the suspected link between household food security and suicidal ideation. The national survey conducted across 3 Canadian provinces (n=5270) included adults over the age of 18 and asked the respondents questions such as whether they had seriously considered committing suicide in the previous 12 months. The Household Food Security Survey Module allowed the researchers to determine the participants’ food insecurity status, classing those who show compromise in quality and/or quantity of food consumption as ‘moderate’, and those with disrupted dietary patterns and lower intake levels as ‘severe’. Although there were variations in the proportion of people with ‘moderate’ and ‘severe’ food insecurities experiencing suicide ideation, there was a significant association between suicidal ideation with moderate and severe food insecurity. These findings suggest that promoting food security could potentially reduce suicide-related morbidity and mortality. It would be even more helpful collecting further longitudinal data to expand the current knowledge on the etiological pathways involved in the interaction between food security and suicide. [NPID: food insecurity, mental health, Canada, suicide, suicidal ideation]

Since food insecurity in Europe is regarded to be in its worst levels, this 2020 study was designed to find out what influences food choice and dietary behavior in a food-insecure sample in the U.K.. Twenty-four consumers at a foodbank in Liverpool were interviewed using questions that focussed on food access, factors affecting food choices, and strategies used to conserve food. Upon analyzing the interview, Puddephatt et al. found six themes: 'income', 'cost of food', 'accessibility of shops', 'health issues', 'food rationing strategies' and 'worsened health outcomes'. The most notable factor impacting the respondents’ food choices was the continuous struggle to afford food. The majority valued food healthiness but the decisions are ultimately based on the cost of the food. The participants have tried to ration by skipping meals, eating small portions, cooking in bulk, and prioritizing the children’s food consumption. Moreover, these subjects reported pre-existing physical and mental health issues that were worsened by poor access to food and resulted in a vicious cycle of stress and poorer health conditions. This study demonstrates the strong impact of a person’s income on their food choices and eating behaviors, and exposes the need to address important matters such as income and cost of healthy food. [NPID: food insecurity, mental health, United Kingdom, cost of food, income, food rationing, cooking in bulk, stress]