Food Insecurity and Mental Health

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.

In this 2017 study, data from nationally representative surveys such as the 2014 Gallup World Poll was used to assess the relationship between food insecurity and mental health across the world. The participants reported their experiences of food insecurities through the Food Insecurity Experience Scale Survey Module, while their depression and mental state were indicated by their Negative Experience Index and Positive Experience Index scores. Reports of food insecurity ranged from 18.3% in East Asia to 76.1% in Sub-Saharan Africa. Across the 149 countries included in the surveys, food insecurity was found to be associated with poorer mental health indices in a dose-response manner. This trend was also observed within regions. Food insecurity correlated with poorer mental health and psychosocial stressors across global regions. The author states that there are likely to be many pathways in which food insecurities can predispose or contribute to common mental disorders.

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.

According to Van der Velde et al. (2019), people at risk of experiencing food insecurity generally exhibit poor dietary behaviors also due to factors such as perceived higher prices of healthy foods, monetary problems, lack of nutritional knowledge, and inadequacy in preparing healthy foods. This study aimed to gather more information on the needs and perceptions of people at risk of having food insecurities by conducting inductive analysis. Overall, the ten participants demonstrated adequate nutritional knowledge, but their eating behaviors were influenced by social and physical factors. For example, subjects considered the food preferences of their kids, cultural food habits, and physical temptations to eat. Moreover, poor mental health, financial stress, and high food prices were reported as the perceived barriers for healthy eating behaviors. Generally, there was a conscious attitude towards their financial state, which results in the coping strategies on a restricted budget. Food insecurity was mostly mentioned when talking about the past or others but not about the individual’s own current experiences. Debt assistance and other resources that can assist with financial strain were perceived in a generally positive way except from the Food Bank. The participants recommended the distribution of free meals, the facilitation of social contacts, the lowering of healthy food prices, and the increase of healthy food supply in the neighborhood. The insights of these people at risk of food insecurity can hopefully inform health promotion programs and help develop interventions designed to enhance diet and thus decrease risk of disease.

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.

This 2018 review takes a look at evidence on the link between food insecurity and mental health among women in high-income countries. Thirty-nine articles were found through searching the PubMed, EMBASE, and psycINFO databases, 31 of which were unique studies or surveys. Maynard et al. identified that 75% of the articles utilized data from a version of the United States Department of Agriculture Household Food Security Survey Module, and that a variety of mental health measures were used to determine depression, depressive symptoms, anxiety, and stress. The majority of the research indicated associations between depression and food insecurity, while bidirectional relationships (food insecurity increasing the risk of depressive symptoms or diagnosis/depression predicting food insecurity) were also suggested. Some articles analyzed vulnerable subgroups such as pregnant women, women at risk of homelessness, refugees, and those with a history of experiencing violence or substance abuse. In essence, this review shows the connection between food insecurity and mental health among women in high-income countries.

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.

In this 2020 study, Gyasi et al. take a look at the associations between food insecurity with hunger and psychological distress among older people in Ghana, since hunger is a frequent and continuous problem in Sub-Saharan Africa and other low-income countries. Using the data on 1200 older (aged 50+) participants of the 2016/2017 Ageing, Health, Psychological Well-being and Health-seeking Behavior Study, the researchers discovered a food insecurity prevalence rate of 36% with roughly 27% and 9% for moderate and severe hunger levels, respectively. Both moderate and severe hunger were significantly linked with increased psychological distress compared to absence of hunger. Subgroup analyses suggested that this interaction between hunger and psychological distress worsens with advancing age and in men. These results can hopefully inform social policy initiatives and health promotion interventions designed to help the older population showing signs of food insecurity.

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.

This 2020 review examines the role of biotechnology in the enhancement of food security and inspects its significant impact on agriculture and the food market. The goal was to expand the understanding of the social economic environment and the dietary behaviors of Canadian residents. Several socio-environmental factors that influence the public’s eating behaviors were discussed, including the development and implementation of national policies. Healthy eating can be determined by individual determinants, as well as social, physical, and economic environments, according to a framework used. Marcone et al. concludes that there is a gap in research and a great need for new policies in the food and nutrition environments.

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.

Bergmans et al. (2019) evaluated whether the local food environment moderates the association between individual food insecurity with poor mental health by analyzing survey data collected from 291 adult residents of Flint, Michigan in 2015. In this survey, respondents were asked to rate their overall "mental or emotional health" using a 5-point Likert scale, before being classed as having either good mental health (good, very good, or excellent rating) or poor mental health (fair or poor rating). Fully adjusted models revealed the 3.2 times increased odds of having poor mental health associated with food insecurity. But it was also found that the participants in the 25th percentile for access to vegetables were 7.4 times likely to report poor mental health, while those in the top 25th percentile for vegetable access were weakly linked with poor psychological health. This means the proximal access to fruits and vegetables moderate the relationship between food security and mental health. The researchers support the longitudinal analysis of programs and policies aimed at improving nutritious food availability since it would suggest if they induce mental health benefits.

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.

Although there is strong evidence linking maternal exposure to domestic violence with her children’s poor nutrition, Lentz (2018) remarks the less researched relationship between domestic violence, nutrition, and food security. The literature has proposed the ideas that the victims’ poor nutrition could be a result of the offenders restricting food as a form of violence or control, and that women’s food preparation and portion allocation could trigger violence in the culprit. Interviews were carried out with over 100 women in rural Bangladesh to reveal an association between violence and food practices. The author believes that domestic violence plays a part in the women’s choices on food consumption and distribution, often leading to the intake of lower quality foods and less quantity. Thus, it was recognized that there are a complex set of relationships involved between hunger, undernutrition, agency and domestic violence, which differ from the 2 previously hypothesized causal pathways. According to Lentz, women often demonstrate agentic decision-making in a context of violence, referred to as “burdened agency”. This “burdened agency” may explain how ladies make decisions around food practices, and why interventions designed around food security and nutrition may not be popular in this target group.

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.

Paslakis et al. (2021) explain that the coronavirus 2019 disease (COVID-19) pandemic has led to food shortages, rising food prices, and income loss, resulting in global food insecurity alerts to be issued. The mounting problems caused by the pandemic for millions of children and adolescents and their families, currently living with or at risk for development of food insecurity, coupled with the past studies on food insecurity and eating pathology have raised concerns about the dietary behaviors of children and adolescents. Non-constant access to nutritious food is associated with chronic physical and mental health issues and death. This present article aims to raise awareness of this threat and to help make food security and healthy dietary attitudes and behaviors a global priority during the COVID-19 pandemic to ensure the health and well-being of our children and adolescents.

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.

Kim & Kim (2020) evaluated the combined impact of disease management and food insecurity on the physical and mental health of Korean adults (aged 30+). Data was taken from the Korea National Health and Nutrition Examination Survey (KNHANES) 2012-2015. Results showed that men with food insecurity were more likely to be underweight compared to men with food security. On the other hand, there was a greater chance of food insecure women being overweight, compared with food secure women. Food security was found to be associated with a high risk of all mental health outcomes. Moreover, unmet healthcare needs and mental health counselling were more prevalent in adults with food insecurity. The researchers reveal that these unmet healthcare needs are related with an increased risk of obesity among food-insecure men. In addition, among adults with food insecurity correlations were found with higher risk of mental health outcomes. Among food insecure ladies, low participation levels in nutrition education or counselling was linked with higher prevalence of obesity. To conclude, unmet healthcare needs may amplify the obesity rates in food insecure men and worsen mental health issues in both men and women with food insecurity. Lack of participation in the nutrition education program or counselling may result in increased obesity in food-insecure women.

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.

In this 2021 article, Elgar et al. comment that the link between food insecurity and mental illness is shown to be stronger in the more affluent countries because of the relative deprivation in these participants. The hypothesis was that the severity of individual food insecurity relative to others in a reference group determines its associations with mental health and wellbeing (after variation in absolute food insecurity are controlled for). After dissecting data collected by the Gallup World Poll on residents of 160 countries, it was discovered that relative food insecurity was associated with increased mental health symptoms, lower positive wellbeing and lower life satisfaction (after controlling for absolute food insecurity, household income, and country differences). This correlation between food insecurity with mental health and wellbeing was stronger where the prevalence of food insecurity was lower. These findings supported the relative deprivation theory, as individuals who constantly worry about not getting sufficient amounts of food, skip meals, or experience chronic hunger, are receiving inadequate mental health support, especially in areas where food insecurity prevalence is low.

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.

The aim of this 2019 study was to determine if disability, BMI, and serious psychological distress are linked with food insecurity among residents of California. Secondary data was collected from the California Health Interview Survey (CHIS) from 2013-2015. Disability was defined by presence of a physical, mental, or emotional condition, while food security of the respondents was categorized as either food secure, food insecure without hunger, or food insecure with hunger. Out of the 61,274 Californian participants, food insecurity was reported in 15.4%. Those born outside of the U.S. accounted for 54.8% of the population with food insecurity, and a large proportion of these food insecure people were Latinos (60.1%). Other statistics include subgroups such as residents on food stamps, with serious psychological distress, disability, and obesity, made up 24.7%, 11.7%, 45.1%, and 34.5% of the food insecure, respectively. Further analysis results revealed that people were more likely to experience food insecurity if they were on food stamps (by 250%), had serious psychological distress (by 142%), were foreign-born (by 138%), or had a disability (by 92%). These significant associations between food insecurity with the Supplemental Nutrition Assistance Program, serious psychological distress, disability, and being overweight/obese among Californian citizens indicates a need for culturally appropriate interventions that will help immigrants manage their mental, physical, and emotional health.

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.

Since there is a lack of research on the mental health of livestock farmers living in developing countries, Nuvey et al. (2020) conducted guided interviews, and collected data from 287 livestock farmers and 24 key-informants in the Northern and Southern Belts of Ghana. Roughly 85% of the farmers lost cattle within 1 year due to animal diseases (91%), theft (50%), and pasture shortages (27%). Poor access to veterinary services has resulted in farmers treating livestock diseases themselves using drugs from unregulated sources. To recover losses, these diseased cows are often sold off for meat. Furthermore, poor mental health was exhibited by 60% of these livestock farmers, and 72% of these individuals were depressed, 66% were anxious, and 59% were stressed. Poorer mental health was associated with an increasing number of adverse events experienced, as well as a rising ratio of livestock lost, greater emotional attachment to the animals, and self-reported personal physical illnesses. But mental wellbeing improved as the herd multiplied in size. In conclusion, the mental wellbeing of these Ghanian livestock farmers is worsening due to the deaths of their animals, and the lack of access to veterinary services have led to farmers using possibly unreliable drugs and selling diseased cattle - posing health risks to the public. Now Ghana needs to evaluate their veterinary services and investigate the effects of high-risk meat consumption on the mental and physical health of the public.

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.

Although mental illness has been repeatedly reported to be connected with poverty, Tirfessa et al. (2019) comment on the lack of research considering the impact of food insecurity. The aim of this study was to compare the food insecurity levels of patients with severe mental disorders with that of the general population in rural Africa, where there is a high burden of food insecurity. The researchers examined households of 292 people living with diagnosed severe mental disorders (SMD), and 284 households without a person with SMD in a rural district in south Ethiopia. It was noted that mental health services were not available within this district. Severe food insecurity was reported by 32.5% of SMD sufferers, and 15.9% of individuals not living with SMDs. It was determined that the odds of experiencing food insecurity dropped as annual income increased. Another finding was the non-significant association between SMD and food insecurity when total disability scores were taken into account, suggesting a possible mediatory role of disability. Overall, the results indicate that people with severe mental disorders are vulnerable to food insecurity, and that addressing the disability factor of SMDs may help reduce food insecurity. While plans are in place to improve access to mental health care in this district, the effects of treatment on disability and food insecurity will need to be continually monitored.

Food iInsecurity is associated with depression, anxiety, and stress: Evidence from the early days of the COVID-19 pandemic in the United States

Unpacking the “black box” of global food insecurity and mental health