Association between food insecurity severity and major depression: Findings from the United States National Health and Nutrition Examination Survey
Food insecurity and mental health disorders have been increasing in all populations globally due to a variety of sociopolitical factors. Our study examines how the severity of food insecurity is associated with major depression in adults. We analyzed data from the 2017–2018 National Health and Nutrition Examination Survey, which includes a nationally representative sample from households across the United States. Our sample was restricted to adults aged 18 and older, resulting in a sample size of 5856 participants. We used a multiple logistic regression with sampling weights applied to evaluate whether adult food insecurity severity is associated with major depression. Overall, higher severity of food insecurity was associated with increased odds of depression. Specifically, adults with very low food security had a 315% significantly increased odds of depression compared to those with full food security (adjusted odds ratio [aOR] = 4.15, 95% CI = 3.09 – 5.64, p < 0.05). Females also had a 60% significantly higher odds of depression (aOR = 1.60, 95% CI = 1.12 – 2.30, p < 0.05) and higher income levels were significantly associated with lower odds of depression (aOR = 0.90, 95% CI = 0.83–0.97, p < 0.05). Our study supports prior research that food insecurity has adverse effects on mental health. These results can be used to inform public health research and interventions for food insecurity and mental health moving forward.
Allen, L.H. (2009). How common is Vitamin B-12 deficiency? American Journal of Clinical Nutrition, 89(2): 693S-696S. https://doi.org/10.3945/ajcn.2008.26947A
Alpert, J.E., Mischoulon, D., Rubenstein, G.E.F., Bottonari, K., Nierenberg, A.A., & Fava, M. (2002). Folinic acid (Leucovorin) as an adjunctive treatment for SSRI-refractory depression. Annals of Clinical Psychiatry, 14(1): 33-38. https://doi.org/10.1023/a:1015271927517
Ashe, K.M., & Lapane, K.L. (2018). Food insecurity and obesity: Exploring the role of social support. Journal of Womens Health (Larchmt), 27(5): 651-658. https://doi.org/10.1089/jwh.2017.6454
Bickel, G., Nord, M., Price, C., Hamilton, W., & Cook, J. (2000). Guide to Measuring Household Food Security, Revised 2000. US Department of Agriculture, Food and Nutrition Service, p.52. Available from: https://fns-prod.azureedge.us/sites/ default/files/fsguide.pdf [Last accessed on 2023 Dec 31].
Burris, M., Kihlstrom, L., Arce, K.S., Prendergast, K., Dobbins, J., McGrath, E., Renda, A., Shannon, E., Cordier, T., Song, Y., & Himmelgreen, D. (2021). Food insecurity, loneliness, and social support among older adults. Journal of Hunger and Environmental Nutrition, 16(1): 29-44. https://doi.org/10.1080/19320248.2019.1595253
Chung, H.K., Kim, O.Y., Kwak, S.Y., Cho, Y., Lee, K.W., & Shin, M.J. (2016). Household food insecurity is associated with adverse mental health indicators and lower quality of life among Koreans: Results from the Korea National Health and Nutrition Examination Survey 2012-2013. Nutrients, 8(12): 819. https://doi.org/10.3390/nu8120819
Goodwin, R.D., Dierker, L.C., Wu, M., Galea, S., Hoven, C.W., & Weinberger, A.H. (2022). Trends in U.S. depression prevalence from 2015 to 2020: The widening treatment gap. American Journal of Preventive Medicine, 63(5): 726-733. https://doi.org/10.1016/j.amepre.2022.05.014
Greenberg, P.E., Fournier, A.A., Sisitsky, T., Simes, M., Berman, R., Koenigsberg, S.H., & Kessler, R.C. (2021). The economic burden of adults with major depressive disorder in the United States (2010 and 2018). Pharmacoeconomics, 39(6): 653-665. https://doi.org/10.1007/s40273-021-01019-4
Hammen, C. (2018). Risk factors for depression: An autobiographical review. Annual Review of Clinical Psychology, 14: 1-28. https://doi.org/10.1146/annurev-clinpsy-050817-084811
Hatsu, I., Hade, E., & Campa, A. (2017). Food security status is related to mental health quality of life among persons living with HIV. AIDS and Behavior, 21(3): 745-753. https://doi.org/10.1007/s10461-016-1573-9
Hintikka, J., Tolmunen, T., Tanskanen, A., & Viinamäki, H. (2003). High Vitamin B12 level and good treatment outcome may be associated in major depressive disorder. BMC Psychiatry, 3(1): 17. https://doi.org/10.1186/1471-244X-3-17
Institute for Health Metrics and Evaluation. (2022). The 2019 Global Burden of Disease (GBD) Study Database. Available from: https://vizhub.healthdata.org/gbd-results [Last accessed on 2022 Dec 27].
Jones, A.D., Ngure, F.M., Pelto, G., & Young, S.L. (2013). What are we assessing when we measure food security? A compendium and review of current metrics. Advances in Nutrition, 4(5): 481-505. https://doi.org/10.3945/an.113.004119
Kroenke, K., Spitzer, R.L., & Williams, J.B. (2001). The PHQ‐9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9): 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Kutner, M.H., Nachtsheim, C.J., Neter, J., & Wasserman, W. (2004). Applied Linear regression Models. Vol. 4. New York: McGraw-Hill/Irwin, p.563-568.
McClain, A.C., Xiao, R.S., Gao, X., Tucker, K.L., Falcon, L.M., & Mattei, J. (2018). Food insecurity and odds of high allostatic load in Puerto Rican adults: The role of participation in the supplemental nutrition assistance program during 5 years of follow-up. Psychosomatic Medicine, 80(8): 733-741. https://doi.org/10.1097/PSY.0000000000000628
Nagata, J.M., Palar, K., Gooding, H.C., Garber, A.K., Whittle, H.J., Bibbins-Domingo, K., & Weiser, S.D. (2019). Food insecurity is associated with poorer mental health and sleep outcomes in young adults. Journal of Adolescent Health, 65(6): 805-811. https://doi.org/10.1016/j.jadohealth.2019.08.010
Patel, V., Burns, J.K., Dhingra, M., Tarver, L., Kohrt, B.A., & Lund, C. (2018). Income inequality and depression: A systematic review and meta‐analysis of the association and a scoping review of mechanisms. World Psychiatry, 17(1): 76-89. https://doi.org/10.1002/wps.20492
Pound, C.M., & Chen, Y. (2021). Female sex and food insecurity in relation to self-reported poor or fair mental health in Canadian adults: A cross-sectional study using national survey data. Canadian Medical Association Journal, 9(1): E71-E78. https://doi.org/10.9778/cmajo.20200112
Roberts, S.H., Bedson, E., Hughes, D., Lloyd, K., Menkes, D.B., Moat, S., Pirmohamed, M., Slegg, G., Thome, J., Tranter, R., Whitaker, R., Wilkinson, C., & Russell, I. (2007). Folate augmentation of treatment-evaluation for depression (FolATED): Protocol of a randomised controlled trial. BMC Psychiatry, 7(1): 65. https://doi.org/10.1186/1471-244X-7-65
Searles, M., & Wong, R. (2022). Food insecurity and COVID-19 diagnosis: Findings from a national United States sample. Journal of Hunger and Environmental Nutrition, 1-16. https://doi.org/10.1080/19320248.2022.2128961
Substance Abuse and Mental Health Services Administration. (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. United States: Substance Abuse and Mental Health Services Administration. Available from: https://www.samhsa.gov/data/sites/default/ files/cbhsq-reports/nsduhnationalfindingsreport2018/ nsduhnationalfindingsreport2018.pdf [Last accessed on 2023 Dec 31].
Tarasuk, V., Cheng, J., Gundersen, C., de Oliveira, C., & Kurdyak, P. (2018). The relation between food insecurity and mental health care service utilization in Ontario. The Canadian Journal of Psychiatry, 63(8): 557-569. https://doi.org/10.1177/0706743717752879
Tarasuk, V., Gundersen, C., Wang, X., Roth, D.E., & Urquia, M.L. (2020). Maternal food insecurity is positively associated with postpartum mental disorders in Ontario, Canada. Journal of Nutrition, 150(11): 3033-3040. https://doi.org/10.1093/jn/nxaa240
USDA ERS-Food Security and Nutrition Assistance. (2022). Available from: https://www.ers.usda.gov/data-products/ ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance [Last accessed on 2022 Dec 26].
Wong, R., Gable, L., & Rivera-Núñez, Z. (2018). Perceived benefits of participation and risks of soil contamination in St. Louis urban community gardens. Journal of Community Health, 43(3): 604-610. https://doi.org/10.1007/s10900-017-0459-8