Abstract
PurposeFood insecurity has been linked with maternal depression in low-income settings. Few studies have looked at factors associated with both food insecurity and maternal depression as outcomes. This study aimed to assess factors associated with food insecurity and depression in a sample of pregnant South African women.MethodsWe conducted a cross-sectional study at a Midwife Obstetric Unit in a low-income suburb in Cape Town. Pregnant women attending the clinic for their first antenatal visit were invited to participate. The shortened form of the US Household Food Security Survey Module was used to measure food insecurity. The Expanded Mini-International Neuropsychiatric Interview was used to diagnose depression, anxiety, alcohol and drug dependence, and assess for suicidal ideation and behaviour. Logistic regression modelling was conducted to explore factors associated with food insecurity and depression in separate models.ResultsWe found that 42% of households were food insecure and that 21% of participants were depressed (N = 376). The odds of being food insecure were increased in women with suicidal behaviour (OR = 5.34; 95% CI 1.26–22.57), with depression (4.27; 1.43–12.70) and in those with three or more children (3.79; 1.25–11.55). The odds of depression was greater in women who were food insecure (5.30; 1.63–17.30), substance dependent (15.83; 1.31–191.48) or diagnosed with an anxiety disorder (5.04; 1.71–14.82).ConclusionsFood insecurity and depression are strongly associated in pregnant women. The relationship between food insecurity and depression is complex and requires further investigation. Interventions that improve both food security and mental health during the perinatal period are likely to benefit the physical and mental well-being of mothers and children.
Highlights
Despite the political and economic advances made in South Africa since achieving democracy in 1994, many South Africans continue to experience poverty and unemployment [1]
The study sample consisted of 376 pregnant women, of whom 158 (42%) were food insecure, 81 (21.4%) were diagnosed with Major depressive episode (MDE) and 86 (22.8%) were diagnosed with anxiety disorder
In the full multivariate model, the odds of having a diagnosis of MDE was more than 15 times greater in women with substance dependence [OR = 15.83 (1.31-191.48); p = 0.030], five times greater in women with anxiety disorder [5.04 (1.71–14.82); p = 0.003], more than five times greater in women who were food insecure [5.30 (1.63–17.30); p = 0.006], and decreased with increasing perceived social. In this cross-sectional study of pregnant South African women living in an urban, low socio-economic setting, we found that 42% of households were food insecure, and that 21% of participants were depressed
Summary
Despite the political and economic advances made in South Africa since achieving democracy in 1994, many South Africans continue to experience poverty and unemployment [1]. In a recent poverty report by Statistics South Africa [2], 30.4 million South Africans (55.5% of the population) were estimated to be living below the upper-bound poverty line, which is less than 992 South African Rands (ZAR992) or US$81.93 per person per month (pppm). South Africans living above the upper-bound poverty line are able to purchase both adequate levels of food and non-food items to ensure adequate health. Social Psychiatry and Psychiatric Epidemiology (2018) 53:363–372 the United States [3] as ‘a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life’. Food insecurity exists when the availability of nutritionally adequate and safe foods, or the ability to acquire acceptable foods in an acceptable way, is limited or uncertain [4]
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