Abstract
Purpose: To understand associations between food insecurity and depression, anxiety, and stress during the COVID-19 pandemic among low-income adults in the United States.Methods: During March 19–24, 2020, we fielded a national, web-based survey (53% response rate) among low-income adults (<250% of the federal poverty line) in the United States (N=1,476). Food security status was measured using the 18-question USDA Household Food Security Module. Multivariable-adjusted logistic regression models examined the association between food insecurity and psychological distress outcomes and COVID-19-specific worries. Qualitative data from an open-response question were also analyzed.Results: More than one-third of low-income adults screened positive for depression (33%), anxiety (39%), and high stress (39%). Greater food insecurity was associated with a dose–response relationship with all psychological distress outcomes (all outcomes p-trend <0.001) and COVID-19-specific worries (all outcomes p-trend <0.001). Compared to food-secure adults, adults with very low food security were more likely to screen positive for depression (odds ratio [OR] 7.72; 95% confidence interval [CI]: 5.52–10.80), anxiety (OR 6.19; 95% CI: 4.51–8.51), and high perceived stress (OR 10.91; 95% CI: 7.78–15.30). Very low food security was also associated with increased worries about the effect of COVID-19 on one's health (OR 2.56; 95% CI: 1.90–3.45), income (OR 5.18; 95% CI: 3.78–7.06), and ability to feed one's family (OR 9.24; 95% CI: 6.61–12.92).Conclusions: The COVID-19 pandemic is negatively associated with the mental health of low-income adults in the United States, with disproportionate associations among adults experiencing food insecurity. These disparities have the potential to increase mental health disparities over the long term.
Highlights
Food insecurity, a condition defined by limited or uncertain access to sufficient, nutritious food for an active, healthy life,[1] has risen dramatically during the COVID-19 pandemic
Compared to food-secure adults, adults with very low food security were more likely to screen positive for depression, anxiety, and high perceived stress
33% of the sample screened positive for depression, 39% screened positive for anxiety, and 39% screened positive for high perceived stress
Summary
A condition defined by limited or uncertain access to sufficient, nutritious food for an active, healthy life,[1] has risen dramatically during the COVID-19 pandemic. Before COVID-19, 11% of US households experienced food insecurity in 2018.1 In the initial months of COVID-19, the rate more than tripled and 35–38% of US households experienced food insecurity.[2,3] Food insecurity disproportionately affects low-income communities and, in mid-March. 2020, 44% of low-income households experienced food insecurity.[4]. Departments of 1Health Management and Policy and 2Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. {Current affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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