Food insecurity patterns and mental health among youth and young adults with diabetes

Introduction & Objective: We explored the associations of food insecurity (FI) patterns with symptoms of depression, anxiety, stress, and changes therein in youth and young adults (YYA) with type 1 (T1D) and type 2 diabetes (T2D). Methods: Longitudinal data (2016-2022) from 747 YYA with T1D and 97 with T2D were analyzed using multivariable linear regression. Food security was ascertained with the Household Food Security Survey Module at 3 times (t1, t2, and t3) and patterned as persistently food secure (PFS), persistently food insecure (PFI), and intermittently food insecure (IFI). Mental health at t3 and changes from t2 to t3 were characterized with the Center for Epidemiologic Studies Depression Scale, the Generalized Anxiety Disorder Scale, and Cohen’s Perceived Stress Scale; higher scores indicated greater severity. Result: Among YYA with T1D, 6.6% experienced PFI and 20.3% IFI; among YYA with T2D, 16.5% were PFI and 42.3% IFI. In T1D, PFI and IFI were associated with greater depressive, anxiety, and stress symptoms at t3 but not with changes. In T2D, PFI was associated with greater depressive symptoms at t3 but not with symptom changes. Conclusion: Both persistent and intermittent patterns of FI were associated with mental health symptoms, more so for those with PFI, underscoring the critical interplay between FI and mental health symptoms in YYA with diabetes. Disclosure A.M. Alfalki: None. E.F. Julceus: None. K. Flory: None. J.A. Mendoza: None. F. Malik: None. E.A. Frongillo: None. B.A. Reboussin: None. A. Bellatorre: None. D. Dabelea: None. C. Pihoker: None. A.D. Liese: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R01DK117461)

BackgroundThe mental health of caregivers has been shown to be important for improving HIV prevention and treatment. Household food insecurity affects hundreds of millions of individuals in Sub-Saharan Africa, a region that experiences a disproportionate burden of the HIV pandemic. Both maternal HIV diagnosis and household food insecurity may be linked with maternal stress. This in turn may lead to unhealthy coping behaviors. We examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress.MethodsGhanaian women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth (N = 232). A locally adapted 7-item version of the US Household Food Security Survey Module was applied at four time points postpartum. We dichotomized participant households as being persistently food insecure (i.e., food insecure at each time point) or not (i.e., food secure at any time point). We dichotomized participant women as not perceiving vs. perceiving stress at 12 months postpartum in reference to the median sample score on the 4-item Cohen’s stress scale. Binary multivariate logistic regression models were used to assess the independent and interactive effects of maternal HIV and persistent household food insecurity on maternal stress.ResultsThe proportion of HIV-positive women that lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection (AOR = 2.31, 95% CI 1.29-4.12) and persistent household food insecurity (AOR = 3.55, 95% CI 1.13-11.13) were independently associated with maternal stress in a multivariate model. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for maternal perceived stress (AOR = 15.35, 95% CI 1.90-124.14).ConclusionIn agreement with syndemic theory there is a powerful synergism between maternal HIV diagnosis and household food insecurity on maternal stress. Comprehensive multi-dimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in Sub-Saharan Africa.

Comparing Food Security Before and During the COVID-19 Pandemic: Considerations When Choosing Measures

Food Insecurity on College and University Campuses: A Context and Rationale for Solutions

Association Between Household Food Security and Disordered Eating Behaviors Among Young Adults with Diabetes: The SEARCH for Diabetes in Youth Study

Persistence and transience of food insecurity and predictors among residents of two disadvantaged communities in South Carolina

Characteristics associated with persistent versus transient food insecurity among US veterans screened in the Veteran Health Administration.

We examined the associations between HIV, PFI, and the PFI*HIV interaction on maternal stress (N=232). Women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth. The US Household Food Security Survey Module was applied at 5 time points. Households were classified as PFI (ie. food insecure at each time point) vs. periodically food insecure or persistently food secure. Maternal stress levels were measured with the 4-item Cohen scale. Women were classified as having low or high stress at 12 months postpartum based in reference to the median stress score. Being HIV-positive (AOR=2.30, 95% CI 1.29–4.12) and PFI (AOR=3.55, 95% CI 1.13–11.13) were independently associated with high stress. With HIV status and PFI included in the model, only being HIV-positive was associated with high stress (AOR= 2.03, 95% CI 1.09–3.77). Being both HIV-positive and PFI, vs. not experiencing these 2 conditions, was strongly associated with high stress (AOR=15.35, 95% CI 1.90–124.14). Intervention studies are needed to understand how to reduce stress among HIV-positive women living in PFI households. Funded by NIH/NICHD HDH 43620, NIMH T32MH020031; solely the responsibility of authors.

Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA. We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score). Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose-response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36-3.13) and 1.99 (p < 0.01; 95% CI = 1.26-3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16-3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19-0.96). Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.

Transient, but Not Persistent, Adult Food Insecurity Influences Toddler Development1–3

The extent to which food insecurity impacts changes in mental health outcomes over time in the context of Covid-19 remains unknown. Using longitudinal data from a nationally representative survey, the objectives of the present study were to: (1) assess the prevalence of food insecurity among U.S. adults amid the Covid-19 pandemic; and (2) investigate the relationships between food insecurity statuses and changes in mental health outcomes over time as the pandemic unfolds. Longitudinal data from the Internet-based Understanding Coronavirus in America survey collected bi-weekly between April and December 2020 were used (n=4,068, 15 repeated measures). Adult respondents (aged ≥18) were asked about their food insecurity experiences and stress/anxiety/depressive symptoms. Linear mixed-effect models examined changes in mental health outcomes over time among groups with various food insecurity statuses. Overall prevalence of food insecurity was 8%. Food insecurity was consistently associated with higher levels of stress/anxiety/depressive symptoms (p<0.001). Stress/anxiety/depressive symptoms declined over time among food-secured U.S adults. However, mental health trajectories of respondents with various food insecurity categories, including food insecurity status, persistent food insecurity, and food insecurity of higher severity and longer duration, remained stable or worsened over time. Moreover, the mental health gap between food-secured and food-unsecured participants widened over time. Food insecurity represents a pressing public health problem during the Covid-19 pandemic with substantial mental health implications. Persistent and severe food insecurity may contribute to mental health disparity in the long term. Food insecurity reduction interventions may alleviate the estimated alarming mental health burden as the pandemic unfolds.

The purpose of this study was to examine the relationship between changes in food insecurity (FI) and cost‐related medication non‐adherence (CRN) among Older Americans Act Nutrition Program participants and waitlisted people in Georgia. This study used 3 waves of self‐administered mail surveys, conducted 4 months apart between 2008 and 2009 (n = 664, mean age 74.6 ± 8.9, 71.5% women, 31.0% African American). FI was assessed by using a modified version of the nationally validated standard 6‐item US Household Food Security Survey Module. Practice of 5 CRN behaviors (i.e., splitting pills, delaying refills, and skipping doses) was evaluated. Changes in FI and CRN were determined based on ≥ 2 repeated measures. Over the 8‐month period, 35.8% were persistently food insecure, 12.7% became food insecure, 16.7% became food secure, and 34.8% were persistently food secure; 29.2% persistently practiced CRN, 16.7% started practicing CRN, 15.7% stopped practicing CRN, and 38.4% were persistently medication adherent. Participants with persistent FI and CRN were more likely to be younger, low‐income, and in poorer health. After controlling for potential confounders, persistently food insecure and newly food insecure individuals were 8.2 times (95% CI: 5.4, 12.5) and 5.3 times (95% CI: 3.2, 8.8) more likely to report higher levels of CRN than persistently food secure individuals. This study was funded in part by UGA FACS.

Household food insecurity (HFI) is the limited or uncertain availability of nutritionally adequate and safe foods and has been associated with decreased cognitive function in persons without diabetes. In persons with diabetes, little is known about the impact of HFI, but cognitive function is known to decline with diabetes duration and poorer glycemic control. We evaluated the cross-sectional association of HFI with cognitive function in youth and young adults (YYA) with type 1 diabetes (T1D), focusing on executive function as measured with the NIH Toolbox Cognition Battery (score range 39-146) and a potential interaction of HFI with glycemic control (high risk &amp;gt;9% vs. optimal/suboptimal ≤9% HbA1c). Age-adjusted composite fluid cognition score was modeled using multivariable linear regression, with HFI (≥3 affirmations on US Household Food Security Survey Module) as the predictor, controlling for covariates. Among 1,272 YYA with T1D (mean age 21, diabetes duration 11 years, 57% non-Hispanic white), 55% had high-risk glycemic control and 18% were food insecure. Food insecure T1D YYA had a 2.7 (SD=1.2) lower fluid cognition score than their food secure peers (93.7 vs. 96.4, p=0.03). Adjustment for sex, race/ethnicity, diabetes duration, site, and glycemic control attenuated this association (β=1.2, p=0.30). However, glycemic control turned out to modify the association of HFI with cognition (multiplicative interaction in adjusted model p&amp;lt;0.01). Among YYA with HbA1c ≤9%, food insecure individuals had a lower mean fluid cognition score than the food secure (99 vs. 104, p&amp;lt;0.02); for YYA with high-risk glycemic control, no association was observed. In this cross-sectional study, food insecurity has a detrimental relationship with cognition among T1D YYA, particularly among those with optimal/suboptimal glycemic control levels. Longitudinal research is needed to further delineate the temporal relationships between household food insecurity, glycemic control, and cognition. Disclosure A. D. Liese: None. B. A. Reboussin: None. A. S. Shah: None. S. M. Marcovina: None. L. M. Dolan: None. D. Dabelea: None. C. Pihoker: None. J. A. Mendoza: None. A. D. Brown: None. A. Shapiro: None. E. A. Frongillo: None. G. Wilkening: None. J. Fridriksson: None. A. Merchant: None. L. Henkin: None. E. T. Jensen: None. Funding National Institutes of Health (1R01DK117461, 1UC4DK108173)

Childhood food insecurity, mental distress in young adulthood and the supplemental nutrition assistance program

Persistent Food Insecurity Is Associated with Adverse Mental Health among Women Living with or at Risk of HIV in the United States