Abstract
Background: Food insecurity is associated with adverse mental health outcomes. Given that federal food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), aim to alleviate food insecurity, there may be heterogeneity in the association between food insecurity and depression by SNAP participation status.Objective: With the use of data from the 2005–2010 NHANES, we examined the associations between household food security and depression and whether these differed by SNAP participation.Methods: The study population was restricted to 3518 adults with household incomes ≤130% of the federal poverty level. Food insecurity was assessed with the 18-item US Household Food Security Survey Module; a score of ≥3 was considered food insecure. Depression was assessed with the 9-item Patient Health Questionnaire and was defined as a score of ≥10. Multivariate logistic regression models examined the associations between food insecurity and depression, adjusting for sociodemographic and health characteristics.Results: The overall prevalence of depression was 9.3%, ranging from 6.7% among SNAP nonparticipants to 12.8% among SNAP participants. For every depressive symptom, there was a dose-response relation, such that a higher prevalence was observed with worsening food insecurity. After multivariate adjustment, food insecurity was positively associated with depression (P-trend < 0.0001), but SNAP participation modified this relation (P-interaction = 0.03). Among low-income, eligible nonparticipants, very low food security was significantly associated with higher odds of depression (OR: 5.10; 95% CI: 3.09, 8.41). Among SNAP participants, very low food security was also associated with higher odds of depression but at a lower magnitude (OR: 2.21; 95% CI: 1.54, 3.17).Conclusion: The complex relation between food insecurity and mental health may vary on the basis of SNAP participation status. Programmatic efforts to address the risk of depression among their beneficiaries may positively affect the mental health of low-income adults.
Highlights
Food insecurity, defined as a lack of consistent access to food for all members of the household, has persisted at high levels in the United States throughout the past decade [1]
The objective of this study was to examine the association between household food security and depression and whether these differed by Supplemental Nutrition Assistance Program (SNAP) participation status among low-income adults
Our results showed a dose-response relation between the level of food insecurity and the prevalence of all depressive symptoms, with most very low food-secure adults experiencing lethargy, trouble sleeping, and feelings of depression or hopelessness
Summary
Food insecurity, defined as a lack of consistent access to food for all members of the household, has persisted at high levels in the United States throughout the past decade [1]. Food insecurity is associated with adverse mental health outcomes, higher rates of anxiety and depressive symptoms among women [9,10,11,12,13,14,15,16]. These associations are not ã 2015 American Society for Nutrition. Among SNAP participants, very low food security was associated with higher odds of depression but at a lower magnitude (OR: 2.21; 95% CI: 1.54, 3.17).
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