Abstract
While food insecurity is a persistent public health challenge, its long-term association with depression at a national level is unknown. We investigated the spatial heterogeneity of food insecurity and its association with depression in South Africa (SA), using nationally-representative panel data from the South African National Income Dynamics Study (years 2008–2015). Geographical clusters (“hotpots”) of food insecurity were identified using Kulldorff spatial scan statistic in SaTScan. Regression models were fitted to assess association between residing in food insecure hotspot communities and depression. Surprisingly, we found food insecurity hotspots (p < 0.001) in high-suitability agricultural crop and livestock production areas with reliable rainfall and fertile soils. At baseline (N = 15,630), we found greater likelihood of depression in individuals residing in food insecure hotspot communities [adjusted relative risk (aRR) = 1.13, 95% CI:1.01–1.27] using a generalized linear regression model. When the panel analysis was limited to 8,801 participants who were depression free at baseline, residing in a food insecure hotspot community was significantly associated with higher subsequent incidence of depression (aRR = 1.11, 95% CI:1.01–1.22) using a generalized estimating equation regression model. The association persisted even after controlling for multiple socioeconomic factors and household food insecurity. We identified spatial heterogeneity of food insecurity at a national scale in SA, with a demonstrated greater risk of incident depression in hotspots. More importantly, our finding points to the “Food Security Paradox”, food insecurity in areas with high food-producing potential. There is a need for place-based policy interventions that target communities vulnerable to food insecurity, to reduce the burden of depression.
Highlights
Since 2011, there has been a growing number of individuals living below the food poverty line (25.2% in 2015 versus 21.4% in 2 0111), where approximately a quarter of households are exposed to food insecurity in South Africa
Our incident cohort consisted of 8,801 participants who were depression-free at baseline, with the socio-demographic characteristics (Table 1) of the incident cohort indicating that 55.3% (n = 5,169) were female, most were Black African (n = 6,771; 78.6%), and were unemployed (n = 5,300; 56.8%)
We found significantly greater likelihood of depression in individuals residing in hotspot communities [adjusted relative risk = 1.13, 95% CI:1.01–1.27] at baseline (Table 4 Model 1) after adjusting for sociodemographic variables, namely gender, race, age, educational attainment, employment status, income, and urban/rural
Summary
As part of the United Nation’s Sustainable Development Goal (SDG) 2.122, and in terms of Section 27(1)(b) of the South African c onstitution[23], as well as preventing depression onset (SDG 3.424), remain monumental challenges in the light of budgetary limitations to address multiple development priorities. This dilemma warrants targeted strategies to first identify food-vulnerable geographical locations, so as to inform prioritized interventions for the most affected areas (which may have mental health implications, yet to be examined). We aimed to identify risk of depression onset between individuals living in/outside food insecure hotspot communities over and above the individual effect of household-level food insecurity
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