Food insecurity and depression among US adults: The National Health and Nutrition Examination Survey

Food insecurity has long been a global challenge associated with negative health outcomes. The spectrum of food insecurity corresponds to a spectrum of negative health outcomes that range from kwashiorkor and marasmus to obesity and chronic disease. The burden of food insecurity is a stressor that additionally negatively effects mental health. In this study, the relationship between food insecurity and mental health was examined using data from the National Health and Nutrition Examination Survey (NHANES). Food insecurity was assessed with the 18-item United States Food Security Survey Module, and participants were classified into one of four categories based on their responses: (1) full food security (FFS), for households with no concerns related to obtaining adequate food, (2) marginal food security (MFS), for households that occasionally had problems obtaining adequate food, (3) low food security (LFS), for households that had to reduce the quality, variety, or desirability of the food they ate, and (4) very low food security (VLFS), for households where at least one member had their food intake reduced due to a lack of money for food. Food insecurity survey scores were classified as FFS if zero affirmative responses were reported, MFS for 1 or 2 affirmative responses, LFS for 3 to 5 affirmative responses, and VLFS for 6 to 10 affirmative responses. Depression was assessed with the Patient Health Questionnaire-9 with scores ≥ 10 indicating depression. Data were analyzed from 28,448 adults aged 20 and older who participated in NHANES from 2005 to 2016. Food insecurity was present in 19.2% of the sample population (n=5,452). Food security status was significantly associated with gender, race, education level, marital status, smoking status, and BMI (Rao-Scott chi-square, p \u3c 0.05). Adults with FFS and VLFS experienced depression at rates of 5.1% and 25.8%, respectively. Participants with VLFS had a significantly greater odds of depression than FFS adults, OR=3.50 (95% CI: 2.98, 4.12). These findings suggest that food insecurity is a significant risk factor for depression among US adults. To address this issue in our citizenry, policy initiatives and public health interventions addressing both food access and mental health should be prioritized