Food Insecurity and Depression

Food insecurity
Depression
Food insecurity and depression
Remedial interventions
References
Further Reading

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Food insecurity is said to be present due to the lack of consistent access to enough food for the household to live an active and healthy life.

Food insecurity

Recent events such as the ongoing pandemic of coronavirus disease 2019 (COVID-19) drove an increase in food insecurity. It involves decreased food availability, affordability, cultural restrictions on the mechanisms of food acquisition, and the utilization of food on the individual level. It has consequences such as obesity, malnutrition, and related illnesses, including diabetes, stunting, developmental deficits, and deficiency illnesses.

Other concurrent events that contribute heavily to this change include conflicts, climate change, and extremes of climate, along with the economic recessions that accompanied the severe restrictions on social and economic interactions implemented in the effort to abort or alleviate the spread of the pandemic. It is important to understand that these are not the causes themselves, which can be traced to social and economic inequalities, inequities, and underlying poverty.

World hunger increased in 2020, with the prevalence of undernourishment (PoU) jumping by 1.5 percentage points in one year. At present, one in ten people are poorly nourished, which makes it unlikely that the world will attain its target of Zero Hunger by 2030. In numerical terms, this comes to about 770 million who are hungry today, which is ~120 million more than in 2019. This rise is equal to the accumulated increase over the previous five years.

If the upper boundary of the estimates are taken, this could be as many as ~160 million. Over half of these are in Asia and over a third in Africa. From 50-60 million more people were hungry in 2020 in Asia and Africa, respectively, with South America’s hungry increasing by 14 million compared to 2019. This means that about 680 million will remain hungry in 2030 unless things change faster than at present. About 30 million of these may be traceable to the occurrence of the pandemic.

In terms of food insecurity, one in three people – about 2.4 billion – were affected, which is 320 million more than in 2019. About 12% of ~900 million were severely food insecure, a rise of ~150 million from the previous year. Moderate to severe food insecurity affected more women than men in 2020, by about 10%, up from the 6% gap in 2019. Even in high-income countries like the USA, one in seven had experienced food insecurity at some point over the year.

Depression

Depression is a serious mental health condition affecting millions globally and is particularly important due to its effect on productivity compared to all other medical conditions. Its occurrence is closely linked to food insecurity, both due to the effects of malnutrition and the stress associated with poor access to sufficient food. As one researcher puts it, “Food insecurity at household- or individual-level also encapsulates an important psychological aspect (i.e., anxiety about restricted food supplies) that is central to the experience of living with food insecurity.”

Food insecurity and depression

The presence of food insecurity is associated with mental ill-health, especially anxiety and depression among women. Those going through this experience had increased chances of sadness, worry, stress, and anger, and were less likely to say they enjoyed life, felt rested, or received respect from others.

How does food insecurity contribute to adverse mental health? Several mechanisms exist, including the uncertainty of whether food supplies will be consistently accessible in the present and/or the future. This generates stress, which is a known trigger for anxiety and depression.

Adverse environmental conditions, an inferior socioeconomic status, life stressors, and disadvantaged conditions are known to trigger depressive symptoms.

If food cannot be acquired in the normal manner, other less acceptable methods may be used, inducing feelings of lack of control, shame, and guilt, besides feeling estranged from the mainstream. These are also potent drivers of depression. Another contributing factor could be the increased gap between the haves and have-nots within the same family, clan, or community, which may make people more sensitive to slights and snubs, again affecting mental health.

Some scientists have observed that positive feelings were highest in Latin America and the Caribbean, while the region of Russia and the Caucasus had the lowest. At the individual level, food insecurity was linked to worse mental health in a dose-dependent manner, with negative feelings registering an increase and positive feelings a decrease as food insecurity increased from mild to severe.

Interestingly, this link was more significant than that between other socioeconomic factors, including employment and educational status. Again, older adults over the age of 65 were at greater risk in countries worldwide except the low-income regions.

In one South African study, the correlates of food insecurity were: living in a food insecurity hotspot (people were food insecure in two-thirds of cases), race, younger age, relatively less educated, unemployment, and rural location. Even after compensating for all these, hotspot locations conferred a higher risk of food insecurity and depression.

The experiences associated with food insecurity include difficulty in getting access to food in ways that are socially acceptable, driving people to other routes that are likely to cause stress due to feelings of guilt and fear; disruption of traditional meal preparation and eating patterns; inability to transfer such patterns to the new generations; and having less food, of lower quality. These effects act as mutually reinforcing pathways that promote deteriorating mental health.

Apart from providing medication and psychotherapy, it is urgent to correct the underlying poverty and hunger at the community level as required to prevent a rise in the underlying causes. Food insecurity has been described as “being a “particularly honest signal” of relative wealth/income and wellbeing.”

Remedial interventions

Three pathways have been suggested to mediate an improvement: correcting the nutritional deficiencies that have biological consequences affecting the neurological function; ensuring reliable access to adequate food supplies, and relieving the social and psychological stress engendered by invidious comparisons between the haves and have-nots that come about as a result of the lack of food associated with food insecurity.

Government interventions are essential in helping to mitigate this distress, in the form of restoring or giving land rights to farmers for subsistence farming, after making sure that these measures do not have offshoots that threaten food security in other ways. Social protection measures such as cash transfers during economic distress are also obvious methods to provide for households.

Food assistance programs are also known to mitigate the adverse effects of food insecurity, especially among the elderly, thus improving their quality of life, preventing deteriorating health and thus saving money spent on healthcare, and supplying the nutrition they need. In all these ways, these programs can prevent or alleviate depression due to food insecurity.

Such programs should be designed with sensitivity to avoid stigmatization of the beneficiaries as recipients of charity. For those who lack health insurance coverage, have to choose between buying food and buying medicine, or are unwilling or unable to make use of the formal healthcare system,

References

• Jones, A. D. (2017). Food Insecurity and Mental Health Status: A Global Analysis of 149 Countries. American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2017.04.008. https://www.sciencedirect.com/science/article/pii/S074937971730243X
• The State of Food Security and Nutrition in the World 2021. https://www.fao.org/3/cb4474en/online/cb4474en.html#
• Tomita, A. et al. (2020). Spatial Clustering of Food Insecurity and Its Association with Depression: A Geospatial Analysis of Nationally Representative South African Data, 2008–2015. Scientific Reports. https://doi.org/10.1038/s41598-020-70647-1. https://www.nature.com/articles/s41598-020-70647-1
• Kim, K. et al. (2007). Participation in Food Assistance Programs Modifies the Relation of Food Insecurity with Weight and Depression in Elders. The Journal of Nutrition. https://doi.org/10.1093/jn/137.4.1005. https://academic.oup.com/jn/article/137/4/1005/4664591
• Fang, D. et al. (2021). The Association Between Food Insecurity and Mental Health During The COVID-19 Pandemic. BMC Public Health. https://doi.org/10.1186/s12889-021-10631-0. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10631-0#citeas

Further Reading

• All Depression Content
• Clinical Depression: Diagnosis, Causes & Treatment
• Causes of Depression
• How Does Your Diet Affect Depression?
• Depression Diagnosis

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.