The relationship between hunger and mental health outcomes among school-going Ecuadorian adolescents

Mental health among adolescents exposed to social inequality in Latin America and the Caribbean: a scoping review

Background and objective

Adolescents from Latin America and the Caribbean grow up in a context of social inequality, which diminishes their well-being and leads to impaired emotional-cognitive development. To understand the problem, it is important to synthesize the available research about it. This study aims to explore the knowledge about adolescents' mental health in Latin America and the Caribbean exposed to social inequality.

Methods

A systematic scoping review was conducted encompassing a search in five databases (Medline, CINAHL, PsycINFO, Scopus, and LILACS) in June 2022. Articles of various typologies were included without time limit. After two rounds of screening, relevant data were manually extracted and synthesized into self-constructed themes using thematic analysis.

Results

Out of 8,825 retrieved records, 42 papers were included in the final review, with a predominance of quantitative approaches. The synthesis revealed two main analytical themes: (a) defining social inequality, wherein intersecting inequalities produce discrimination and determine conditions for social vulnerability; (b) social inequality and mental health, which highlights the association between socio-structural difficulties and emotional problems, amplifying vulnerability to mental ill health and poor mental health care.

Conclusion

The scientific evidence reveals that social inequality is related to impaired well-being and mental ill health on the one hand and a lack of access to mental health care on the other hand.

Food insecurity and its impact on substance use and suicidal behaviours among school-going adolescents in Africa: evidence from the Global School-Based Student Health Survey

The study sought to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its impact on substance use and suicidal behaviours (ideation, planning, and repeated attempted suicide) among school-going adolescents in Africa. The study involved a secondary analysis of cross-sectional data from the Global School-Based Student Health Survey (GSHS) conducted in Africa. Substance use and suicidal behaviours were the main outcomes. We employed the Double Selection Least Absolute Shrinkage and Selection Operator Poisson regression (DSLASSOPM) model to assess risk factors associated with FI and further employed Coarsened Exact Matching involving DSLASSOPM to assess the influence of FI on the study outcomes. Meta-analysis was conducted to obtain between-country heterogeneity in the prevalence of FI and the prevalence ratio of substance use and suicidal behaviours. The study involved 34,912 school-going adolescents. The pooled 30-day prevalence estimate of FI was 11.1% (95% CI  9.1-18.6), ranging from 6.7% (95% CI 5.0-8.3) in Tanzania to 18.4% (95% CI 14.4-22.4) in Benin. The most common associated factors included the experience of insomnia and the number of times injured. The pooled prevalence ratio of substance use, suicidal ideation, suicidal planning, and repeated attempted suicide among adolescents experiencing food insecurity were 1.92(95% CI 1.69-2.16), 1.56(95% CI 1.46-1.66), 1.50 (95% CI 1.41-1.58), and 1.90 (95% CI 1.73-2.07) respectively. A considerable heterogeneity between the sub-regions prevalence ratio for suicidal ideation and planning was also observed (I2 = 0, p value > 0.05). The study observed a high prevalence of food insecurity in West Africa with negligible heterogeneity between the countries. A significant positive association between FI and the study outcomes (substance use and suicidal behaviours) was observed. The study recommends country-specific social and school-based health interventions to screen risk factors associated with food insecurity for early identification. Measures to achieve Sustainable Development Goal 2 (Zero Hunger) by 2030 are key in these African countries and is likely to yield demographic dividends through improvement in mental health among school-going adolescents.

The global burden of suicidal behavior among people experiencing food insecurity: A systematic review and meta-analysis

BACKGROUND

Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association.

METHODS

Databases (Ovid, PubMed, Web of Science, and CINAHL) were searched from inception to July 2022 using appropriate search terms. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858).

RESULTS

A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3 % for suicide ideation (95 % CI: 14.7-29.9; I2 = 99.6 %, p < 0.001, k = 18), 18.1 % for suicide plans (95 % CI: 7.0-29.1; I2 = 99.6 %, p < 0.001, k = 4), 17.2 % for suicide attempts (95 % CI: 9.6-24.8; I2 = 99.9 %, p < 0.001, k = 12), and 4.6 % for unspecified suicidal behavior (95 % CI: 2.8-6.4; I2 = 85.5 %, p < 0.001, k = 5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR = 1.049 [95 % CI: 1.046-1.052; I2 = 99.6 %, p < 0.001, k = 31]), (ii) suicide plans (aOR = 1.480 [95 % CI: 1.465-1.496; I2 = 99.1 %, p < 0.001, k = 5]), and (iii) unspecified suicide behaviors (aOR = 1.133 [95 % CI: 1.052-1.219; I2 = 53.0 %, p = 0.047, k = 6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR = 0.622 [95 % CI: 0.617-0.627; I2 = 98.8 %, p < 0.001, k = 15]). The continent and the countries income status where the study was conducted were the common causes of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity.

LIMITATIONS

There was significant heterogeneity among the included studies.

CONCLUSION

There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity. The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research.

Association between food insecurity and depressive symptoms among adolescents aged 12-15 years from 22 low- and middle-income countries

Food insecurity may be a risk factor for depression in adolescents. However, data on this topic from low- and middle-income countries (LMICs) are scarce, despite food insecurity being most common in LMICs. Therefore, we aimed to examine the association between food-insecurity and depressive symptoms among school-going adolescents from 22 LMICs. Cross-sectional data from the Global school-based Student Health Survey were analyzed. Self-report measures assessed past 12-month depressive symptoms and past 30-day food insecurity (hunger). Multivariable logistic regression and meta-analysis were conducted to assess associations. Data on 48,401 adolescents aged 12-15 years were analyzed [mean (SD) age 13.8 (0.9) years; 51.4 % females]. The prevalence of depressive symptoms was 29.3 %, and those of moderate and severe food insecurity were 45.0 and 6.3 %, respectively. After adjustment for potential confounders, compared to no food insecurity, the pooled OR (95 %CI) of moderate and severe food insecurity were 1.36 (1.30-1.42) and 1.81 (1.67-1.97), respectively. The level of between-country heterogeneity was low. Food insecurity was associated with significantly higher odds for depressive symptoms among adolescents in LMICs. Policies to address food insecurity may also help prevent depression in this population, pending future longitudinal research.

Association of food insecurity and sleep difficulty among 189,619 school-going adolescents: a study from the global in-school students survey

Introduction

Adolescents' sleep disturbances are associated with chronic and dramatic physical, emotional, and mental development and school performance consequences. Although food insecurity could significantly contribute to these effects, few studies have explored the effect of food insecurity on sleep disturbances among adolescents. The study aimed to examine the relationship between adolescents' food insecurity and sleep disturbance.

Methods

Data on 189,619 adolescents were drawn from the cross-sectional global adolescent health surveys conducted between 2015 and 2018 in 35 countries and territories. Univariate and multivariable multinomial regression models were fitted to examine the hypothesized associations.

Results

Overall pooled prevalence of moderate [45.2% (95%CI = 43-47)] and severe [5.8% (95%CI = 5-6)] food insecurity levels were reported. About [52.6% (95%CI = 51-54)] moderate and [8.6% (95%CI = 8-9)] severe worry-induced sleep disturbances were found. Considering the fully adjusted multinomial logistic model, moderate food insecurity was significantly associated with moderate (AOR = 1.70 CI = 1.59-1.81; p < 0.0001) and severe (AOR = 1.63 CI = 1.42-1.87; p < 0.0001) sleep disturbances. Also, adolescents reporting severe levels of food insecurity had moderate (AOR = 1.88 CI = 1.68-2.11; p < 0.0001) and severe (AOR = 4.07 CI = 4.74-6.11; p < 0.0001) sleep disturbances. Females and those aged between 15 and 17 years and 18 or more were at higher risk of moderate and severe sleep disturbances in the context of food insecurity.

Conclusion

Reducing food insecurity could be an effective policy strategy for enhancing adolescent sleep quality.

Food insecurity is associated with multiple psychological and behavioural problems among adolescents in five Caribbean countries

The study aimed to assess associations between food insecurity and multiple psychological and behavioural problems among adolescents in five Caribbean countries. Data from national and cross-sectional school health surveys from 9,956 adolescents (15 years, median age) in Trinidad and Tobago, Suriname, Jamaica, Anguilla and the Dominican Republic in 2016-2017 were analyzed in 2016-2017. Results show that the prevalence of moderate (rarely or sometimes) past-month food insecurity was 35.9% and severe (mostly or always) food insecurity was 4.6%. Severe food insecurity among adolescents ranged from 2.9% in Dominican Republic to 11.2% in Suriname. In adjusted logistic regression analyses, the higher severity of food insecurity was associated with negative psychological outcomes (loneliness, suicidal ideation, suicide plan, suicide attempt, anxiety, current tobacco use and any trouble from alcohol use) and negative behavioural outcomes (truancy, bullied, physically attacked, physical injury, and multiple sexual partners). Two out of five adolescents experienced some form of food security. Food interventions, such as school feeding programmes, are warranted to reduce negative psychosocial outcomes.

Coexistence of obesity and hunger in young adolescents: Evidence from the Global School-based Student Health Survey

BACKGROUND

Hunger and obesity among young adolescents are serious public health issues; however, the relationship between these issues in this demographic has yet to be examined.

OBJECTIVE

To determine whether both obesity and hunger coexist in young adolescents from a global perspective.

METHODS

We analysed data of 142 565 adolescents (age, 12-15 years) from 60 countries from the Global School-based Student Health Survey.

RESULTS

Total prevalence of moderate and severe hunger was 22.32% and 7.8%, respectively-with the highest in Africa (29.14% and 12.14%, respectively) and the lowest in the Americas (16.83% and 5.31%, respectively). The prevalence of obesity among adolescents with severe hunger was 1.26 (95% confidence interval [CI]: 1.15-1.38) times the prevalence among those without hunger; however, this association varied across countries or regions. Moreover, the prevalence of obesity was 17% (95% CI: 1.04-1.29) higher in adolescent girls with moderate hunger in high-income countries, 91% (95% CI: 1.23-2.58) higher in adolescents with severe hunger in low-income countries and 54% (95% CI: 1.34-1.76) higher in lower middle-income countries compared to those without hunger.

CONCLUSIONS

Both obesity and hunger coexist in adolescent populations worldwide. Our findings emphasize the need for double-duty actions to simultaneously address burdens of hunger and obesity among adolescents.

Assessment of mental health problems among adolescents in Sri Lanka: Findings from the cross-sectional Global School-based Health Survey

Background and Aims

Mental health condition among adolescents is a leading cause of health-related disability in Sri Lanka. The study aims to estimate the prevalence and evaluate the associated risk factors in three major mental health domains-loneliness, anxiety and suicidal ideation-among Sri Lankan adolescents.

Methods

We conducted a secondary analysis of cross-sectional data of 3262 adolescents from the Global School-based Health Survey (GSHS) conducted by the WHO in 2016. We modeled the binary outcome variables using multivariable logistic regression models with exposures representing demography, food habits, personal hygiene, behavior, substance abuse, parental and social engagement of the respondents.

Results

We estimated the prevalence of loneliness, anxiety and suicidal ideation as 30.8% (95% CI: 29.3, 32.5), 20.2% (95% CI: 18.8, 21.6) and 3.7% (95% CI: 3.1, 4.4), respectively, and the overall prevalence as 40.3% (95% CI: 38.6, 42.0). Mental health problems were more prevalent among females than males. Engagement with parents and close friends, adequate nutritional intake and physically active lifestyles reduced the risk of common mental health problems. Exposure variables like food insecurity, truancy, second-hand smoking, physical fight, and being bullied increased adolescents' risk of reported psychological problems.

Conclusions

We conclude that the prevalence of mental health problems in the Sri Lankan adolescent population was higher than the global average. Results suggest that future policy decisions to mitigate mental health problems among Sri Lankan adolescents should incorporate an integrated approach involving the individual, family and community to promote positive home and school environments combined with an active and healthy lifestyle.

Investigating the role of climate-related disasters in the relationship between food insecurity and mental health for youth aged 15-24 in 142 countries

Food insecurity (FI) represents a major global health challenge. Because climate-related disasters are a determinant of both FI and poor mental health, we investigated whether the severity of these disasters intensifies the relationship between FI and youth mental health. Data on FI and mental health came from the Gallup World Poll, a nationally representative survey of individuals in 142 countries, which included 28,292 youth aged 15-24. Data on climate-related disasters came from the International Disaster Database, a country-level record of disasters. Multilevel negative binomial regression was used to calculate relative risk (RR) of poor mental health. Youth with moderate or severe FI were significantly more likely to report poor mental health experiences compared to those with none/mild FI (moderate: RR 1.37, 95% confidence interval (CI) 1.32-1.41; severe: 1.60, 95% CI 1.54-1.66). We also observed a weak yet significant interaction effect (p<0.0001), which suggested that the country-level relationship between FI and poor mental health is slightly stronger at greater disaster severity. While further research is needed to improve our understanding of these complex relationships, these findings suggest that mental health should be considered when undertaking national climate change actions and that additional FI-related supports may work to improve youth mental health.

The risk and protective factors for suicidal burden among 251 763 school-based adolescents in 77 low- and middle-income to high-income countries: assessing global, regional and national variations

BACKGROUND

Adolescent suicide is a global public health concern and the second leading cause of adolescent death worldwide. This study aimed to estimate the burden of adolescent suicidal behaviours and its association with violence and unintentional injury, psychosocial, protective, lifestyle and food security-related factors amongst school-based adolescents across 77 countries in the six World Health Organization (WHO) regions.

METHODS

This study comprised a sample of 251 763 adolescents drawn from the latest Global School-based Student Health Survey of school-based adolescents, aged 11-17 years, across 77 countries. Logistic regression analyses were employed to estimate the adjusted effect of independent factors on adolescent suicidal behaviours.

RESULTS

The population-weighted 12-month prevalence of suicidal ideation (SI), suicidal planning (SP) and suicidal attempts (SA) amongst school-based adolescents was 18, 18 and 16%, respectively. Adolescent suicidal behaviours (i.e. SI, SP and SA) were respectively associated with being physically attacked, physical fighting, high levels of anxiety, feeling lonely, being bullied, lack of parental support, poor peer support, not having close friends and high levels of sedentary behaviours. Overall, these associations also extended to the context of food insecurity across regions and country income groups, where the magnitude of association slightly varied from odds ratios of 1.25 times to 3.13.

CONCLUSIONS

The burden of school-going adolescent suicidal thoughts, suicide planning and suicide attempts is of particular concern in low-resource countries. Comprehensive suicide prevention programmes for school-going adolescents in LMICs are needed that address socio-cultural inequities related to violence and unintentional injury, social support and psychological factors, protective, and lifestyle-related factors.

Prevalence and correlates of multiple suicide attempts among adolescents aged 12-15 years from 61 countries in Africa, Asia, and the Americas

Suicide is the fourth leading cause of death worldwide in young people aged 15-19 years. However, little is known about the correlates of multiple suicide attempts in adolescents, especially from a global perspective. Therefore, the aim of the present study was to investigate the association of putative physical, behavioral, and social correlates with multiple suicide attempts among adolescents aged 12-15 years from 61 countries. Data from the Global school-based Student Health Survey (2009-2017) were analyzed. Multiple suicide attempts was classified as having attempted suicide at least twice in the past 12 months. Multivariable logistic regression analyses were conducted to assess the potential correlates. Data on 162,994 adolescents [mean (SD) age 13.8 (0.9) years; 50.8% boys] were analyzed. The overall prevalence of multiple suicide attempts was 4.4% [range 1.2% (Laos) to 13.8% (Ghana)]. Among those who had attempted suicide at least once in the past 12 months, in the overall sample, food insecurity, smoking, alcohol consumption, cannabis use, amphetamine use, sedentary behavior, sexual intercourse, sleep problems, loneliness, no close friends, and bullying victimization were all independently associated with higher odds for multiple suicide attempts although some regional differences were observed. Our study results indicate potential target factors that could be addressed amongst those who had attempted suicide in the past to reduce future suicide attempts and possibly completed suicides. Furthermore, it is possible that region-specific interventions are necessary.

Pathways linking bullying victimisation and suicidal behaviours among adolescents

AIMS

To examine the pathways explaining the association between bullying victimisation and suicidal behaviours among school-based adolescents.

METHODS

We used data from the Global School-based Student Health Survey from 90 countries conducted between 2003 and 2017. We applied multivariate regression and generalised structural equation models to examine the pathways.

RESULTS

Of 280,076 study adolescents, 32.4% experienced bullying and 12.1%, 11.1% and 10.9% reported suicidal ideation, suicidal planning and suicidal attempt, respectively. Adolescents who experienced bullying had higher rates of hunger (8.7% vs 5.0%), drinking soft drinks (44.0% vs 40.2%), truancy (35.8% vs 22.7%), smoking (14.0% vs 6.9%), alcohol consumption (19.9% vs 11.8%), peer victimisation (54.0% vs 25.6%), peer conflict (47.4% vs 20.1%), sleep disturbance (13.7% vs 5.6%), loneliness (18.1% vs 7.6%), no close friends (7.5% vs 5.2%), lack of peer support (64.9% vs 53.3%), lack of parental connectedness (67.0% vs 60.4%) and less parental bonding (64.1% vs 55.2%). Nearly one-fourth (18.7%) of the total association between bullying and suicidal ideation was mediated by loneliness. Similarly, sleep disturbances and alcohol consumption also mediated 4 to 9% of the association between bullying and suicidal behaviours.

CONCLUSION

This study suggests targeted policies and early implementation of interventional strategies focusing on addressing loneliness, sleep disturbance and alcohol consumption to reduce the risk of adverse suicidal behaviours among adolescents.

Correlates of leisure-time sedentary behavior among 181,793 adolescents aged 12-15 years from 66 low- and middle-income countries

BACKGROUND

Sedentary behavior is a growing public health concern in young adolescents from low- and middle-income countries (LMICs). However, a paucity of multinational studies, particularly in LMICs, have investigated correlates of leisure-time sedentary behavior (LTSB) in young adolescents. In the current study, we assessed socio-demographic, socio-economic, socio-cultural and health behavior related correlates of LTSB among adolescents aged 12-15 years who participated in the Global school-based Student Health Survey (GSHS).

METHODS

Self-reported LTSB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework, was analyzed in 181,793 adolescents from 66 LMICs [mean (SD) age 13.8 (1.0) years; 49% girls). Multivariable logistic regression was used to assess the potential LTSB correlates.

RESULTS

The overall prevalence of ≥3 hours/day of LTSB was 26.4% (95%CI = 25.6%-27.2%). Increasing age (OR = 1.14; 95%CI = 1.11-1.17), past 30-day smoking (OR = 1.85; 95%CI = 1.69-2.03), alcohol consumption (OR = 2.01; 95%CI = 1.85-2.18), and bullying victimization (OR = 1.39; 95%CI = 1.31-1.48) were positively associated with increased LTSB across the entire sample of 181,793 adolescents. Food insecurity (OR = 0.93; 95%CI = 0.89-0.97) and low parental support/monitoring (OR = 0.91; 95%CI = 0.85-0.98) were negatively associated with LTSB. There were some variations in the correlates between countries.

CONCLUSIONS

Our data indicate that in adolescents aged 12 to 15 years living in LMICs, LTSB is a complex and multi-dimensional behavior determined by socio-demograhic, sociocultural, socio-economic, and health behavior related factors. Future longitudinal data are required to confirm/refute these findings, and to inform interventions which aim to reduce sedentary levels in adolescents living in LMICs.

Correlates of physical activity among 142,118 adolescents aged 12-15 years from 48 low- and middle-income countries

Physical inactivity is a serious public health concern in adolescents from low- and middle-income countries (LMICs). Despite this, only a few multinational studies has investigated correlates of physical activity (PA) in young adolescents in this part of the world. In this study, we identified physical activity correlates using data from the Global school-based Student Health Survey. In total, 142,118 adolescents from 48 LMICs (age 13.8 ± 1.0 years; 49% girls) were included in the analyses. PA was assessed by the PACE+ Adolescent Physical Activity Measure and participants were dichotomised into those who do (60 min of moderate-vigorous PA every day of the week) and do not comply with the World Health Organization recommendations. We used multivariable logistic regression in order to assess the correlates. The prevalence of low PA was 15.3% (95%CI = 14.5%-16.1%). Boys (OR = 1.64; 95%CI = 1.47-1.83) and those who participated in physical education for ≥5 days/week (OR = 1.12; 95%CI = 1.10-1.15) were more likely to meet PA guidelines, while adolescents with food insecurity (OR = 0.85; 95%CI = 0.80-0.90), low fruit and vegetable intake (OR = 0.68; 95%CI = 0.63-0.74), low parental support/monitoring (OR = 0.68; 95%CI = 0.62-0.74), no friends (OR = 0.80; 95%CI = 0.72-0.88), and who experienced bullying (OR = 0.93; 95%CI = 0.86-0.99) were less likely to have adequate levels of PA. There were a few variations in the correlates depending on country-income level. Our data indicate that in adolescents aged 12 to 15 years living in LMICs physical activity participation is a complex and multi-dimensional behavior determined by sociocultural, socio-economic, and policy-related factors. Longitudinal research is needed to confirm/refute the present findings.

Food insecurity (hunger) and suicide attempts among 179,771 adolescents attending school from 9 high-income, 31 middle-income, and 4 low-income countries: A cross-sectional study

BACKGROUND

Data on food insecurity and suicide attempts in adolescence are scarce. Thus, the aim of the current study was to assess the association between food insecurity (hunger) and suicide attempts in adolescents from 44 countries.

METHODS

Cross-sectional, school-based data from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and past 30-day food insecurity (hunger) were collected. Multivariable logistic regression, meta-analysis, and meta-regression were conducted to assess the associations.

RESULTS

The final sample consisted of 179,771 adolescents attending school. The prevalence of moderate (rarely/sometimes hungry) and severe (most of the time/always hungry) food insecurity were 46.7% and 7.0%, respectively. After adjustment for potential confounders, severe food insecurity (vs. no food insecurity, i.e., no hunger) was significantly associated with higher odds for suicide attempts in 31 of the 44 countries studied with the pooled OR (95% CI) being 1.90 (1.77-2.04) (I² = 45.2%). The associations were similar across country-income levels. However, meta-regression analysis by country showed that stronger associations were related with lower population prevalence of severe food insecurity. The pooled OR (95% CI) for moderate food insecurity (vs. no food insecurity) was 1.26 (1.21-1.32) (I² = 29.7%).

LIMITATIONS

Causality cannot be established due to the cross-sectional study design.

CONCLUSIONS

Food insecurity (hunger) is a global problem and is associated with suicide attempts. The identification of children suffering from food insecurity (hunger) and remedying this condition may be important to improve mental health among adolescents worldwide.

Trends and Spatial Patterns of Suicide Among Adolescent in Ecuador, 1997-2016

Background:

Suicide is a global public health problem, ranking among the top 20 leading causes of mortality.

Objective:

The aim of the present study is two-fold. Firstly, it describes the temporal trends of suicide in adolescents from 1997 to 2016 in Ecuador, allowing us to identify critical periods. Secondly, it analyzes the spatiotemporal clusters of high mortality rates and the spatial distribution due to suicide in the country, from 2011 to 2016.

Methods:

This is an ecological study; we included all death certificates of suicide among adolescents in the 10 - 19 age groups both sex, from the National Institute of Statistics and Census (INEC) database in Ecuador from 1997 to 2016. In order to assess the trend of suicide rates, we obtained Annual Percentage Changes (APCs) and average Annual Percent Changes (AAPCs) through Joinpoint regression analysis. Space-time scan statistics were used to identify high-risk clusters, and the spatial autocorrelation was evaluated through global Moran index.

Results:

Suicides at a national level increased from 165 deaths in 1997 to 286 deaths in 2016; rates increased from 12.7 to 23.3 per 100,000 population along with a significant increase of the trend at the national level (AAPC=3.7%; 95% CI: 2.1 to 5.2). We identified two significant spatial clusters for a high occurrence of suicide: the primary most likely cluster included 83 cantons (Risk Relative=2.28) while the second most likely cluster included 20 cantons (Risk Relative=1.74). The Global Moran I index for the study period showed a positive spatial autocorrelation (0.27; p = 0.001).

Conclusion:

Suicide rates in adolescents significantly increased over the 20-year study period; the spatial analysis indicates the presence of high occurrence clusters in the Amazon and Southern Highlands regions of the country. This growing phenomenon may be a reflection of the lack of policies and strategies focused on the adolescent’s mental health at a national level, added to factors such as family dysfunction, school failure, vulnerable ethnic groups, and immigration patterns.

Food insufficiency is associated with depression among street-involved youth in a Canadian setting

OBJECTIVE

Food insufficiency, defined by the experience of hunger, is known to be prevalent and a source of health-related harm among-street involved youth, but little is known about its relationship with depression in this population. Therefore, we sought to assess the association between food insufficiency and symptoms of depression among a cohort of street-involved youth.

DESIGN

Multivariable logistic regression was used to assess the relationship between food insufficiency, defined as being hungry but not having enough money to buy food, and depression as measured by the Center for Epidemiological Studies Depression (CES-D) scale.

SETTING

Data from April 2006 to November 2013 were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit drugs in Vancouver, Canada.

SUBJECTS

There were 1066 street-involved youth enrolled in the study, including 340 (31·9 %) females.

RESULTS

Of 1066 youth enrolled in the study, 724 (67·9 %) reported some food insufficiency and 565 (53·0 %) met criteria for depression. Compared with youth who did not report food insufficiency, those who reported often experiencing food insufficiency had a higher likelihood of reporting depression (adjusted OR=2·52; 95 % CI 1·74, 3·67), as did those who reported sometimes experiencing food insufficiency (adjusted OR=1·99; 95 % CI 1·47, 2·70).

CONCLUSIONS

Food insufficiency was prevalent and associated in a dose-dependent trend with symptoms of depression among street-involved youth in our setting. Findings highlight the need to address the nutritional and mental health needs of youth and identify pathways by which food insufficiency may contribute to depression among vulnerable populations.

Childhood Hunger and Thoughts of Death or Suicide in Older Adults

OBJECTIVE

There is little research on the effects of childhood hunger on adult mental health. This study examined the association between childhood hunger and recurrent thoughts of death or suicide in older adults.

DESIGN

Data collected during the Estonian Health Interview Survey 2006 (N = 2455) were analyzed from adults aged 60 and above. Retrospective information was obtained on the frequency (never, seldom, sometimes, often) of going to bed hungry in childhood and on the presence of recurrent thoughts of death or suicide in the past 4 weeks. Multivariate logistic regression analysis was used to examine associations between variables.

RESULTS

Experiencing hunger in childhood was common (37.6%), with 14.3% of the respondents stating that they often went to bed hungry. In a univariate analysis, going to bed hungry either sometimes or often more than doubled the odds for thoughts of death or suicide. Although adjustment for a range of covariates (including physical diseases and depressive episode) attenuated the associations, in the fully adjusted model, going to bed hungry sometimes continued to be associated with significantly increased odds for thoughts of death or suicide in older adults (odds ratio = 1.74, 95% confidence interval = 1.10-2.74, Wald χ² = 5.7, degrees of freedom = 1, p = 0.017).

CONCLUSION

The findings of this study suggest that the effects of childhood hunger may be long lasting and associated with mental health and well-being even in older adults.

Childhood hunger and depressive symptoms in adulthood: Findings from a population-based study

BACKGROUND

Several studies have linked childhood hunger to an increased risk for later depression. However, as yet, there has been little research on this relation in adults of all ages or whether there are sex differences in this association. The current study examined these issues using data from a national population-based sample.

METHODS

Data were analyzed from 5095 adults aged 25-84 collected during the Estonian Health Interview Survey 2006. Information was obtained on the frequency of going to bed hungry in childhood and on depressive symptoms using the Emotional State Questionnaire (EST-Q). Logistic regression analysis was used to examine the association between hunger and depression while controlling for other demographic, socioeconomic and health-related variables.

RESULTS

In a fully adjusted model, going to bed hungry in childhood either sometimes or often was associated with significantly increased odds for depressive symptoms. When the analysis was stratified by sex the association was more evident in men where any frequency of childhood hunger was linked to adult depression while only women who had experienced hunger often had higher odds for depressive symptoms in the final model.

LIMITATIONS

Data on childhood hunger were retrospectively reported and may have been affected by recall bias. We also lacked information on potentially relevant variables such as other childhood adversities that might have been important for the observed associations.

CONCLUSION

Childhood hunger is associated with an increased risk for depressive symptoms among adults. Preventing hunger in childhood may be important for mental health across the life course.