Risk for depression and suicidal ideation among food insecure US veterans: data from the National Health and Nutrition Examination Study

"Just Food doesn't Do It": Understanding Food Insecurity Among Rural Veterans in the United States

Food security among rural veteran populations is an understudied subject. This study uses qualitative data from 106 semi-structured interviews conducted with staff from programs at the United States Department of Veterans Affairs (VA) and other federal agencies, staff from non-governmental organizations (NGOs), food security researchers, and food insecure veterans to identify the barriers to and facilitators for rural veteran food security. Barriers identified included external, structural barriers that exist in rural areas; internal barriers to using food assistance, such as feeling stigmatized; and barriers related to other social determinants of health, including a lack of education, employment, or housing stability.

Food Insecurity and Suicidal Ideation: Results from a National Longitudinal Study of Military Veterans

OBJECTIVE

Research examining social determinants of suicide risk in veterans suggests a potential link between food insecurity and subsequent suicidal ideation in military veterans. The objective of this study is to investigate, if and how, food insecurity predicts subsequent suicidal ideation in a nationally representative longitudinal survey of veterans.

METHODS

A national longitudinal survey was analyzed of participants randomly drawn from over one million U.S. military service members who served after September 11, 2001. N = 1,090 veterans provided two waves of data one year apart (79% retention rate); the final sample was representative of post-9/11 veterans in all 50 states and all military branches.

RESULTS

Veterans with food insecurity had nearly four times higher suicidal ideation one year later compared to veterans not reporting food insecurity (39% vs 10%). In multivariable analyses controlling for demographic, military, and clinical covariates, food insecurity (OR = 2.37, p =.0165) predicted suicidal ideation one year later, as did mental health disorders (OR = 2.12, p = .0097). Veterans with both food insecurity and mental health disorders had a more than nine-fold increase in predicted probability of suicidal ideation in the subsequent year compared to veterans with neither food insecurity nor mental health disorders (48.5% vs. 5.5%).

CONCLUSION

These findings identify food insecurity as an independent risk marker for suicidal ideation in military veterans in addition to mental disorders. Food insecurity is both an indicator of and an intervention point for subsequent suicide risk. Regularly assessing for food insecurity, and intervening accordingly, can provide upstream opportunities to reduce odds of suicide among veterans.

Past-Year Suicidal Ideation, Plans, and Attempts by Food Security Level in a Nationally Representative Sample of U.S. Adults

OBJECTIVE

The Interpersonal Theory of Suicide posits that suicidal behavior results from thwarted belongingness, perceived burdensomeness, and capability for suicide. Considering that food insecurity (FI) may be linked to these constructs to differing extents based on severity of FI, this study examined cross-sectional associations between levels of FI and suicidal ideation, plans, and attempts in a nationally representative sample of adults in the United States.

METHODS

Data for this study were collected in 2001-2003 from 5,552 participants in the National Comorbidity Survey Replication (Mage=44.8 ± 0.5 years; 53.8% female). Prevalence ratios (PRs) and 95% confidence intervals (CIs) were generated using modified Poisson regression to examine past-year ideation, plans, and attempts with intent of lethality by past-year FI level (assessed with a modified version of the Short Form U.S. Household Food Security Scale).

RESULTS

After controlling for sociodemographic covariates, low food security was significantly associated with elevated prevalence of suicidal ideation, plans, and attempts (ideation: PR = 2.21, 95% CI 1.32-3.70; plans: PR = 5.42, 95% CI 2.71-10.83; attempts: PR = 5.35, 95% CI 2.38-12.03). Very low food security (i.e., more severe FI) exhibited stronger associations yet with suicidal ideation, plans, and attempts (ideation: PR = 6.99, 95% CI 4.10-11.92; plans: PR = 17.21, 95% CI 8.41-35.24; attempts: PR = 14.72, 95% CI 4.96-43.69).

CONCLUSIONS

Findings indicative of a dose-response relationship between FI and suicidal ideation, plans, and attempts emphasize the need to increase reach of food assistance programs, increase availability of mental health services in food-insecure populations, and routinely screen for FI in mental health practice.

Association of Food Insecurity With Multiple Forms of Interpersonal and Self-Directed Violence: A Systematic Review

Economic stress, broadly defined, is associated with an increased likelihood of multiple forms of violence. Food insecurity is a distinct economic stressor and material hardship that is amenable to programmatic and policy intervention. To inform intervention and identify gaps in the current evidence base, we conducted a systematic review to synthesize and critically evaluate the existing literature regarding the association between food insecurity and five forms of interpersonal and self-directed violence: intimate partner violence (IPV), suicidality, peer violence and bullying, youth dating violence, and child maltreatment, in high-income countries. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched six electronic databases from their start date through February of 2022. We included studies that examined food insecurity as the exposure and an outcome measure of IPV, suicide, suicidality, peer violence, bullying, youth dating violence, or child maltreatment; were peer-reviewed and published in English; reported quantitative data; and took place in a high-income country. We identified 20 relevant studies. Nineteen studies found that food insecurity was associated with an increased likelihood of these forms of violence. Results highlight the potential for programs and policies that address food insecurity to function as primary prevention strategies for multiple forms of violence and underscore the importance of trauma-informed approaches in organizations providing food assistance. Additional theory-driven research with validated measures of food insecurity and clearly established temporality between measures of food insecurity and violence is needed to strengthen the existing evidence base.

The joint effect of female sex and food insecurity on self-reported mood disorder among Canadian adults: the Canadian community health survey

BACKGROUND

Food insecurity is prevalent in Canada and may influence mental health, particularly among females. The present study examined the joint effect of female sex and food insecurity on mood disorders.

METHODS

The study used data from 104,420 adults aged 18 years or older who participated in the 2017/2018 Canadian Community Health Survey (CCHS). Log-binomial models explored the independent and joint associations of female sex and food insecurity with the prevalence of self-reported mood disorder. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were used to assess the additive interaction of female sex and food insecurity. The complex survey design was taken into consideration.

RESULTS

The prevalence of mood disorder was 6.7% for males and 11.4% for females, with an adjusted prevalence ratio being 1.59 (95% CI 1.51, 1.68) for females versus males. Mood disorder was associated with moderate food insecurity (PR 2.06, 95% CI 1.91, 2.23) and severe food insecurity (PR 3.29, 95% CI 3.06, 3.55). There was a significant additive interaction between female sex and food insecurity in association with the prevalence of mood disorders among females aged 18 to 39 years (RERI 1.19, 95% CI 0.27,2.08).

CONCLUSION

Food insecurity was associated with an increased prevalence of mood disorders, especially in younger females. Interventions that facilitate access to food while being cognizant of the socioeconomic vulnerabilities of females may have substantial benefits for the prevention and management of mood disorders.

Lower Urinary Tract Symptoms in Depression: A Review

Lower Urinary Tract Symptoms (LUTS) are frequently present in the general population as patients age with approximately a third of individuals experiencing LUTS during their lifetime. LUTS can be further defined as having any of the following symptoms: urinary hesitancy, straining, nocturia, increased urination frequency, and dysuria. LUTS has the potential for patients to contribute their symptoms to what can normally occur as we age. This can lead to a decrease in patients seeking care and could negatively impact patients' health-related quality of life (HRQL). In conjunction with LUTS, we obtained from our analysis that LUTS and depression are closely related and worsening depressive symptoms may increase the severity of LUTS. We also discerned three categories of factors that can yield major depression namely adversity, internalizing, and externalizing factors. Within these categories, trauma, social support, genetic factors, and minimal education appeared to increase the risk of depression in patients. With the recent increase in mental health awareness and more access to mental health care amid the COVID-19 Pandemic, further screening, and collaboration between providers to treat both urological and psychiatric symptoms could improve patient outcomes. It is important for providers to have an increased understanding of the mental and physical impact both LUTS and depression can have on patients' wellbeing. This has the potential to help patients be more open about their symptoms with the aim of better addressing LUTS and depression to positively impact their HRQL.

Longitudinal Associations Between Food Insecurity and Suicidal Ideation Among Adults Aged ≥65 in the Korean Welfare Panel Study

Objectives : This study aimed to explore longitudinal associations between food insecurity and suicidal ideation, and the moderating roles of intervention programs. Methods: Data were derived from the 2012-2019 waves of the Korean Welfare Panel Study. Participants aged ≥65 at baseline (n = 4,425) and their annual follow-up measurements for a mean of 6.58 years were included. Conditional fixed effects logistic regressions were used to test 1) associations between food insecurity and the onset of suicidal ideation; 2); whether associations were attenuated by food assistance and income support programs. Results: Food insecurity was associated with higher odds of suicidal ideation in the full sample (OR, 1.77; 95% CI, 1.37-2.29), among women (OR, 1.67; 95% CI, 1.24-2.26) and men (OR, 2.06; 95% CI, 1.25-3.40). The association between food insecurity and suicidal ideation was attenuated by participation in home-delivered meal services (OR, 0.43; 95% CI, 0.21-0.88). Conclusion: Food insecure older adults were more likely to consider committing suicide than their food secure counterparts. Food assistance through home-delivered meal services, but not other intervention programs, could weaken this link.

Service, Scholarship, and Sacrifice: A Qualitative Analysis of Food Security Barriers and Strategies among Military-Connected Students

BACKGROUND

In the United States, 41% of 4-year university student veterans have reported food insecurity, but literature on food insecurity among military-connected students is limited.

OBJECTIVE

The objective of the study was to increase knowledge of military-connected student food insecurity experiences and potential strategies to address food access.

DESIGN

The study is a cross-sectional survey and nonexperimental qualitative cohort analysis.

PARTICIPANTS AND SETTING

Military-connected students (n = 127) responded to a survey sampling all enrolled students at a Mountain West land grant university during spring 2020. Military-connected student focus group participants (n = 8) were purposively sampled from the same university during fall 2020.

MAIN OUTCOME MEASURES

Main outcome measures were demographic data and food insecurity rates. Qualitative measures included responses to questions about food insecurity among military-connected students, actions for improving food insecurity, and insight into food access resources on campus.

STATISTICAL ANALYSIS

Descriptive statistics were used to determine food insecurity rates. Qualitative analysis included audio recording and transcription, then a step-by-step process for coding and theme development.

RESULTS

Food insecurity was reported by 42.5% of military-connected student survey respondents. Qualitative analysis revealed themes about current and planned food access resources, barriers to food security, and strategies to promote military-connected student food security. Main themes related to resources were access to resources and food offerings. Main barrier themes were pride and shame. Main strategy themes included military pride and military connections and culture.

CONCLUSIONS

Military-connected students are at least as vulnerable to food insecurity as the student body at large. Qualitative analysis identified barriers and strategies for food security among military-connected students. Feelings of pride in identifying with the military seemed to amplify feelings of shame about food insecurity; however, this pride and sense of military community also suggest that food security efforts specifically tailored to military-connected students could be successful.

Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans

Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.