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Culquichicón C, Astudillo-Rueda D, Niño-Garcia R, Martinez-Rivera RN, Tsui NM, Gilman RH, Levy K, Lescano AG. Post-traumatic stress disorder, food insecurity, and social capital after the 2017 coastal El Niño flooding among mothers from Piura, Peru: A mixed method study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002996. [PMID: 38635669 PMCID: PMC11025727 DOI: 10.1371/journal.pgph.0002996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024]
Abstract
In order to understand the impacts in the post-disaster scenario of the 2017 El Niño events in the Piura region-Peru, we examined post-traumatic stress disorder (PTSD), food insecurity (FI), and social capital (SC) across three-time points in mothers in highly affected areas. In the Piura, Castilla, and Catacaos districts, we studied mothers combining mixed-method assessments at three (June-July 2017), eight and 12 months after the flooding. Each outcome was measured with the PTSD-Checklist-Civilian (PCL-C), the Household-Food-Insecurity-Access-Scale (HFIAS), the Adapted-Social-Capital-Assessment-Tool (SASCAT) surveys. In-depth interviews at the first evaluation were also conducted. At the first evaluation, 38.1% (n = 21) of 179 mothers reported PTSD; eight months and one year after the flooding, it dropped to 1.9% and virtually zero, respectively. Severe FI also declined over time, from 90.0% three months after the flooding to 31.8% eight months after, to 13.1% one year after. Conversely, high-cognitive SC was increased three months after the flooding (42.1%) and much greater levels at eight and 12 months after (86.7% and 77.7%, respectively). High levels of PTSD and severe FI three months after the flooding consistently decreased to nearly zero one-year post-disaster. High levels of high-cognitive SC may have helped mothers to recover from PTSD and FI in Piura.
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Affiliation(s)
- Carlos Culquichicón
- CI-Emerge, Center of Emerging Diseases and Climate Change, Universidad Nacional de Piura, Piura, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - David Astudillo-Rueda
- CI-Emerge, Center of Emerging Diseases and Climate Change, Universidad Nacional de Piura, Piura, Peru
- School of Medicine, Universidad Cesar Vallejo, Piura, Peru
| | - Roberto Niño-Garcia
- CI-Emerge, Center of Emerging Diseases and Climate Change, Universidad Nacional de Piura, Piura, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Raisa N. Martinez-Rivera
- CI-Emerge, Center of Emerging Diseases and Climate Change, Universidad Nacional de Piura, Piura, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicole Merino Tsui
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Robert H. Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Asociación Benéfica PRISMA, Lima, Peru
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karen Levy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Andrés G. Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Beck J, Koebach A, Abreu L, Regassa MD, Hoeffler A, Stojetz W, Brück T. COVID-19 Pandemic and Food Insecurity Fuel the Mental Health Crisis in Africa. Int J Public Health 2024; 68:1606369. [PMID: 38283859 PMCID: PMC10811217 DOI: 10.3389/ijph.2023.1606369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Objective: Providing country-level estimates for prevalence rates of Generalized Anxiety Disorder (GAD), COVID-19 exposure and food insecurity (FI) and assessing the role of persistent threats to survival-exemplified by exposure to COVID-19 and FI-for the mental health crisis in Africa. Methods: Original phone-based survey data from Mozambique, Sierra Leone, Tanzania and Uganda (12 consecutive cross-sections in 2021; n = 23,943) were analyzed to estimate prevalence rates of GAD. Logistic regression models and mediation analysis using structural equation models identify risk and protective factors. Results: The overall prevalence of GAD in 2021 was 23.3%; 40.2% in Mozambique, 17.0% in Sierra Leone, 18.0% in Tanzania, and 19.1% in Uganda. Both COVID-19 exposure (ORadj. 1.4; CI 1.3-1.6) and FI (ORadj 3.2; CI 2.7-3.8) are independent and significant predictors of GAD. Thus, the impact of FI on GAD was considerably stronger than that of COVID-19 exposure. Conclusion: Persistent threats to survival play a substantial role for mental health, specifically GAD. High anxiety prevalence in the population requires programs to reduce violence and enhance social support. Even during a pandemic, addressing FI as a key driver of GAD should be prioritized by policymakers.
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Affiliation(s)
- Jule Beck
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Anke Koebach
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Liliana Abreu
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | | | - Anke Hoeffler
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Wolfgang Stojetz
- ISDC—International Security and Development Center, Berlin, Germany
| | - Tilman Brück
- Leibniz Institute of Vegetable and Ornamental Crops, Großbeeren, Germany
- ISDC—International Security and Development Center, Berlin, Germany
- Albrecht Daniel Thaer Institute for Agricultural and Horticultural Sciences, Faculty of Life Sciences, Humboldt University of Berlin, Berlin, Germany
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van den Berg L, Walsh CM. Household food insecurity in South Africa from 1999 to 2021: a metrics perspective. Public Health Nutr 2023; 26:2183-2199. [PMID: 37771235 DOI: 10.1017/s1368980023001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To review and synthesize studies on household food security in South Africa. DESIGN Systematic mapping review of metrics (methodological review). SETTING Electronic databases, including EBSCOHost, Scopus and Web of Science, were searched for studies and reports on household food security in South Africa, reporting household food security published between 1999 and 2021. Searching, selecting and reporting were performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. PARTICIPANTS South African households. RESULTS Forty-eight articles reporting on six national surveys (one repeated annually since 2002) and forty sub-national studies meeting the inclusion criteria were selected. Various metrics, with different recall periods and ways of categorizing food security levels, were identified. Surveys that used similar metrics showed that the percentage of South African households that have experienced food insecurity and hunger has decreased over the review period yet remains concerning. However, the multitude of metrics used to assess the different components and levels of food security limits the comparability of the results to evaluate the scope and scale of the problem. CONCLUSIONS There is growing support for developing multi-variable approaches for food security research in sub-Saharan Africa. Future research should focus on finding the most appropriate combination of complementary metrics that would allow comparable data while holistically capturing food security and providing insight into the causes and consequences.
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Affiliation(s)
- Louise van den Berg
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein9300, South Africa
| | - Corinna May Walsh
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein9300, South Africa
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Multiple aspects of energy poverty are associated with lower mental health-related quality of life: A modelling study in three peri-urban African communities. SSM - MENTAL HEALTH 2022; 2:100103. [PMID: 36688234 PMCID: PMC9792378 DOI: 10.1016/j.ssmmh.2022.100103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 02/01/2023] Open
Abstract
Objective Over 900 million people in sub-Saharan Africa (SSA) live in energy poverty, relying on cooking polluting fuels (e.g. wood, charcoal). The association between energy poverty and mental/physical health-related quality of life (HRQoL) among women in SSA, who are primarily tasked with cooking, is unknown. Methods Females (n = 1,150) from peri-urban Cameroon, Kenya and Ghana were surveyed on their household energy use and mental/physical health status using the standardized Short-Form 36 (SF-36) questionnaire. Random effects linear regression linked household energy factors to SF-36 mental (MCS) and physical component summary (PCS) scores. A binary outcome of 'likely depression' was derived based on participants' MCS score. Random effects Poisson regression with robust error variance assessed the relationship between household energy factors and odds of likely depression. Results The prevalence of likely depression varied by a factor of four among communities (36%-Mbalmayo, Cameroon; 20%-Eldoret, Kenya; 9%-Obuasi, Ghana). In the Poisson model (coefficient of determination (R2) = 0.28), females sustaining 2 or more cooking-related burns during the previous year had 2.7 (95%CI:[1.8,4.1]) times the odds of likely depression as those not burned. Females cooking primarily with charcoal and wood had 1.6 times (95%CI:[0.9,2.7]) and 1.5 times (95%CI:[0.8,3.0]) the odds of likely depression, respectively, as those primarily using liquefied petroleum gas. Women without electricity access had 1.4 (95%CI:[1.1,1.9]) times the odds of likely depression as those with access. In the MCS model (R2 = 0.23), longer time spent cooking was associated with a lower average MCS score in a monotonically increasing manner. In the PCS model (R2 = 0.32), women injured during cooking fuel collection had significantly lower (-4.8 95%CI:[-8.1,-1.4]) PCS scores. Conclusion The burden of energy poverty in peri-urban communities in SSA extends beyond physical conditions. Experiencing cooking-related burns, using polluting fuels for cooking or lighting and spending more time cooking are potential risk factors for lower mental HRQoL among women.
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Mukhopadhyay S. The effects of medicaid expansion on job loss induced mental distress during the COVID-19 pandemic in the US. SSM Popul Health 2022; 20:101279. [PMCID: PMC9617676 DOI: 10.1016/j.ssmph.2022.101279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic led to an unprecedented level of job losses in the U.S., where job loss is also associated with the loss of health insurance. This paper uses data from the 2020 Household Pulse Survey (HPS) and difference-in-difference (DD) regressions to estimate the effect of Medicaid expansion on anxiety and depression associated with job loss. Estimates show that the respondents who live in expansion states are 96.6% more likely to have Medicaid coverage, and 14.2% less likely to have moderate to severe mental distress following their job loss compared to those living in non-expansion states. The corresponding numbers associated with a family member's job loss are 36.3% and 7.6%, respectively. Next, we explore the mechanisms which suggest that the economic security provided by Medicaid is as important (if not more) as the access to or utilization of healthcare. The difference-in-difference-in-difference (DDD) estimates using just above and below the Medicare eligibility age (65) confirm these results.
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Affiliation(s)
- Sankar Mukhopadhyay
- Department of Economics (MS – 030), University of Nevada, Reno, NV, 89557, USA
- IZA, Bonn, Germany
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Fan H, Nie X, Wilson S. Mental Health, Material Possessions, and Social Capital During COVID-19: A Study of the United States Urban Working-Age Population. APPLIED RESEARCH IN QUALITY OF LIFE 2022; 18:561-599. [PMID: 35991286 PMCID: PMC9382014 DOI: 10.1007/s11482-022-10093-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
This study evaluates the associations between the urban working-age population's mental health, material possession, and social capital during the COVID-19 pandemic. The specific stressors examined in this empirical analysis are income level, food insecurity, and virtual psychological support. This paper further examines the differences across the employed and unemployed population groups. We obtained data from the COVID-19 Household Impact Survey and constructed four measures of mental health conditions: Nervous, Depressed, Lonely, and Hopeless. Our empirical analyses use an ordinal regression model that takes both time and regional factors into consideration to control for potential time effects and time-invariant confounders that only vary between regions. For the employed group, the main results suggest that lower income and food insecurity is correlated with a higher frequency of mental health symptoms, while virtual psychological support predicts a better mental health status. For the unemployed group, food insecurity is negatively associated with mental health, and virtual psychological might help alleviate nervousness and depression.
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Affiliation(s)
- Haobin Fan
- Shanghai Academy of Social Sciences, Fudan University, The Development Research Center of Shanghai Municipal People’s Government, Shanghai, China
| | - Xuanyi Nie
- Harvard T.H. Chan School of Public Health, Department of Architecture, National University of Singapore, Cambridge, MA USA
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Nwosu CO, Kollamparambil U, Oyenubi A. Food insecurity and health outcomes during the coronavirus pandemic in South Africa: a longitudinal study. HEALTH ECONOMICS REVIEW 2022; 12:32. [PMID: 35723759 PMCID: PMC9207854 DOI: 10.1186/s13561-022-00375-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Given that South Africa experienced significant food insecurity even before the COVID-19 pandemic, it is not surprising that the pandemic would result in even greater food insecurity in the country. This paper provides additional evidence on the relationship between food insecurity and health. METHODS Data came from the National Income Dynamics Study-Coronavirus Rapid Mobile Survey, a longitudinal survey of adult South Africans. Health was a self-reported indicator of general health, while food insecurity was measured by household hunger, the frequency of household hunger, and households running out of money to buy food. We performed descriptive and econometric analyses. RESULTS Food insecurity has remained high even in the face of greater re-opening of the economy. Moreover, among hunger-affected households, between a quarter and a third struggled with hunger almost daily or daily. Belonging to a hunger-affected household was associated with a 7-percentage point higher probability of worse health compared to not experiencing hunger. Compared to being unaffected by hunger, being hungry everyday was associated with a 15-percentage point higher probability of worse health in wave 1, an effect that became statistically insignificant by wave 4. CONCLUSIONS These results show the enormity of the hunger problem in South Africa and its adverse effects on health. In the face of economic uncertainty and the removal of COVID-19 palliatives like the grant top-ups, we enjoin policy makers to protect the vulnerable from food insecurity by continuing the implementation of anti-hunger policies and other measures that enhance food security in the country.
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Affiliation(s)
- Chijioke O. Nwosu
- Department of Economics and Finance, University of Free State University of the Free State, Bloemfontein, 9301 South Africa
| | | | - Adeola Oyenubi
- School of Economics & Finance, University of the Witwatersrand, Johannesburg, South Africa
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Shepherd DL. Food insecurity, depressive symptoms, and the salience of gendered family roles during the COVID-19 pandemic in South Africa. Soc Sci Med 2022; 301:114830. [PMID: 35367907 PMCID: PMC8882481 DOI: 10.1016/j.socscimed.2022.114830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/22/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Abstract
Extensive research has indicated food insecurity to be associated with depressive symptoms, both of which have been indicated to increase globally during the COVID-19 pandemic. Few studies, however, have made use of nationally representative and longitudinal data to investigate this relationship, making causal claims difficult. In South Africa (SA), as with other low- and middle-income contexts, population-based studies have generally focused on mothers during the perinatal period and other vulnerable groups. This study made use of Cross-Lagged Dynamic Panel Models to examine the relationship between household food insecurity and the depressive symptoms of adults across three waves of the National Income Dynamics Survey–Coronavirus Rapid Mobile Survey (NIDS-CRAM) study collected in 2020 and 2021, a dataset nationally representative of all adults in SA in 2017. Stratification of the sample by gender, parenthood and marital statuses allowed for the assessment of gender differences in family roles that might account for differential impacts of food insecurity on mental health outcomes. The findings of this study indicated a significant impact of food insecurity on the depressive symptoms of adults. Controlling for stable trait-like individual differences eliminated much of this relationship, indicating partial or full mediation by unobserved factors. Gender differences in food security's association with depressive symptoms amongst cohabitating parents following the inclusion of individual effects provided support for a gendered role response. These findings provide further evidence of the complex interactions between sex, gender and health.
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Affiliation(s)
- Debra L Shepherd
- Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
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Aguiar A, Maia I, Pinto M, Duarte R. Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [PMCID: PMC9059064 DOI: 10.1159/000522319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern. Aim The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics. Methodology This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated. Results Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling; OR 2.966; 95% CI 1.250–7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602; 95% CI 1.004–6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007; 95% CI 0.001–0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic. Conclusions These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.
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Affiliation(s)
- Ana Aguiar
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- *Ana Aguiar,
| | - Isabel Maia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Marta Pinto
- Unidade de Investigação Clínica da ARS Norte, Porto, Portugal
- Faculdade de Psicologia e Ciências da Educação, Universidade do Porto, Porto, Portugal
| | - Raquel Duarte
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unidade de Investigação Clínica da ARS Norte, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Boateng GO, Workman CL, Miller JD, Onono M, Neilands TB, Young SL. The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women. Soc Sci Med 2022; 295:113043. [PMID: 32482382 PMCID: PMC8869838 DOI: 10.1016/j.socscimed.2020.113043] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023]
Abstract
Depression is a leading cause of disability worldwide and a major contributor to the overall global burden of disease, especially for women of childbearing age. Social science scholarship has demonstrated significant relationships between mental health, food insecurity (FI), water insecurity (WI), and HIV. Little is known, however, about the temporal relationships between food and water insecurity or the mechanisms through which these multiple stressors may operate or interact to impact depression. We therefore used syndemic theory to explore the complex relationships between FI, WI, and HIV on depressive symptomatology among Kenyan women of mixed HIV status (n=183, NCT02979418). We sought to 1) understand the temporal relationships between time-variant risk factors for depression, i.e. FI and WI, and 2) assess how these factors potentially interacted with HIV to impact depressive symptomatology. We first assessed the bidirectional relationship between WI and FI using a cross-lagged three-wave, two-variable panel model. Next, we modeled depressive symptomatology at 21 months as a linear function of the potentially syndemic interaction between FI, WI, and HIV status, adjusting for household wealth. WI had a predominant predictive effect on FI (Bayesian posterior predictive p-value=0.13); there was no reverse causality for the influence of FI on WI. The interaction effect of FI, WI, and HIV was significantly associated with greater depressive symptomatology (β=0.06) at 21 months postpartum. These data suggest that water insecurity may be an important determinant of food insecurity. Further, the co-occurrence of FI, WI, and HIV increases the likelihood of maternal depressive symptomatology, i.e. there is a syndemic relationship. These findings suggest that the role of household WI in other adverse health outcomes beyond mental well-being should be examined, and that interventions to improve mental health will be more effective if they also consider concurrent resource insecurities, regardless of HIV status.
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Affiliation(s)
- Godfred O Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA; Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA
| | - Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | | | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Sera L Young
- Department of Anthropology & Global Health, Faculty Fellow, Institute for Policy Research, Northwestern University, Evanston, IL, 60208, USA.
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Prevalence of food insecurity and association with mental health in an indigenous population in Panamá. Public Health Nutr 2021; 24:5869-5876. [PMID: 34407903 PMCID: PMC10195598 DOI: 10.1017/s1368980021003554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Understanding food insecurity and its health consequences is important for identifying strategies to best target support for individuals and communities. Given the limited information that exists for indigenous groups in Latin America, this study aimed to understand the association between food insecurity and mental health in an indigenous population in Panama. DESIGN Cross-sectional data were collected using a survey conducted with Kuna Indians residing off the coast of Panama. Data sources included measures from the Panamanian prevalence of risk factors associated with CVD survey, and validated measures for psychosocial factors and standardised health outcome measures. Regression models with each of the mental health outcomes (depression, serious psychological distress, perceived stress) were used to examine the association between food insecurity and mental health outcomes. SETTING Indigenous Kuna community residing on the San Blas Islands of Panama. PARTICIPANTS Two-hundred nine adults. RESULTS Food insecurity was reported by 83 % of the participants. Across demographic categories, the only significant difference was by age with higher prevalence in younger ages. After adjusting for demographics, higher food insecurity was significantly associated with higher number of depressive symptoms and more serious psychological distress, but not with levels of perceived stress. CONCLUSIONS Based on these findings, treatment for mental health in the Kuna community may need to account for social determinants of health and be tailored to meet the needs of younger age groups in this population. In addition, interventions designed to decrease food insecurity should be considered as a possible means for improving mental health.
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Teasdale SB, Müller-Stierlin AS, Ruusunen A, Eaton M, Marx W, Firth J. Prevalence of food insecurity in people with major depression, bipolar disorder, and schizophrenia and related psychoses: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2021:1-18. [PMID: 34783286 DOI: 10.1080/10408398.2021.2002806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
People with severe mental illness (SMI), such as major depression, bipolar disorder, and schizophrenia, experience numerous risk factors that may predispose them to food insecurity; however, the prevalence of food insecurity and its effects on health are under-researched in this population group. This systematic review and meta-analysis aimed to describe the prevalence and correlates of food insecurity in people with SMI. A comprehensive electronic search was conducted up to March 2021. Random effects meta-analysis was employed to determine the prevalence of food insecurity in SMI, and odds ratio (OR) of food insecurity in people with SMI compared to non-psychiatric controls/general population. Twenty-nine unique datasets (31 publications) were included. Prevalence estimate of food insecurity in people with SMI was 40% (95% CI 29-52%, I2 = 99.7%, N = 27). People with SMI were 2.71 (95% CI 1.72-3.25) times more likely to report food insecurity than the comparator group (Z = 11.09, p < 0.001, I2 = 95%, N = 23). The odds of food insecurity in SMI were higher in high/high-middle income countries compared to low/low-middle income countries, likely due to the high food insecurity rates in the general population of lower income countries. There was no difference in food insecurity rates by diagnosis. Food insecurity should be a consideration for health professionals working with community-dwelling people with SMI.
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Affiliation(s)
- Scott B Teasdale
- School of Psychiatry, University of New South Wales and Mindgardens Neuroscience Network, Kensington, Australia
| | - Annabel S Müller-Stierlin
- Department of Psychiatry II, Ulm University, Ulm, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Anu Ruusunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, iMPACT - the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Melissa Eaton
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - Wolfgang Marx
- Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, iMPACT - the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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K C D, Ulak N, Poudyal A, Shrestha N, Gautam N, Ghimire L, Paudel U. Household Food Security Access and Nutritional Status among Early Adolescents in a Poor Neighborhood of Sinamangal, Nepal. Curr Dev Nutr 2021; 5:nzab127. [PMID: 34805724 PMCID: PMC8598737 DOI: 10.1093/cdn/nzab127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/26/2021] [Accepted: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early adolescence is an important period of the life cycle wherein the food system plays a critical role in protecting food security as well as the nutritional needs essential for a healthy transition from childhood to adulthood. Despite the surging concerns regarding the food and nutrition security of adolescents throughout the nation, people in a poor neighborhood are often neglected and considered the most vulnerable. OBJECTIVES This research aims to assess the status of household food security and nutritional status among early adolescents living in a poor neighborhood of Kathmandu, Nepal. METHODS Using a cross-sectional study design, data was collected with the Household Food Insecurity Access Scale (HFIAS) tool. Nutritional status was measured using the WHO Child Growth Standard Reference 2007 Statistical Software for Social Science (SPSS) macro package based on BMI-for-age z-score, height-for-age z-score, and weight-for-age z-score, respectively. Data were entered in a predetermined format of SPSS version 20.0 and imported into STATA version 13.1 for univariate and bivariate analyses. Ethical approval was sought from the Ethical Review Board of Nepal Health Research Council (NHRC) prior to the study. RESULTS More than one-fifth (21%) of the households were food insecure. Based on BMI-for-age, 5.5% of the adolescents were found to be moderately undernourished and 2.6% were severely undernourished. The percentage of moderately and severely stunted adolescents were 8.4% and 5.8%, respectively, based on height-for-age. Based on weight-for-age, moderately and severely underweight adolescents accounted for 13.0% and 1.3% of the total. CONCLUSION The prevalence of underweight, stunting, and wasting among early adolescents was high. The households in a poor neighborhood were also experiencing some form of food insecurity. This calls for targeted efforts to address malnutrition and improve the nutritional status of early adolescents, particularly in poor neighborhoods.
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Affiliation(s)
- Dirghayu K C
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Namuna Ulak
- College of Applied Food and Dairy Technology, Kathmandu, Nepal
| | - Anil Poudyal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Namuna Shrestha
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Nitisha Gautam
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Laxmi Ghimire
- Sanjeevani College of Medical Sciences, Butwal, Nepal
| | - Uttam Paudel
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
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The Mental Health Outcomes of Food Insecurity and Insufficiency in West Africa: A Systematic Narrative Review. Behav Sci (Basel) 2021; 11:bs11110146. [PMID: 34821607 PMCID: PMC8614760 DOI: 10.3390/bs11110146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Food insufficiency is a global pandemic affecting many people, especially those residing in developing countries. African countries have been affected by food insufficiency, which is mostly caused by drought or wars. Famine or food insufficiency has been reported to have an impact on the psychological health and quality of life of people affected. This review assessed the mental health outcomes of famine and food insufficiency in West Africa. (2) Methods: A search of the published literature was conducted using PubMed, PsycExtra, Medline, and PsycINFO databases. The search was limited to papers published in English between the years 2010 and 2020. Two reviewers independently screened the titles and abstracts of the retrieved papers using pre-defined inclusion and exclusion criteria and a third reviewer resolved conflicts. Data were extracted and appraised using a data extraction form and an appraisal checklist. (3) Results: A total of 81 papers were identified through the journal databases search. Out of the seven papers that met the inclusion criteria, six papers used cross-sectional designs and one paper used an experimental design. The six papers used quantitative approach for data collection, while the one paper used a qualitative technique. The evidence synthesized from this review indicated that exposure to food insecurity or insufficiency is associated with increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability. (4) Conclusions: This review strongly highlights the need for further research across the sub-region. It further suggests that famine and food insufficiency are associated with significant mental health problems in adults and impacts the cognitive and intellectual development of children. Although there is paucity of literature about famine and its impact on mental health in West Africa, these findings are important for developing social policy initiatives for increasing food supply and mental health interventions for all ages.
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Madeghe BA, Kogi-Makau W, Ngala S, Kumar M. Nutritional Factors Associated With Maternal Depression Among Pregnant Women in Urban Low-Income Settlements in Nairobi, Kenya. Food Nutr Bull 2021; 42:334-346. [PMID: 34219489 DOI: 10.1177/03795721211025123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nutritional deficiencies are common during pregnancy and a year after childbirth. At the same time, maternal depression affects many women during pregnancy up to 1 year after childbirth. The objectives of this study were to determine the associations between nutrition status, dietary intake, and maternal depression among pregnant women. METHODS This was a cross-sectional study that included 262 pregnant women aged 15 to 49 years attending the antenatal clinic in 2 public health facilities in urban low-income settlements in Nairobi, Kenya. Maternal depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Mid-upper arm circumference (MUAC) was used to determine nutritional status. Dietary intake was assessed using the 24-hour recall, and brain essential nutrients were assessed through a questionnaire. Odds ratio was used to test the associations. All maternal characteristics with P < .001 in the univariable analysis were considered in the multivariable logistic regression, variables with P < .05 were considered significant. RESULTS Of the 262 pregnant women, 33.6% (95% CI: 27.9-40.7) had depressive illness as indicated by EPDS >13. About 9.9% of pregnant women had MUAC < 23 cm. The study established statistically significant association between poor nutrition by MUAC and maternal depression (P < .001). Maternal depression was statistically significantly associated with inadequate intake of brain food essential (P = .002). Maternal depression was statistically significantly associated with lower income (P < .001). In multivariable regression analysis, the main predictor of maternal depression was poor nutrition (P < .004). CONCLUSION These findings reveal an association between poor nutrition and maternal depression. These results suggest that nutritional deficiencies could be a contributing factor for maternal depression. Study recommends dietary interventions as cost-effective way to reduce deficiencies and improve mental health problems for pregnant women. Assessment of maternal depression and dietary intake be integrated as fundamental components of antenatal care.
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Affiliation(s)
- Beatrice A Madeghe
- Department of Food Science Nutrition and Technology, 309371University of Nairobi, Nairobi, 00625, Kenya
| | - Wambui Kogi-Makau
- Department of Food Science Nutrition and Technology, 309371University of Nairobi, Nairobi, 00625, Kenya
| | - Sophia Ngala
- Department of Food Science Nutrition and Technology, 309371University of Nairobi, Nairobi, 00625, Kenya
| | - Manasi Kumar
- Department of Psychiatry, 108330College of Health Sciences, University of Nairobi, Nairobi, 00100, Kenya
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Unpacking the "black box" of global food insecurity and mental health. Soc Sci Med 2021; 282:114042. [PMID: 34144433 DOI: 10.1016/j.socscimed.2021.114042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/22/2022]
Abstract
Food insecurity is a global concern. While it was once characterized mainly as a problem of undernutrition, it is now recognized that a person may be food insecure without experiencing hunger. Numerous studies have demonstrated that food insecurity is strongly related to poor mental health around the world, but the mechanisms that underpin that relationship remain poorly understood. One body of research from nutritional sciences posits that nutrient deficiency impacts brain function, producing symptoms of depression and anxiety. Another body of research from the social sciences posits that the social consequences of having to eat non-preferred foods or obtain food in socially unacceptable ways may compromise mental health through stress. This study was designed to clarify the mechanisms linking food insecurity and mental health using case studies in rural Brazil and urban Ethiopia. Working with samples consisting of about 200 adult household decision-makers (mostly female) recruited between 2015 and 2019 at each site, we tested for nutritional and social mediation of the food insecurity-mental health relationship using multivariable linear regression and mediation analysis. Our analyses found no evidence of mediation in either setting. Moreover, there was no association between nutritional status variables and food insecurity. These findings suggest that food insecurity likely impacts mental health directly through forms of basic needs deprivation, such as worrying about where one's next meal will come from, rather than by acting as a social signal or even by impacting nutritional status. These results underscore the power of basic-needs deprivation for impacting mental health.
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Trudell JP, Burnet ML, Ziegler BR, Luginaah I. The impact of food insecurity on mental health in Africa: A systematic review. Soc Sci Med 2021; 278:113953. [PMID: 33971482 DOI: 10.1016/j.socscimed.2021.113953] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity's effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making.
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Affiliation(s)
- John Paul Trudell
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Maddison L Burnet
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Bianca R Ziegler
- Department of Geography, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
| | - Isaac Luginaah
- Department of Geography, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
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Food security mediates the decrease in women's depressive symptoms in a participatory nutrition-sensitive agroecology intervention in rural Tanzania. Public Health Nutr 2021; 24:4682-4692. [PMID: 33706829 DOI: 10.1017/s1368980021001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women's depressive symptoms. DESIGN We used annual longitudinal data (four time points) from a cluster-randomised effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project. Structural equation modelling estimation of total, natural direct and natural indirect effects was used to investigate food security's role in the intervention's impact on women's risk of probable depression (Center for Epidemiologic Studies Depression Scale > 17) across 3 years. SETTING Rural Singida, Tanzania. PARTICIPANTS 548 food insecure, married, smallholder women farmers with children < 1 year old at baseline. RESULTS At baseline, one-third of the women in each group had probable depression (Control: 32·0 %, Intervention: 31·9 %, P difference = 0·97). The intervention lowered the odds of probable depression by 43 % (OR = 0·57, 95 % CI: 0·43, 0·70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0·90, 95 % CI: 0·83, 0·95). CONCLUSIONS This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women's depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e. improvements in mental health; changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women's well-being in farming communities.
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Lee SJ, Lee KW, Cho MS. Association of Food Insecurity with Nutrient Intake and Depression among Korean and US Adults: Data from the 2014 Korea and the 2013-2014 US National Health and Nutrition Examination Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E506. [PMID: 33435492 PMCID: PMC7827165 DOI: 10.3390/ijerph18020506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to understand the current status of food insecurity in Korea and the US and to compare the relationship of food insecurity with nutrient intake and depression. Data from the 2014 Korea and the 2013-2014 US National Health and Nutrition Examination Surveys were analyzed, and a total of 3102 Korean and 3234 American adults aged 20-64 years were included. Study subjects were classified into three groups according to degree of food insecurity assessed by the 18-item Household Food Security Survey Module: food secure (FS), mildly food insecure (FI 1), and moderately-to-severely food insecure (FI 2) groups. Energy and nutrient intake were assessed using a 24-h dietary recall. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9) screener. The prevalence of food insecurity was 17.2% in Korea and 26.4% in the US. In both countries, the people in the FI 2 group had lower incomes and education levels and were mostly single. Energy and nutrient intake differed by food insecurity status. In both Korea and the US, adults with moderate-to-severe food insecurity (FI 2) consumed fewer proteins, fiber, potassium, and vitamin C. Additionally, the FI 2 groups had higher proportions of people not meeting the Dietary Reference Intake for protein, potassium, niacin, and vitamin C than the FS groups in Korea and the US. FI 2 people were three times more likely to be depressed than FS group; this difference was stronger in Korea than the US. We found that the prevalence of food insecurity was higher in the US than in Korea, and food insecurity was associated with reduced nutrient intake and increased odds of depression in both Korean and US adults. Therefore, food insecurity is an important public health issue at both the individual and national levels. Continuous monitoring and new intervention activities to promote food security are needed.
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Affiliation(s)
- Seung Jae Lee
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea;
| | - Kyung Won Lee
- Department of Home Economics Education, Korea National University of Education, Cheongju 28173, Korea;
| | - Mi Sook Cho
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea;
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Horwood C, Haskins L, Hinton R, Connolly C, Luthuli S, Rollins N. Addressing the interaction between food insecurity, depression risk and informal work: findings of a cross-sectional survey among informal women workers with young children in South Africa. BMC WOMENS HEALTH 2021; 21:2. [PMID: 33388054 PMCID: PMC7777389 DOI: 10.1186/s12905-020-01147-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022]
Abstract
Background There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability. Methods A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata. Results Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned < US$70 per month, and few earned > US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p < 0.001). Conclusions Informal women workers were shown to be vulnerable with low incomes and high rates of food insecurity, thus increasing the risk for poor maternal health. However, levels of depression risk were low compared to previous estimates in South Africa, suggesting that informal workers may have high levels of resilience. Interventions to improve social protection, access to health services, and support for safe childcare in the workplace could improve the health and wellbeing of these mothers and support them to care for their children.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa.
| | - Lyn Haskins
- Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | | | - Catherine Connolly
- Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Silondile Luthuli
- Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland
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Seasonality, Food Insecurity, and Clinical Depression in Post-Partum Women in a Rural Malawi Setting. Matern Child Health J 2020; 25:751-758. [PMID: 33231821 DOI: 10.1007/s10995-020-03045-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We evaluate the association between food insecurity (FI) and clinical depression, and the modifying effects of seasonality on this association. METHODS Food insecurity is assessed from 175 post-partum women in the rural Ntcheu District of central Malawi using the USAID's Household Food Insecurity Access Scale (HFIAS). Clinical depression is measured using a validated Chichewa version of the Self-Reporting Questionnaire (SRQ). Interviews were conducted from October 2016 to June 2017 and spanned 5 months of the dry season (April-November) and the 4 months of rainy season (December-March). RESULTS After adjusting for age and parity, participants who reported high FI (HFIAS score ≥ 9) had 4.6 (95%CI 1.8-11.4) times the odds of meeting the cut-off for clinical depression (SRQ score ≥ 8). The effect was greater during the dry season (OR 9.9; 95%CI 2.0-48.6), than in the rainy season (OR 2.6; 95%CI 0.8-8.3) though the interaction term was not statistically significant (p = 0.18) CONCLUSIONS FOR PRACTICE: High FI is associated with diagnostic markers of clinical depression.
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Emerson JA, Caulfield LE, Kishimata EM, Nzanzu JP, Doocy S. Mental health symptoms and their relations with dietary diversity and nutritional status among mothers of young children in eastern Democratic Republic of the Congo. BMC Public Health 2020; 20:225. [PMID: 32054476 PMCID: PMC7020353 DOI: 10.1186/s12889-019-8092-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022] Open
Abstract
Background In developing countries, maternal mental health problems have been linked to sub-optimal child feeding practices and child underweight and stunting, but little is known about how maternal mental health is associated with mothers’ own diets and nutritional status. The objective of the study was to investigate the association between mental health symptoms and diet and nutritional status of mothers of young children in South Kivu, DR Congo. Methods Participants were 828 mothers of young children enrolled in a larger, quasi-experimental study evaluating a multi-year food security and nutrition project. The present analysis was conducted with cross-sectional data collected from 2015 to 2016. We assessed symptoms of anxiety and depression using the Hopkins Symptom Checklist-25 (HSCL-25) and post-traumatic stress disorder (PTSD) with the Harvard Trauma Questionnaire (HTQ), using a four-point Likert scale. Mean scale scores were calculated ranging from one to four. A variable was created for high distress (participants scoring in the upper quartile of both measures). Dietary diversity scores were calculated from the number of food groups (range zero to ten) consumed the previous day, identified from an open recall. Nutritional status was measured by body mass index (BMI) and underweight (BMI < 18.5 kg/m2, or mid-upper arm circumference < 23 cm for pregnant women). Bivariate and multivariate (adjusting for parent study intervention group, education, age, health, parity, livelihoods zone, and territory of origin) regression analyses were conducted. Results Maternal mental health measures were positively and statistically significantly associated with higher dietary diversity scores in adjusted analyses (HSCL-25: ß= 0.18, p = 0.002, HTQ: ß= 0.12, p = 0.029, High Distress: ß= 0.47, p < 0.001). Mental health symptoms were not significantly associated with BMI (HSCL-25: ß = − 0.04, p = 0.824; HTQ: ß = 0.02, p = 0.913; High distress: ß= − 0.02, p = 0.938) or underweight (HSCL 25: OR = 0.91, p = 0.640; HTQ: OR = 1.03, p = 0.866; High distress: OR = 0.78, p = 0.489). Conclusions More severe maternal mental health symptoms were associated with higher dietary diversity but not nutritional status, and the reasons for these findings are not clear from available data. More research is needed to identify underlying factors that could influence mental health symptomatology and diet quality among food insecure and extremely resource-limited populations.
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Affiliation(s)
- Jillian A Emerson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Laura E Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | | | - Jean-Pierre Nzanzu
- Adventist Development and Relief Agency, Uvira, South Kivu, Democratic Republic of Congo
| | - Shannon Doocy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Drammeh W, Hamid NA, Rohana A. Determinants of Household Food Insecurity and Its Association with Child Malnutrition in Sub-Saharan Africa: A Review of the Literature. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE 2019. [DOI: 10.12944/crnfsj.7.3.02] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Food insecurity is a global public health challenge. Household food insecurity is the leading risk factor of malnutrition, claiming approximately 300,000 deaths each year. Whether directly or indirectly, due to inadequate food consumption and poor diet quality, it is also accountable for over half of all deaths among children in Sub-Saharan Africa. It is estimated that the prevalence of food-insecure individuals in the area will reach 17 million by the year 2021. Inadequate nutrition may result in low immunity, impaired physical and mental development and reduced productivity among children under five years and throughout the life course. This review article attempts to discuss the various household food insecurity determinants and their association with child malnutrition in a Sub-Saharan Africa context. The purposes of this article are to inform governments, policymakers and service providers regarding the importance of household food security and its determinants on child malnutrition, and to plan strategies to improve the household food security status in Sub-Saharan Africa.
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Affiliation(s)
- Wuyeh Drammeh
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan
| | - Noor Aman Hamid
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan
| | - A.J. Rohana
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan
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Depression and anxiety among pregnant women living with HIV in Kilimanjaro region, Tanzania. PLoS One 2019; 14:e0224515. [PMID: 31671160 PMCID: PMC6822761 DOI: 10.1371/journal.pone.0224515] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mental health disorders in pregnant women living with HIV are associated with poor maternal and child outcomes, and undermine the global goals of prevention of mother-to-child transmission of HIV (PMTCT). This study aimed to determine prevalence of depression and anxiety and identify factors associated with these common mental health disorders among HIV-infeced pregnant women in Tanzania. METHODS We enrolled 200 pregnant women living with HIV from antenatal care clinics in the Kilimanjaro region. Women were eligible if they were in the second or third trimester of pregnancy and had been in PMTCT care for a minimum of one month. Data were collected via interviewer administered surveys. Participants self reported depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and anxiety symptoms (Brief Symptom Index, BSI). Multivariate logistic regression models examined factors associated with depression, anxiety, and comorbid depression and anxiety. RESULTS 25.0% of women met screening criteria for depression (EPDS ≥10). Depression was significantly associated with being single (aOR = 4.2, 95% CI = 1.1-15.5), food insecurity (aOR = 2.4, 95% CI = 1.0-6.4), and HIV shame (aOR = 1.2, 95% CI = 1.1-1.3). 23.5% of participants met screening criteria for anxiety (BSI ≥1.01). Anxiety was associated with being single (aOR = 3.6, 95%CI = 1.1-11.1), HIV shame (aOR = 1.1, 95% CI = 1.1-1.2) and lifetime experience of violence (aOR = 2.3, 95% CI = 1.0-5.1). 17.8% of the sample met screening criteria for both depression and anxiety. Comorbid depression and anxiety was associated with being single (aOR = 4.5, 95%CI = 1.0-19.1), HIV shame (aOR = 1.2, 95%CI = 1.1-1.3) and lifetime experience of violence (aOR = 3.4, 95% CI = 1.2-9.6). CONCLUSION Depression and anxiety symptomatology was common in this sample of pregnant women living with HIV, with a sizable number screening positive for comorbid depression and anxiety. In order to successfully engage women in PMTCT care and support their well-being, strategies to screen for mental health disorders and support women with mental illnesses are needed.
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Piperata BA, Salazar M, Schmeer KK, Herrera Rodríguez A. Tranquility is a child with a full belly: Pathways linking food insecurity and maternal mental distress in Nicaragua. Ecol Food Nutr 2019; 59:79-103. [PMID: 31573333 DOI: 10.1080/03670244.2019.1671835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A growing body of literature identifies food insecurity (FI) as a critical social determinant of mental health. Across settings, quantitative studies report positive correlations between FI and mental distress, especially among women. Less understood are the pathways by which FI undermines women's mental well-being. To address this gap, we conducted six focus group discussions with 45 Nicaraguan mothers. Thematic analysis identified three themes linking the management of FI and maternal mental well-being in this setting. The theme, la lucha, underscored how the chronicity of FI served as a constant mental strain by demanding mothers strategize on a daily basis to resolve it. The themes "tranquility is a child with a full belly" and "the despairing and frustrated mother" emphasized how FI challenged women's abilities to fulfill the responsibilities of motherhood and served as a reminder of social status. Our findings advance earlier quantitative work by identifying how the management of food insecurity undermines maternal mental well-being in a low-middle income setting and indicate that policies aimed at combating food insecurity can concomitantly improve maternal mental well-being if they bolster women's agency and work to reduce the stigma associated with being food insecure.
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Affiliation(s)
- Barbara A Piperata
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
| | - Mariano Salazar
- Department of Public Health Science, Karolinka Institutet, Stockholm, Sweden
| | - Kammi K Schmeer
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Andrés Herrera Rodríguez
- Center for Demography and Health Research (CIDS), Nicaraguan National AutonomousUniversity, León, Nicaragua
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Garman EC, Schneider M, Lund C. Perinatal depressive symptoms among low-income South African women at risk of depression: trajectories and predictors. BMC Pregnancy Childbirth 2019; 19:202. [PMID: 31200665 PMCID: PMC6570971 DOI: 10.1186/s12884-019-2355-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy. METHODS This is a secondary analysis of a randomised controlled trial among 384 women living in Khayelitsha, a low income setting in South Africa, recruited at their first antenatal visit if they scored 13 or above on the Edinburgh Postnatal Depression Scale, were at least 18 years of age, less than 29 weeks pregnant and spoke isiXhosa. Participants were followed up at 8 months gestation, 3 and 12 months postpartum. Latent trajectories of depressive symptoms were identified using growth mixture modelling, based on the Hamilton Depression Rating Scale (HDRS). There were no differences in HDRS scores between the control and intervention arms, so all participants were assessed together. Health, social and economic predictors of trajectories were investigated to identify high-risk groups with greater or more chronic depressive symptoms, using univariate logistic regression. RESULTS Two trajectories were identified: antenatal only (91.4%), with moderate to severe symptoms at baseline which later subside; and antenatal and postnatal (8.6%), with severe depressive symptoms during pregnancy and later in the postpartum period, which subside temporarily to moderate levels at 3 months postpartum. Predictors for the antenatal and postnatal trajectory include severe food insecurity, intimate partner violence, lower social support, greater functional impairment, problematic drinking and suicide risk. CONCLUSIONS A small proportion of women who are at risk for depression antenatally remain at risk throughout the perinatal period, and can be differentiated from those who show a natural remission. Identification and referral strategies should be developed with these findings in mind, especially given the limited mental health resources in low-income settings.
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Affiliation(s)
- Emily C. Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Nampijja M, Natamba B, Mpango R, Kinyanda E. The burden and risk factors for postnatal depression and depressive symptomatology among women in Kampala. Trop Doct 2019; 49:170-177. [PMID: 30885057 DOI: 10.1177/0049475519837107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Major depressive disorder (MDD) is a major global health challenge and postnatal women may be at an increased risk for this disorder. Very few studies have tested this hypothesis in sub-Saharan Africa (SSA), so it is uncertain whether risk factors implicated elsewhere in the world are relevant in SSA. We explored prevalence and risk factors for MDD and depressive symptomatology among postnatal mothers in Kampala. Three hundred postnatal mothers at Nsambya Hospital were assessed for MDD using the DSM IV-based MINI; prevalence and risk factors were determined using frequencies and regressions, respectively. Four women (1.33%) had MDD; however, 94 (31%) had 'sub-threshold' or depressive symptomatology, with which partner violence is particularly associated. MDD is rare among postnatal women in a paying hospital in Kampala; however, the high prevalence of depressive symptomatology suggests susceptibility to MDD. Longitudinal studies should investigate this hypothesis and the susceptibility due to partner violence should guide appropriate interventions.
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Affiliation(s)
- Margaret Nampijja
- 1 Scientist, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Barnabas Natamba
- 1 Scientist, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Richard Mpango
- 1 Scientist, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Eugene Kinyanda
- 2 Senior Scientist, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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Barnett W, Pellowski J, Kuo C, Koen N, Donald KA, Zar HJ, Stein DJ. Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors. BMJ Open 2019; 9:e018277. [PMID: 30867198 PMCID: PMC6429723 DOI: 10.1136/bmjopen-2017-018277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Better understanding of psychosocial risk factors for food insecurity (FI) during pregnancy and how they interact is crucial, given long-term health implications for maternal and child health. We investigated the association between maternal childhood trauma as well as intimate partner violence (IPV) and FI among pregnant women in South Africa, in the Drakenstein Child Health Study, and whether maternal depression mediates these relationships. SETTING Two primary care clinics in Paarl, South Africa. PARTICIPANTS 992 pregnant women; inclusion criteria were clinic attendance and remaining in area for at least 1 year; women were excluded if a minor. METHODS We examined psychosocial predictors of FI using multivariate regression. Mediation analyses investigated whether depression mediated the relationship between IPV and FI as well as between childhood trauma and FI, including disaggregation by two study communities. FI was assessed using an adapted US Department of Agriculture food security scale; households were coded as food insecure where 2 of 5 affirmative responses were recorded. RESULTS Among 992 pregnant women, there were high rates of IPV (7%-27%), depression (24%) and childhood trauma (34%). In multivariate cross-sectional analysis, emotional IPV (adjusted OR [aOR] 1.60; 95% CI 1.04 to 2.46), depression (aOR 1.05; 95% CI 1.01 to 1.08) and childhood trauma (aOR 1.52; 95% CI 1.08 to 2.15) predicted FI. In mediation models, depression partially mediated the relationship between emotional IPV and FI as well as physical IPV and FI; depression partially mediated the relationship between childhood trauma and FI. Differing degrees of mediation were found when applied to communities. CONCLUSIONS Antenatal maternal depression, IPV and childhood trauma were highly prevalent and associated with FI. Depression, IPV and trauma screening services should be considered within routine antenatal care and may offer an opportunity to identify and intervene. Community-level differences in risk and in mediation analyses indicate that contextual tailoring of interventions may be important.
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Affiliation(s)
- Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Jennifer Pellowski
- Department of Behavioral and Social Sciences and International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Caroline Kuo
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University, Providence, USA
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Kirsten A Donald
- Division of Developmental Paediatrics, Department of Paediatrics & Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
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Meinck F, Orkin FM, Cluver L. Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model. J Int AIDS Soc 2019; 22:e25262. [PMID: 30869202 PMCID: PMC6416665 DOI: 10.1002/jia2.25262] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 02/20/2019] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Adolescent girls are at high risk of HIV infection in sub-Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision. METHODS Self-report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one-year follow-up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection. RESULTS Internalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow-up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow-up via higher externalizing problems. Free schooling provision at baseline and follow-up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACEs and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow-up through a direct negative effect on externalizing mental health distress. CONCLUSIONS Reducing ACEs and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls.
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Affiliation(s)
- Franziska Meinck
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- OPTENTIAFaculty of Health SciencesNorth‐West UniversityVanderbijlparkSouth Africa
| | - FM Orkin
- MRC Developmental Pathways for Health Research UnitSchool of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lucie Cluver
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
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Payne CF, Pesando LM, Kohler HP. Private Intergenerational Transfers, Family Structure, and Health in a sub-Saharan African Context. POPULATION AND DEVELOPMENT REVIEW 2019; 45:41-80. [PMID: 32440034 PMCID: PMC7241093 DOI: 10.1111/padr.12225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Collin F Payne
- Australian National University College of Arts and Social Sciences, School of DemographyHC Coombs Building, Canberra, Australian Capital Territory, Australia
| | - Luca Maria Pesando
- University of Pennsylvania, Population Studies Center, Philadelphia, Pennsylvania, United States
| | - Hans-Peter Kohler
- University of Pennsylvania, Department of Sociology, 3718 Locust Walk/272 McNeil Building, Philadelphia, Pennsylvania, United States
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Household Food Insecurity and Mental Health Among Teenage Girls Living in Urban Slums in Varanasi, India: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081585. [PMID: 30049971 PMCID: PMC6121584 DOI: 10.3390/ijerph15081585] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 11/16/2022]
Abstract
This study was undertaken to investigate the relation between household food insecurity and mental health problems in teenage girls living in urban slums. This community-based cross-sectional study was conducted in 5 urban slums in Varanasi, India, between September 2016 and July 2017. A probability proportion to size (PPS) method was employed to select 5 of 210 urban slums at a first stage, and in the second stage, 418 teenage girls were chosen randomly from selected households. The Household Food Insecurity Access Scale (HFIAS) and mental health inventory tools were employed to assess food insecurity and mental health status. Multivariable logistic regression analysis with at a 95% confidence interval (CI) was used to assess the association between household food insecurity and mental health status. Of 418 respondents, 47.6% were food insecure; 64.1%, 57.7%, and 58.4% had high levels of anxiety, depression, or psychological distress, respectively; and 57.2% exhibited a medium level of loss of behavioral control. Furthermore, teenage girls from food insecure households were more likely to have high levels of anxiety, depression, loss of behavioral control and psychological distress than those living in food secure households. This study shows food insecurity is independently associated with mental health problems among teenage girls. Food insecurity in Indian slums should be addressed by specific public health intervention programs that provide access to sufficient safe, nutritious food.
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Ogum Alangea D, Addo-Lartey AA, Sikweyiya Y, Chirwa ED, Coker-Appiah D, Jewkes R, Adanu RMK. Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial. PLoS One 2018; 13:e0200874. [PMID: 30024948 PMCID: PMC6053193 DOI: 10.1371/journal.pone.0200874] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022] Open
Abstract
Intimate partner violence (IPV) is a significant global public health problem. Understanding risk factors is crucial for developing prevention programmes. Yet, little evidence exists on population-based prevalence and risk factors for IPV in West Africa. Our objective was to measure both lifetime and past year prevalence of IPV and to determine factors associated with past year physical or sexual IPV experience. This population-based survey involved 2000 randomly selected women aged 18 to 49 years living in 40 localities within four districts of the Central Region of Ghana. Questionnaires were interviewer-administered from February to May 2016. Respondents were currently or ever-partnered, and resident in study area ≥12months preceding the survey. Data collected included: socio-demographics; sexual behavior; mental health and substance use; employment status; 12-month and lifetime experience of violence; household food insecurity; gender norms/attitudes; partner characteristics and childhood trauma. Logistic regression modelling was used to determine factors associated with sexual or physical IPV, adjusting for age and survey design. About 34% of respondents had experienced IPV in the past year, with 21.4% reporting sexual and or physical forms. Past year experience of emotional and economic IPV were 24.6% and 7.4% respectively. Senior high school education or higher was protective of IPV (AOR = 0.51[0.30-0.86]). Depression (AOR = 1.06[1.04-1.08], disability (AOR = 2.30[1.57-3.35]), witnessing abuse of mother (AOR = 2.1.98[1.44-2.72]), experience of childhood sexual abuse (AOR = 1.46[1.07-1.99]), having had multiple sexual partners in past year (AOR = 2.60[1.49-4.53]), control by male partner (AOR = 1.03[1.00-1.06]), male partner alcohol use in past year (AOR = 2.65[2.12-3.31]) and male partner infidelity (AOR = 2.31[1.72-3.09]) were significantly associated with increased odds of past year physical or sexual IPV experience. Male perpetrated IPV remains a significant public health issue in Ghana. Evidence-based interventions targeting women's mental health, disabilities, exposure to violence in childhood, risky sexual behavior and unequal power in relationships will be critical in reducing IPV in this setting.
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Affiliation(s)
- Deda Ogum Alangea
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Esnat Dorothy Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | | | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Richard Mawuena Kofi Adanu
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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TABRIZI JS, NIKNIAZ L, SADEGHI-BAZARGANI H, FARAHBAKHSH M, NIKNIAZ Z. Socio-demographic Determinants of Household Food Insecurity among Iranian: A Population-based Study from Northwest of Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:893-900. [PMID: 30087876 PMCID: PMC6077642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND We aimed to evaluate the household food security status and associated factors in East-Azerbaijan, Iran (urban and regional areas). METHODS Data (n=1385) as a part of the major lifestyle promotion project conducted in northwest of Iran were collected in 2015, by short form of the Household Food Security Scale consisting six questions. The Chi-square and Logistic regression were used to for statistical analysis. RESULTS The prevalence of food insecurity was 58.4%. The rate of food insecurity in the residents of capital city (59.7%) was higher than those of residents of regional cities (57.18%), however, this difference was not statistically significant (P=0.36). The respondents with family size more than 3 (P=0.01), unemployed (0.001) and married (0.01) respondents and the ones with lower education levels (P<0.001) were significantly more food insecure than other respondents. After adjusting for depending factors, the marital status, household size, educational level and the employment status of the head of the family had significant association with food security. CONCLUSION Family size, employment status and educational level of the head of the family were significant predictors of food insecurity. Policymakers should focus on increasing minimum education levels and employment situations to decrease food insecurity.
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Affiliation(s)
- Jafar Sadegh TABRIZI
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila NIKNIAZ
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Homayoun SADEGHI-BAZARGANI
- Road and Traffic Injury Research Center, Dept. of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa FARAHBAKHSH
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab NIKNIAZ
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding Author:
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Maharaj V, Tomita A, Thela L, Mhlongo M, Burns JK. Food Insecurity and Risk of Depression Among Refugees and Immigrants in South Africa. J Immigr Minor Health 2018; 19:631-637. [PMID: 26984226 DOI: 10.1007/s10903-016-0370-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded 'often true' to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09-9.80) and depression (aOR = 4.51, 95 % CI: 2.01-10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56-5.31) and depression (aOR = 2.88, 95 % CI: 1.54-5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population.
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Affiliation(s)
- Varsha Maharaj
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa.
| | - Andrew Tomita
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, USA.,Africa Centre for Health and Population Studies, University of KwaZulu-Natal, P.O. Box 198, Mtubatuba, Durban, 3935, South Africa
| | - Lindokuhle Thela
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Mpho Mhlongo
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
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The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context. Demography 2018; 54:1529-1558. [PMID: 28752487 DOI: 10.1007/s13524-017-0596-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Very few studies have investigated mental health in sub-Saharan Africa (SSA). Using data from Malawi, this article provides a first picture of the demography of depression and anxiety (DA) among mature adults (aged 45 or older) in a low-income country with high HIV prevalence. DA are more frequent among women than men, and individuals affected by one are often affected by the other. DA are associated with adverse outcomes, such as poorer nutrition intake and reduced work efforts. DA also increase substantially with age, and mature adults can expect to spend a substantial fraction of their remaining lifetime-for instance, 52 % for a 55-year-old woman-affected by DA. The positive age gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that has been shown in high-income contexts, where older individuals often experience lower levels of DA. Although socioeconomic and risk- or uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical health with age is the key driver of the rise of DA with age in this low-income SSA context.
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Goodman ML, Serag H, Gitari S, Keiser PH, Dacso M, Raimer BG. Exploring Pathways Between HIV+ Status and Excellent Overall Health Among Kenyan Women: Family Functioning, Meaningfulness of Life, Seroconcordance, Social Support and Considering the Need for Integrated Care. J Community Health 2018; 41:989-97. [PMID: 27000039 DOI: 10.1007/s10900-016-0181-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
As people living with HIV/AIDS (PLWHA) live longer, and HIV incidence declines, health systems are transitioning from vertical-only care delivery to horizontal integration with social and other services. This is essential to responding to the chronic nature of the disease, and health systems must respond to full-breadth of socio-economic conditions facing PLWHA. We use excellent self-rated health as a referent, and assess the role of non-biomedical conditions in mediating HIV+ status and excellent overall health among a large community sample of Kenyan women. After controlling for age and wealth, we found significant mediation by social support, partner HIV status, meaningfulness of life, family functioning, food sufficiency, and monthly income. If the goal of health systems is to help all people attain the highest level of health, integrating vertical HIV services with socio-economic support and empowerment may be required. Further investigation of the relative contribution of social support, family functioning, food and financial sufficiency should be conducted longitudinally, ideally in collaboration with HIV clinical services.
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Affiliation(s)
- Michael L Goodman
- University of Texas Medical Branch, Galveston, TX, 77550, USA. .,Sodzo International, Houston, TX, 77002, USA. .,, 301 University Blvd, Marvin Graves 4.314c, Galveston, TX, 77555, USA.
| | - Hani Serag
- University of Texas Medical Branch, Galveston, TX, 77550, USA
| | | | - Philip H Keiser
- University of Texas Medical Branch, Galveston, TX, 77550, USA
| | - Matthew Dacso
- University of Texas Medical Branch, Galveston, TX, 77550, USA
| | - Ben G Raimer
- University of Texas Medical Branch, Galveston, TX, 77550, USA
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van Heyningen T, Honikman S, Myer L, Onah MN, Field S, Tomlinson M. Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study. Arch Womens Ment Health 2017; 20:765-775. [PMID: 28852868 PMCID: PMC6086488 DOI: 10.1007/s00737-017-0768-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Abstract
Anxiety is highly prevalent in many populations; however, the burden of anxiety disorders amongst pregnant women in low-resource settings is not well documented. We investigated the prevalence and predictors of antenatal anxiety disorders amongst low-income women living with psychosocial adversity. Pregnant women were recruited from an urban, primary level clinic in Cape Town, South Africa. The Mini-International Neuropsychiatric Interview diagnostic interview assessed prevalence of anxiety disorders. Four self-report questionnaires measured psychosocial characteristics. Logistic regression models explored demographic and socioeconomic characteristics, psychosocial risk factors and psychiatric comorbidity as predictors for anxiety disorders. Amongst 376 participants, the prevalence of any anxiety disorder was 23%. Although 11% of all women had post-traumatic stress disorder, 18% of the total sample was diagnosed with other anxiety disorders. Multivariable analysis revealed several predictors for anxiety including a history of mental health problems (adjusted odds ratio [AOR] 4.11; 95% confidence interval (CI) 2.03-8.32), Major depressive episode (MDE) diagnosis (AOR 3.83; CI 1.99-7.31), multigravidity (AOR 2.87; CI 1.17-7.07), food insecurity (AOR 2.57; CI 1.48-4.46), unplanned and unwanted pregnancy (AOR 2.14; CI 1.11-4.15), pregnancy loss (AOR 2.10; CI 1.19-3.75) and experience of threatening life events (AOR 1.30; CI 1.04-1.57). Increased perceived social support appeared to reduce the risk for antenatal anxiety (AOR 0.95; CI 0.91-0.99). A range of antenatal anxiety disorders are prevalent amongst pregnant women living in low-resource settings. Women who experience psychosocial adversity may be exposed to multiple risk factors, which render them vulnerable to developing antenatal anxiety disorders.
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Affiliation(s)
- Thandi van Heyningen
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael N Onah
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada
| | - Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Maternal depression symptoms are highly prevalent among food-insecure households in Ethiopia. Public Health Nutr 2017; 21:849-856. [DOI: 10.1017/s1368980017003056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveWe aimed to evaluate the association between household food insecurity and maternal depression in Ethiopia.Design/Setting/SubjectsIn 2014, we conducted a cross-sectional study in southern Ethiopia, including 591 food-secure and 2500 food-insecure households. We measured depression status of women using the Patient Health Questionnaire-9 validated for Ethiopia, with a cut-off of ≥5. We evaluated household-level food insecurity using a validated Household Food Insecurity Access Scale. We applied Bayesian modelling to evaluate the relationship between food insecurity and maternal depression accounting for other observed characteristics.ResultsAmong the analytic sample, 80·8 (95 % CI 79·4, 82·2) % of women were living in food-insecure households. The overall prevalence of probable depression (mild and moderate forms) was 4·7 (95 % CI 4·1, 5·6) %. All individual depressive symptoms had a significantly higher prevalence in the food-insecure group, except for suicidal ideation (but small numbers; P<0·001). In the Bayesian model adjusting for paternal characteristics, there was a significant dose–response linear relationship (trend) between household food insecurity and maternal depression (P<0·01). The adjusted OR (95 % Bayesian credible interval) for depression for differing levels of food insecurity were: mild food insecurity, 3·29 (1·63, 6·18); moderate, 3·82 (1·91, 7·45); severe, 12·50 (3·38, 32·70).ConclusionsThe study documented a high burden of depression among women who lived in food-insecure households. Given this finding, we recommend integrating mental health in the livelihood programmes in areas suffering from food insecurity.
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Prioreschi A, Wrottesley SV, Cohen E, Reddy A, Said-Mohamed R, Twine R, Tollman SM, Kahn K, Dunger DB, Norris SA. Examining the relationships between body image, eating attitudes, BMI, and physical activity in rural and urban South African young adult females using structural equation modeling. PLoS One 2017; 12:e0187508. [PMID: 29145423 PMCID: PMC5690598 DOI: 10.1371/journal.pone.0187508] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/22/2017] [Indexed: 02/02/2023] Open
Abstract
The persistence of food insecurity, malnutrition, increasing adiposity, and decreasing physical activity, heightens the need to understand relationships between body image satisfaction, eating attitudes, BMI and physical activity levels in South Africa. Females aged 18-23 years were recruited from rural (n = 509) and urban (n = 510) settings. Body image satisfaction was measured using Stunkard's silhouettes, and the 26-item Eating Attitudes questionnaire (EAT-26) was used to evaluate participants' risk of disordered eating. Minutes per week of moderate to vigorous physical activity (MVPA) was assessed using the Global Physical Activity Questionnaire (GPAQ). Significant linear correlates were included in a series of regressions run separately for urban and rural participants. Structural equation modeling (SEM) was used to test the relationships between variables. Urban females were more likely to be overweight and obese than rural females (p = 0.02), and had a greater desire to be thinner (p = 0.02). In both groups, being overweight or obese was positively associated with a desire to be thinner (p<0.01), and negatively associated with a desire to be fatter (p<0.01). Having a disordered eating attitude was associated with body image dissatisfaction in the urban group (β = 1.27, p<0.01, CI: 0.38; 2.16), but only with a desire to be fatter in the rural group (β = 0.63, p = 0.04, CI: 0.03; 1.23). In the SEM model, body image dissatisfaction was associated with disordered eating (β = 0.63), as well as higher MVPA participation (p<0.01). These factors were directly associated with a decreased risk of disordered eating attitude, and with a decreased desire to be thinner. Findings indicate a shift in both settings towards more Westernised ideals. Physical activity may provide a means to promote a healthy body image, while reducing the risk of disordered eating. Given the high prevalence of overweight and obesity in both rural and urban women, this study provides insights for future interventions aimed at decreasing adiposity in a healthy way.
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Affiliation(s)
- Alessandra Prioreschi
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Stephanie V. Wrottesley
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Emmanuel Cohen
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ankita Reddy
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M. Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - David B. Dunger
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, MRL Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Shane A. Norris
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Abstract
OBJECTIVE The primary aim of this study was to investigate eating disorder (ED) pathology in those living with food insecurity. A secondary aim was to investigate whether any-reason dietary restraint, weight self-stigma, and worry increased as level of food insecurity increased. METHOD Participants (N = 503) seeking food from food pantries completed questionnaires assessing level of food insecurity, demographics, ED pathology, dietary restraint, weight self-stigma, and worry. RESULTS Consistent with hypotheses, participants with the highest level of food insecurity (i.e., adults who reported having hungry children in their household) also endorsed significantly higher levels of binge eating, overall ED pathology, any-reason dietary restraint, weight self-stigma, and worry compared to participants with lower levels of food insecurity. Contrary to hypotheses, compensatory behaviors also increased as level of food insecurity worsened. Overall, 17% of those in the child hunger food insecurity group reported clinically significant ED pathology. DISCUSSION This is the first study to assess the full spectrum of ED pathology in a low-income, marginalized population with food insecurity. Given that food insecurity is a global concern, results from this study suggest that greater attention to the association between ED pathology and food insecurity is warranted by researchers around the world.
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Affiliation(s)
| | - Keesha Middlemass
- Department of Political Science, Trinity University, San Antonio, Texas
| | - Brigitte Taylor
- Department of Psychology, Trinity University, San Antonio, Texas
| | - Clara Johnson
- Department of Psychology, Trinity University, San Antonio, Texas
| | - Francesca Gomez
- Department of Psychology, Trinity University, San Antonio, Texas
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Emerson JA, Tol W, Caulfield LE, Doocy S. Maternal Psychological Distress and Perceived Impact on Child Feeding Practices in South Kivu, DR Congo. Food Nutr Bull 2017. [PMID: 28627261 DOI: 10.1177/0379572117714385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal mental health problems are associated with poor child growth and suboptimal child feeding practices, yet little qualitative research has been conducted to understand mothers' perceptions about how maternal mental ill health and child nutrition are related. OBJECTIVE The objective of the study was to understand maternal perceptions on sources of psychological distress, and how distress impacts functioning, especially related to childcare and feeding practices among mothers of young children in South Kivu, DR Congo. METHODS Mothers of young children who were participating in a larger study were eligible. Using purposive sampling, participants were selected if they had high or low levels of psychological distress, based on their mean item score on measures of symptoms of depression, anxiety, and post-traumatic stress. Twenty in-depth interviews and 2 focus group discussions were conducted, with a total of 35 mothers. Key informant interviews were conducted with 5 local health workers. Audio recordings were transcribed and coded, and the analysis was guided by Grounded Theory methodology. RESULTS Major themes to emerge were that women's husbands were a significant source of distress, with husbands' infidelity, abandonment, and lack of financial support mentioned by participants. Psychological distress resulted in appetite and weight loss, and poor nutritional status made it difficult to breastfeed. Participants perceived psychological distress caused milk insufficiency and difficulty breastfeeding. CONCLUSION Mothers experiencing psychological distress may need greater support for maternal nutrition and breastfeeding, and engaging fathers through responsible parenting interventions may reduce psychological distress and have a positive impact on child health.
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Affiliation(s)
- Jillian A Emerson
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse Tol
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,2 Peter C. Alderman Foundation, New York, NY, USA
| | - Laura E Caulfield
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shannon Doocy
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Jebena MG, Lindstrom D, Lachat C, Belachew T, Kolsteren P. The effect of food insecurity on health status of adolescents in Ethiopia: longitudinal study. BMC Public Health 2017; 17:465. [PMID: 28521757 PMCID: PMC5437384 DOI: 10.1186/s12889-017-4406-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 05/07/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The effect of food insecurity on health and wellbeing of a population has been the subject of much research. Yet, limited research has investigated its effect on adolescents' health and wellbeing in Ethiopia. METHOD We used data from the Jimma Longitudinal Family Survey of Youth which began tracking a cohort of adolescents in 2005 to examine the social, behavioral and economic determinants of their health and well-being. A total of 1,919 sample were included in the main analyses. All youths provided data related to their food insecurity experiences and their health status. A mixed effect logistic regression using random intercept and trend model was used to examine the relationship between food insecurity and their health status. Fixed effects estimates were also computed to check the parsimoniousness of the random intercept and trend model. RESULTS The results indicated that the mean (±SD) age of adolescents was 18.6(±1.4). Nine hundred twenty three (48.1%) of them were female. The magnitude of self-rated health status was relatively unstable ranging from 18.9%, 34.7% to 37.3% in each round. Similarly, 20.4%, 48.4% and 20.6% of adolescents were food insecure during each consecutive round of the survey respectively. Exposure to food insecurity is strongly associated with self-rated health status (β = 0.28, P < 0.001) and poor self-rated health was also more pronounced for some time (β =2.11, P < 0.001) and decline after a turning point (β = -0.38, P < 0.001). CONCLUSIONS These findings imply that any social, nutrition and public health interventions designed to improve adolescent health should consider underlying social determinants of health such as food insecurity.
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Affiliation(s)
- Mulusew G. Jebena
- Department of Population and Family Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| | - David Lindstrom
- Department of Sociology, Brown University, Box 1916, Maxcy Hall, Providence, RI 02912 USA
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
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Atuoye KN, Luginaah I. Food as a social determinant of mental health among household heads in the Upper West Region of Ghana. Soc Sci Med 2017; 180:170-180. [DOI: 10.1016/j.socscimed.2017.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/12/2016] [Accepted: 03/08/2017] [Indexed: 10/20/2022]
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Steenkamp L, Goosen A, Venter D, Beeforth M. Food insecurity among students living with HIV: Strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa. SAHARA J 2016; 13:106-112. [PMID: 27687153 PMCID: PMC5642430 DOI: 10.1080/17290376.2016.1218791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The HIV prevalence in South Africa among students at higher education institutions (HEIs) in 2008 was reported to be 3.4%, with the highest HIV prevalence found in the Eastern Cape Province. Students at these facilities are also increasingly affected by socio-economic constraints that may impact on food security. Little is known about the impact of food insecurity on HIV-infected students in HEIs in South Africa. The purpose of this paper is to describe food insecurity and the nutritional status among HIV-infected students on the Nelson Mandela Metropolitan University campuses in South Africa, as well as current initiatives to strengthen the safety nets for food-insecure students. This descriptive, cross-sectional survey was conducted among a convenience sample of known HIV-infected, registered students (n = 63), older than 18 years of age and managed as part of the Campus Health Service antiretroviral therapy (ART) programme. Ethical approval for the study was obtained from the Research Ethics Committee (NMMU) and participants were included in the sample after providing written, informed consent. Findings indicate that food insecurity was common with more than 60% of the sample reporting food insecurity at the household level during the previous month. Of the sample, 51% were classified as being either overweight or obese. Although food insecurity did not contribute to weight loss in our sample, food-insecure students were more likely to consume inadequate amounts of vitamins and minerals, especially antioxidants that are important in supporting the immune system. Food insecurity has been identified as affecting the majority of HIV-infected students in this study, especially regarding their difficulty in accessing nutritious foods. As overweight and obesity also seem to threaten the health and future well-being of the students, appropriate management of the overweight individuals and those with obesity should be instituted in order to prevent the development of chronic diseases of lifestyle, thus allowing for a healthier more productive life. Current intervention strategies to strengthen food security have made inroads to improve access to healthier food options.
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Affiliation(s)
- L. Steenkamp
- PhD (Dietetics), is a Research Associate at the HIV&AIDS Research Unit, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - A. Goosen
- MCur (Advanced Primary Health Care), is a Head of Department at the Campus Health Service, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - D. Venter
- PhD, is a Statistical Consultant at the Unit for Statistical Consultation at the Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - M. Beeforth
- BSc Dietetics, is a Postgraduate Student at the Department of Dietetics, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
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Jebena MG, Lindstrom D, Belachew T, Hadley C, Lachat C, Verstraeten R, De Cock N, Kolsteren P. Food Insecurity and Common Mental Disorders among Ethiopian Youth: Structural Equation Modeling. PLoS One 2016; 11:e0165931. [PMID: 27846283 PMCID: PMC5113011 DOI: 10.1371/journal.pone.0165931] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/20/2016] [Indexed: 12/14/2022] Open
Abstract
Background Although the consequences of food insecurity on physical health and nutritional status of youth living have been reported, its effect on their mental health remains less investigated in developing countries. The aim of this study was to examine the pathways through which food insecurity is associated with poor mental health status among youth living in Ethiopia. Methods We used data from Jimma Longitudinal Family Survey of Youth (JLFSY) collected in 2009/10. A total of 1,521 youth were included in the analysis. We measured food insecurity using a 5-items scale and common mental disorders using the 20-item Self-Reporting Questionnaire (SRQ-20). Structural and generalized equation modeling using maximum likelihood estimation method was used to analyze the data. Results The prevalence of common mental disorders was 30.8% (95% CI: 28.6, 33.2). Food insecurity was independently associated with common mental disorders (β = 0.323, P<0.05). Most (91.8%) of the effect of food insecurity on common mental disorders was direct and only 8.2% of their relationship was partially mediated by physical health. In addition, poor self-rated health (β = 0.285, P<0.05), high socioeconomic status (β = -0.076, P<0.05), parental education (β = 0.183, P<0.05), living in urban area (β = 0.139, P<0.05), and female-headed household (β = 0.192, P<0.05) were associated with common mental disorders. Conclusions Food insecurity is directly associated with common mental disorders among youth in Ethiopia. Interventions that aim to improve mental health status of youth should consider strategies to improve access to sufficient, safe and nutritious food.
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Affiliation(s)
- Mulusew G. Jebena
- Population and Family Health, Jimma University, Jimma, Ethiopia
- Department of Food Safety and Food Quality,Ghent University, Coupure Links, Ghent, Belgium
- * E-mail:
| | - David Lindstrom
- Department of Sociology, Brown University, Providence, Rhode Island, United States of America
| | - Tefera Belachew
- Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Craig Hadley
- Deparment of Anthropology, Emory University, Atlanta, Georgia, United States of America
| | - Carl Lachat
- Department of Food Safety and Food Quality,Ghent University, Coupure Links, Ghent, Belgium
| | - Roos Verstraeten
- Nutrition and Child Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nathalie De Cock
- Department of Food Safety and Food Quality,Ghent University, Coupure Links, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality,Ghent University, Coupure Links, Ghent, Belgium
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Piperata BA, Schmeer KK, Rodrigues AH, Salazar Torres VM. Food insecurity and maternal mental health in León, Nicaragua: Potential limitations on the moderating role of social support. Soc Sci Med 2016; 171:9-17. [PMID: 27855323 DOI: 10.1016/j.socscimed.2016.10.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
Poor mental health among those living in poverty is a serious global public health concern. Food insecurity (FI) is recognized as an important, yet critically understudied social determinant of mental health. The relationship between FI and mothers' mental health in low- and middle-income countries (LMIC) is especially important to understand considering the high rates of poverty and associated FI in these settings. For these mothers, social support may serve as a buffer in ameliorating the impact of FI on mental distress. However, data required to understand these relationships in LMIC remain sparse. To address this gap we used quantitative and qualitative data and convergence parallel analysis to assess: the association between FI and maternal mental distress; and, whether three forms of social support - mother's general social network support and family support (spouse/partner living in the home, parents/in-laws living in the home) - moderated the association. A survey that included data on FI (ELCSA) and mental distress (SRQ-20) was administered to a population-based sample of mothers in León, Nicaragua (n = 434) in 2012. The survey was complemented by data from 6 focus groups. Regression models identified a strong positive relationship between household-level FI and maternal distress. Evidence of social support moderation was mixed: while maternal social network and spousal/partner support did not moderate this relationship, parental support did. Our ethnographic data revealed three themes that help explain these findings: FI is embarrassing/shameful, close family is the most appropriate source of social support and, fear of gossip and ridicule limit the buffering capacity of the social support network. Our findings contribute to a growing literature demonstrating that FI is an important social determinant of maternal mental distress in LMIC; and that some forms of social support may reduce (but not eliminate) the impact of FI on mental distress.
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Affiliation(s)
- Barbara A Piperata
- The Ohio State University, Department of Anthropology, 4034 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210, USA.
| | - Kammi K Schmeer
- The Ohio State University, Department of Sociology, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH 43210, USA
| | - Andres Herrera Rodrigues
- Center for Demographic and Health Research (CIDS), Faculty of Medical Sciences, National Autonomous University of Nicaragua - León (UNAN-León), Nicaragua
| | - Virgilio Mariano Salazar Torres
- Global Health (IHCAR), Department of Public Health Science, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
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Heyningen TV, Myer L, Onah M, Tomlinson M, Field S, Honikman S. Antenatal depression and adversity in urban South Africa. J Affect Disord 2016; 203:121-129. [PMID: 27285725 PMCID: PMC5777271 DOI: 10.1016/j.jad.2016.05.052] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/22/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND In low and middle-income countries (LMIC), common mental disorders affecting pregnant women receive low priority, despite their disabling effect on maternal functioning and negative impact on child health and development. We investigated the prevalence of risk factors for antenatal depression among women living in adversity in a low-resource, urban setting in Cape Town, South Africa. METHODS The MINI Neuropsychiatric Interview (MINI Plus) was used to measure the diagnostic prevalence of depression amongst women attending their first antenatal visit at a primary-level, community-based clinic. Demographic data were collected followed by administration of questionnaires to measure psychosocial risk. Analysis examined the association between diagnosis of depression and psychosocial risk variables, and logistic regression was used to investigate predictors for major depressive episode (MDE). RESULTS Among 376 women participating, the mean age was 26 years. The MINI-defined prevalence of MDE was 22%, with 50% of depressed women also expressing suicidality. MDE diagnosis was significantly associated with multiple socioeconomic and psychosocial risk factors, including a history of depression or anxiety, food insecurity, experience of threatening life events and perceived support from family. LIMITATIONS The use of self-report measures may have led to recall bias. Retrospective collection of clinical data limited our ability to examine some known risk factors for mental distress. CONCLUSION These findings confirm the high prevalence of MDE among pregnant women in LMIC settings. Rates of depression may be increased in settings where women are exposed to multiple risks. These risk factors should be considered when planning maternal mental health interventions.
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Affiliation(s)
- Thandi van Heyningen
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Michael Onah
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Mark Tomlinson
- Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, South Africa
| | - Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Association of Household Food Insecurity with the Mental and Physical Health of Low-Income Urban Ecuadorian Women with Children. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2016; 2016:5256084. [PMID: 27752266 PMCID: PMC5056290 DOI: 10.1155/2016/5256084] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/28/2016] [Indexed: 12/11/2022]
Abstract
Chronic physical and mental health conditions account for a rising proportion of morbidity, mortality, and disability in the Americas region. Household food insecurity (HFI) has been linked to chronic disease in US and Canadian women but it is uncertain if the same is true for low- and middle-income Latin American countries in epidemiologic transition. We conducted a survey to investigate the association of HFI with the physical and mental health of 794 women with children living in low-income Quito, Ecuador, neighborhoods. Data were collected on HFI and health indicators including self-reported health (SF-1), mental health (MHI-5), blood pressure, and self-reported mental and physical health complaints. Fasting blood glucose and lipids were measured in a subsample. The multivariate analyses revealed that HFI was associated with poorer self-rated health, low MHI-5 scores, and mental health complaints including stress, depression, and ethnospecific illnesses. It was also associated with chest tightness/discomfort/pain, dental disease, and gastrointestinal illness but not other conditions. The findings suggest that improving food security in low-income households may help reduce the burden of mental distress in women with children. The hypothesized link with diabetes and hypertension may become more apparent as Ecuador moves further along in the epidemiologic transition.
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Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr 2016; 19:2965-2974. [DOI: 10.1017/s1368980016001178] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AbstractObjectiveTo investigate the direct and indirect associations between psychological and physical intimate partner violence and the occurrence of common mental disorders (CMD) and how they relate to the occurrence of household food insecurity (HFI).DesignThis was a population-based cross-sectional study. Intimate partner violence was assessed using the Brazilian version of the Revised Conflict Tactics Scale (CTS2) and HFI was assessed using the Brazilian Food Insecurity Scale. The propositional analytical model was based on a review of the literature and was tested using path analysis.SettingDuque de Caxias, Greater Rio de Janeiro, Brazil (April–December 2010).SubjectsWomen (n 849) who had been in a relationship in the 12 months preceding the interview.ResultsBoth psychological and physical violence were found to be major risk factors of HFI. Psychological violence was associated with HFI indirectly via physical violence and CMD, and directly by an unidentified path. The effects of physical violence seemed to be manifested exclusively through CMD. Most of the variables in the propositional model related to socio-economic position, demographic characteristics, degree of women’s social support and partner alcohol misuse were retained in the ‘final’ model, indicating that these factors contribute significantly to the increased likelihood of HFI.ConclusionsThe results reinforce the importance of considering domestic violence and other psychosocial aspects of family life when implementing interventions designed to reduce/eradicate HFI.
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Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. Soc Sci Med 2016; 151:69-77. [PMID: 26773296 DOI: 10.1016/j.socscimed.2015.12.042] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/03/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Abstract
RATIONALE Food insecurity has emerged as an important, and potentially modifiable, risk factor for depression. Few studies have brought longitudinal data to bear on investigating this association in sub-Saharan Africa. OBJECTIVE To estimate the association between food insufficiency and depression symptom severity, and to determine the extent to which any observed associations were modified by social support. METHODS AND RESULTS We conducted a secondary analysis of population-based, longitudinal data collected from 1238 pregnant women during a three-year cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 months, 18 months, and 36 months (85% retention). A validated, single-item food insufficiency measure inquired about the number of days of hunger in the past week. Depression symptom severity was measured using the Xhosa version of the 10-item Edinburgh Postnatal Depression Scale. In multivariable regression models with cluster-correlated robust estimates of variance, lagged food insufficiency had a strong and statistically significant association with depression symptom severity (β = 0.70; 95% CI, 0.46-0.94), suggesting a 6.5% relative difference in depression symptom severity per day of hunger. In stratified analyses, food insufficiency had a statistically significant association with depression only among women with low levels of instrumental support. Using quantile regression, we found that the adverse impacts of food insufficiency were experienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity. Estimates from fixed-effects regression models and fixed-effects quantile regression models, accounting for unobserved confounding by time-invariant characteristics, were similar. CONCLUSIONS Food insufficiency was associated with depression symptom severity, particularly for women in the upper end of the conditional depression distribution. Instrumental social support buffered women against the adverse impacts of food insufficiency.
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Affiliation(s)
- Alexander C Tsai
- Massachusetts General Hospital, MGH Global Health, Boston, USA; Harvard Center for Population and Development Studies, Cambridge, USA; Mbarara University of Science and Technology, Mbarara, Uganda.
| | | | - W Scott Comulada
- Center for HIV Identification, Prevention and Treatment Services, University of California at Los Angeles, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, USA
| | - Mary Jane Rotheram-Borus
- Center for HIV Identification, Prevention and Treatment Services, University of California at Los Angeles, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, USA
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