Association between socioeconomic position of the household head, food insecurity and psychological health: an application of propensity score matching

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Abstract

Background

Mental health outcomes can be influenced by various factors, one of which has recently gained attention, namely food security. Food security is paramount to maintaining not only physical, but also mental health. There is an increasing need to understand the interplay between food insecurity (FI) and mental health outcomes, especially among vulnerable populations. The objective of this study was to investigate the effect of FI on psychological health (anxiety and depression) as well as to examine the modifying effect of socioeconomic position on this relationship.

Methods

A cross-sectional study was conducted in Maputo City, Mozambique, in 1,842 participants. Data were collected through structured interviews using a modified version of the US Department of Agriculture Household Food Security Module to measure FI, and the Hospital Anxiety and Depression Scale to measure anxiety and depression. A composite variable for psychological health was created. Propensity score matching and interaction effect analyses were employed to examine the effects of FI on psychological health and the moderating role of socioeconomic position.

Results

Of the 1,174 participants randomly assigned to propensity score matching, 787 were exposed to FI while 387 were unexposed. The analysis revealed stark disparities in psychological health outcomes associated with FI. The risk of poor psychological health among those exposed to FI was 25.79%, which was significantly higher than the 0.26% in unexposed individuals. The risk difference was 25.54% points (95% CI: 22.44–28.63), with a risk ratio of 99.82. Our assessment of population attributable fractions indicated that nearly all the risk for poor psychological health in the exposed group could be ascribed to FI. The interaction effects analysis revealed that socioeconomic status modifies this relationship. Specifically, heads of food-insecure households with a lower socioeconomic position tended to report poor mental health compared to their food-secure counterparts with a higher position.

Conclusions

The findings underscore the profound impact of FI on the mental health of household heads in Maputo City, socioeconomic position being a significant modifier. Addressing household FI along with the socioeconomic position of household heads could be pivotal to mental health promotion, especially among vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-20153-0.

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Most cited references 71

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Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

(2022)

Summary Background The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019. Methods In this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019. Findings Between 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5–105·9) to 125·3 million (93·0–163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4–3·9) to 4·9% (3·9–6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9–2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1–2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0–163·2; 14·6% [12·2–16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5–21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4–1869·5) per 100 000 population among males and 1703·3 (1261·5–2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America. Interpretation GBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative. Funding Bill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.

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Indicators of socioeconomic position (part 1).

B Galobardes, George Smith (2006)

This glossary presents a comprehensive list of indicators of socioeconomic position used in health research. A description of what they intend to measure is given together with how data are elicited and the advantages and limitation of the indicators. The glossary is divided into two parts for journal publication but the intention is that it should be used as one piece. The second part highlights a life course approach and will be published in the next issue of the journal.

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Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis

Surapon Nochaiwong, Chidchanok Ruengorn, Kednapa Thavorn … (2021)

To provide a contemporary global prevalence of mental health issues among the general population amid the coronavirus disease-2019 (COVID-19) pandemic. We searched electronic databases, preprint databases, grey literature, and unpublished studies from January 1, 2020, to June 16, 2020 (updated on July 11, 2020), with no language restrictions. Observational studies using validated measurement tools and reporting data on mental health issues among the general population were screened to identify all relevant studies. We have included information from 32 different countries and 398,771 participants. The pooled prevalence of mental health issues amid the COVID-19 pandemic varied widely across countries and regions and was higher than previous reports before the COVID-19 outbreak began. The global prevalence estimate was 28.0% for depression; 26.9% for anxiety; 24.1% for post-traumatic stress symptoms; 36.5% for stress; 50.0% for psychological distress; and 27.6% for sleep problems. Data are limited for other aspects of mental health issues. Our findings highlight the disparities between countries in terms of the poverty impacts of COVID-19, preparedness of countries to respond, and economic vulnerabilities that impact the prevalence of mental health problems. Research on the social and economic burden is needed to better manage mental health problems during and after epidemics or pandemics. Systematic review registration : PROSPERO CRD 42020177120.

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Author and article information

Contributors

Elias M. A. Militao:

ORCID: https://orcid.org/0000-0003-1148-383X

elias.militao@miun.se

Gloria Macassa:

ORCID: https://orcid.org/0000-0003-4415-7942

gloria.macassa@hig.se

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 27 September 2024

Publication date PMC-release: 27 September 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 2590

Affiliations

[1 ]Department of Health Sciences, Faculty of Humanities, Mid Sweden University, ( https://ror.org/019k1pd13) Holmgatan 10, Sundsvall, SE-851 70 Sweden

[2 ]Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, ( https://ror.org/043fje207) Kungsbacksvägen 47, Gävle, 80176 Sweden

[3 ]Department of Biological Sciences, Faculty of Science, Eduardo Mondlane University, ( https://ror.org/05n8n9378) 3453 Julius Nyerere Avenue, Maputo 257, Maputo, 257 Mozambique

[4 ]Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, ( https://ror.org/01a77tt86) Coventry, CV4 7AL UK

[5 ]Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Health Sciences, Stellenbosch University, ( https://ror.org/05bk57929) Francie van Zijl Drive, Cape Town, 7505 South Africa

[6 ]Department of Public Health, School of Health Sciences, University of Skövde, ( https://ror.org/051mrsz47) Skövde, 541 28 Sweden

[7 ]EPI Unit, Instituto de Saúde Pública, Universidade do Porto, ( https://ror.org/043pwc612) Rua das Taipas 135, Porto, 4050-600 Portugal

Author information

Elias M. A. Militao https://orcid.org/0000-0003-1148-383X

Olalekan A. Uthman https://orcid.org/0000-0002-8567-3081

Elsa M. Salvador https://orcid.org/0000-0002-2929-5442

Stig Vinberg https://orcid.org/0000-0002-5935-5688

Gloria Macassa https://orcid.org/0000-0003-4415-7942

Article

Publisher ID: 20153

DOI: 10.1186/s12889-024-20153-0

PMC ID: 11429249

PubMed ID: 39334082

SO-VID: 4fe3ace6-d0c6-4e21-a7e0-0d75ce8a6958

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 19 December 2023

Date accepted : 20 September 2024

Funding

Funded by: University of Gävle

Open Access :

Open access funding provided by University of Gävle.

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ScienceOpen disciplines: Public health

Keywords: socioeconomic position,food insecurity,psychological health outcomes,anxiety and depression,heads of household

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ScienceOpen disciplines: Public health

Keywords: socioeconomic position, food insecurity, psychological health outcomes, anxiety and depression, heads of household

Association between socioeconomic position of the household head, food insecurity and psychological health: an application of propensity score matching

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Abstract

Background

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Supplementary Information

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Global Health Next Generation Network

Most cited references 71

Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Indicators of socioeconomic position (part 1).

Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis

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