Household food insecurity is positively associated with depression among low-income supplemental nutrition assistance program participants and income-eligible nonparticipants.
BACKGROUND
Food insecurity is associated with adverse mental health outcomes. Given that federal food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), aim to alleviate food insecurity, there may be heterogeneity in the association between food insecurity and depression by SNAP participation status.


OBJECTIVE
With the use of data from the 2005-2010 NHANES, we examined the associations between household food security and depression and whether these differed by SNAP participation.


METHODS
The study population was restricted to 3518 adults with household incomes ≤130% of the federal poverty level. Food insecurity was assessed with the 18-item US Household Food Security Survey Module; a score of ≥3 was considered food insecure. Depression was assessed with the 9-item Patient Health Questionnaire and was defined as a score of ≥10. Multivariate logistic regression models examined the associations between food insecurity and depression, adjusting for sociodemographic and health characteristics.


RESULTS
The overall prevalence of depression was 9.3%, ranging from 6.7% among SNAP nonparticipants to 12.8% among SNAP participants. For every depressive symptom, there was a dose-response relation, such that a higher prevalence was observed with worsening food insecurity. After multivariate adjustment, food insecurity was positively associated with depression (P-trend < 0.0001), but SNAP participation modified this relation (P-interaction = 0.03). Among low-income, eligible nonparticipants, very low food security was significantly associated with higher odds of depression (OR: 5.10; 95% CI: 3.09, 8.41). Among SNAP participants, very low food security was also associated with higher odds of depression but at a lower magnitude (OR: 2.21; 95% CI: 1.54, 3.17).


CONCLUSIONS
The complex relation between food insecurity and mental health may vary on the basis of SNAP participation status. Programmatic efforts to address the risk of depression among their beneficiaries may positively affect the mental health of low-income adults.
Center for Health and Community, School of Medicine, and cindyleung@post.harvard.edu.
Cindy W
CW
Leung
Center for Health and Community, School of Medicine, and Department of Psychiatry, University of California, San Francisco, San Francisco, CA;
Elissa S
ES
Epel
Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and.
Walter C
WC
Willett
Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and.
Eric B
EB
Rimm
School of Public Health, University of California, Berkeley, Berkeley, CA.
Barbara A
BA
Laraia
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005191:Family Characteristics; D005260:Female; D063105:Food Assistance / Q000191:economics*; D005523:Food Supply / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
National Health and Nutrition Examination Surveys; Supplemental Nutrition Assistance Program; depression; food insecurity; food stamps