title: The relationship between hunger and mental health outcomes among school-going Ecuadorian adolescents.
abstract: OBJECTIVE
  Mental health and food insecurity are major public health issues among adolescents in Ecuador. Our objective was to determine the relationship between hunger, symptoms of depression, and suicidal ideation among school-going Ecuadorian adolescents.
  
  
  METHODS
  We conducted crude and multivariable logistic regression models using data from the 2007 Global School-based Student Health Survey from Quito, Guayaquil, and Zamora, Ecuador (N = 5524). Hunger was defined as having gone hungry in the past 30 days due to lack of food in the home. Outcomes of interest were symptoms of depression and suicidal ideation with or without planning in the past year.
  
  
  RESULTS
  Overall, 41.2 % (2200/5467) of students reported experiencing hunger. In multivariable logistic regression models, hunger had an increasing exposure-response relationship with symptoms of depression [sometimes hungry odds ratio (OR) 1.80, P = 0.0001; most of the time or always hungry OR 2.01, P < 0.0001] and suicidal ideation with planning (sometimes hungry OR 1.55, P = 0.04; most of the time or always hungry OR 2.63, P = 0.001).
  
  
  CONCLUSIONS
  Hunger was associated with increased odds of symptoms of depression and suicidal ideation with planning. Strategies to improve mental health among adolescents in Ecuador should consider the potential contribution of hunger and food insecurity.
authors.affiliation: Epidemiology and Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, NY, 10035, USA.|CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.|Dirección de Investigación, Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Romo
authors.affiliation: Dirección de Investigación, Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador.
authors.forename: Victoria
authors.initials: V
authors.lastname: Abril-Ulloa
authors.affiliation: Epidemiology and Biostatistics Program, School of Urban Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, NY, 10035, USA. Elizabeth.Kelvin@sph.cuny.edu.|CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA. Elizabeth.Kelvin@sph.cuny.edu.|Doctor of Public Health Program, The Graduate Center, City University of New York, New York, NY, USA. Elizabeth.Kelvin@sph.cuny.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Kelvin
mesh_terms: D000293:Adolescent; D003863:Depression / Q000453:epidemiology*; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D006815:Hunger; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data*; D012574:Schools / Q000706:statistics & numerical data; D013334:Students / Q000706:statistics & numerical data*; D059020:Suicidal Ideation
keywords: Adolescent; Depression; Ecuador; Food security; Hunger; Suicidal ideation