title: Food insecurity and maternal mental health in León, Nicaragua: Potential limitations on the moderating role of social support.
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.
authors.affiliation: The Ohio State University, Department of Anthropology, 4034 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210, USA. Electronic address: piperata.1@osu.edu.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Piperata
authors.affiliation: The Ohio State University, Department of Sociology, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH 43210, USA.
authors.forename: Kammi K
authors.initials: KK
authors.lastname: Schmeer
authors.affiliation: Center for Demographic and Health Research (CIDS), Faculty of Medical Sciences, National Autonomous University of Nicaragua - León (UNAN-León), Nicaragua.
authors.forename: Andres Herrera
authors.initials: AH
authors.lastname: Rodrigues
authors.affiliation: Global Health (IHCAR), Department of Public Health Science, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden.
authors.forename: Virgilio Mariano
authors.initials: VM
authors.lastname: Salazar Torres
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005523:Food Supply / Q000592:standards*; D006801:Humans; D000068097:Maternal Health / Q000592:standards*; D001523:Mental Disorders / Q000150:complications / Q000209:etiology*; D009035:Mothers / Q000523:psychology*; D009527:Nicaragua; D011204:Poverty Areas; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D036301:Qualitative Research; D012044:Regression Analysis; D012944:Social Support; D011795:Surveys and Questionnaires