Food insecurity is associated with anxiety, stress, and symptoms of posttraumatic stress disorder in a cohort of women with or at risk of HIV in the United States

Abstract

Background Food insecurity, which disproportionately affects marginalized women in the United States, is associated with depressive symptoms. Few studies have examined relations of food insecurity with other mental health outcomes. Objective The aim of this study was to investigate the associations of food insecurity with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD) in the Women's Interagency HIV Study (WIHS), a prospective cohort study of women with or at risk of HIV in the United States. Methods Participants were 2553 women with or at risk of HIV, predominantly African American/black (71.6%). Structured questionnaires were conducted during April 2013–March 2016 every 6 mo. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. We measured longitudinal outcomes for GAD (GAD-7 score and a binary GAD-7 screener for moderate-to-severe GAD). Only cross-sectional data were available for outcomes measuring perceived stress (PSS-10 score) and PTSD (PCL-C score and a binary PCL-C screener for PTSD). We examined associations of FS with the outcomes through use of multivariable linear and logistic regression, including lagged associations with GAD outcomes. Results After adjusting for sociodemographic and health-related factors including HIV serostatus, current marginal, low, and very low FS were associated with increasingly higher GAD-7 scores, and with 1.41 (95% CI: 1.10, 1.80; P < 0.01), 2.03 (95% CI: 1.59, 2.61; P < 0.001), and 3.23 (95% CI: 2.43, 4.29; P < 0.001) times higher odds of screening positive for moderate-to-severe GAD, respectively. Low and very low FS at the previous visit (6 mo earlier) were independently associated with GAD outcomes at current visit. Associations of FS with PSS-10 and PCL-C scores exhibited similar dose-response relations. Very low FS was associated with 1.93 (95% CI: 1.15, 3.24; P < 0.05) times higher odds of screening positive for PTSD. Conclusions Food insecurity may be associated with a range of poor mental health outcomes among women in the United States with or at risk of HIV.

Elucidating Mental Health Disorders among Rohingya Refugees: A Malaysian Perspective

“…Fundamentally PTSD commonly occurs following exposure to a violent terrifying event, this is because violence disrupts several domains namely personal safety, interpersonal attachments, sense of justice, identity, and existential-meaning, which results in various psychosocial responses within these domains [ 63 ]. Moreover, studies also suggest that exposure to violence causes disturbances in the left hemispheric function, hyperadrenergic activity in the central nervous system (CNS), stimulation of the serotonergic receptors signaling in the CNS, increase in the corticotrophin-releasing factor in the cerebrospinal fluid, and signaling of the dynorphin/κ opioid receptor in the brain, which all may increase the risk of PTSD [ 64 , 65 ]. Furthermore, in this study majority of the participants were separated from a family member during the process of migration.…”

“…Food insecurity results in high-stress levels that are generated through the following ways; first insufficient quantity, quality, or diversity of available foods, second feelings of deprivation, or restricted choice about the amount or type of available foods and third having to engage in procurement strategies such as begging, dependence on charity, stealing, or exchanging sex to obtain food [ 65 ]. Furthermore, food insecurity also causes hunger and energy depletion, which affects emotion, cognition, behaviors, and is linked to the recollection of violence and trauma that results in increased chances of PTSD [ 65 ]. Repeated prolonged exposure to food insecurity has been conceptualized as a traumatic experience that could elevate the risk of developing symptoms of PTSD in response [ 65 , 66 , 67 ].…”

“…Furthermore, food insecurity also causes hunger and energy depletion, which affects emotion, cognition, behaviors, and is linked to the recollection of violence and trauma that results in increased chances of PTSD [ 65 ]. Repeated prolonged exposure to food insecurity has been conceptualized as a traumatic experience that could elevate the risk of developing symptoms of PTSD in response [ 65 , 66 , 67 ].…”

A conceptual model for understanding the rapid COVID-19–related increase in food insecurity and its impact on health and healthcare

“…Individuals experiencing food insecurity are also more likely to experience symptoms of depression ( 60 , 61 ), anxiety ( 62 ), and post-traumatic stress disorder (PTSD) ( 62 ), as well as suicidality ( 60 ). Qualitative research suggests that financial and food insecurity can fuel feelings of sadness, shame, guilt, anxiety, and hopelessness ( 52 , 63 ).…”

Evaluation of smartphone APP-based case-management services among antiretroviral treatment-naïve HIV-positive men who have sex with men: a randomized controlled trial protocol

“…Both instruments comprise four-point Likert scales with the responses based on occurrence of symptoms during the last week. In each scale, the sum of all items will be calculated and categorized into different levels of mental health disorder: normal (0-4), mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), and moderate to severe (≥15) [50,51].…”