Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa

Abstract

Rationale Food insecurity has emerged as an important, and potentially modifiable, risk factor for depression. Few studies have brought longitudinal data to bear on investigating this association in sub-Saharan Africa. Objective To estimate the association between food insufficiency and depression symptom severity, and to determine the extent to which any observed associations are modified by social support. Methods and Results We conducted a secondary analysis of population-based, longitudinal data collected from 1,238 pregnant women during a three-year cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 months, 18 months, and 36 months (85% retention). A validated, single-item food insufficiency measure inquired about the number of days of hunger in the past week. Depression symptom severity was measured using the Xhosa version of the 10-item Edinburgh Postnatal Depression Scale. In multivariable regression models with cluster-correlated robust estimates of variance, lagged food insufficiency had a strong and statistically significant association with depression symptom severity (β=0.70; 95% CI, 0.46-0.94), suggesting a 6.5% relative difference in depression symptom severity per day of hunger. In stratified analyses, food insufficiency had a statistically significant association with depression among women with low levels of instrumental support. Using quantile regression, we found that the adverse impacts of food insufficiency were experienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity. Estimates from fixed-effects regression and fixed-effects quantile regression, accounting for unobserved confounding by time-invariant characteristics, were similar. Conclusions Food insufficiency was associated with depression symptom severity, particularly for women in the upper end of the conditional depression distribution. Instrumental social support buffered women against the adverse impacts of food insufficiency.

Depression and ART Initiation Among HIV Serodiscordant Couples in Kenya and Uganda

“…Problem alcohol use was indicated if participants responded “yes” to any of four items about harmful and hazardous drinking behavior. Social support was measured by calculating a mean score from the 10-item Functional Social Support Questionnaire (29,30), with a score closer to four indicating greater perceived social support. Stigma, alcohol use, and social support were also all analyzed as time-dependent covariates with scores carried forward between annual visits.…”

Mental health symptoms and their relations with dietary diversity and nutritional status among mothers of young children in eastern Democratic Republic of the Congo

“…In such a food insecure environment, opportunities to improve dietary diversity are limited, and differences in dietary diversity among participants with higher levels of mental health symptoms compared to those with less severe symptoms may be due to other underlying or modifying factors, such as social support and work burden. For example, social support was found to modify the association between depression and food insecurity among people living with HIV/AIDS in Uganda, as well as among perinatal women in urban South Africa [49,50]. Additionally, women who have a higher work burden may experience increased stress and related mental health symptoms but might also have more income with which to purchase more diverse foods.…”

Preventive Factors of Postpartum Depression in Adult Mothers: A Systematic Review of Randomized Controlled Trials

“…The majority of the studies (n=8) were conducted in the USA [27,30,31,34,35,37,40,41], two in the UK [4,28] and two in China [7,39]. One study was conducted in each of the following countries: Canada [29], Mexico [33], Norway [8], Hungary [32], France [5], Iran [26], Australia [6], Denmark [36], South Africa [25], Brazil [38].…”

“…Tsai et al [25] evaluated the link between food shortages, depression and the role of social support. For this population-based, cluster-randomized trial all pregnant females living in the study catchment area who were willing to participate were recruited, resulting in 958 subjects.…”