Food security mediates the decrease in women’s depressive symptoms in a participatory nutrition-sensitive agroecology intervention in rural Tanzania

Abstract

Objective: To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women’s depressive symptoms. Design: We used annual longitudinal data (4 time points) from a cluster-randomized effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project (SNAP-Tz). Structural equation modelling estimation of total, natural direct, and natural indirect effects was used to investigate food security’s role in the intervention’s impact on women’s risk of probable depression (CES-D > 17) across three years. Setting: Rural Singida, Tanzania. Participants: 548 food insecure, married, smallholder women farmers with children < 1-year-old at baseline. Results: At baseline, one third of the women in each group had probable depression (Control: 32.0%, Intervention: 31.9%, p difference=0.97). The intervention lowered odds of probable depression by 43% (OR=0.57, 95% CI: 0.43-0.70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0.90, 95% CI: 0.83-0.95). Conclusions: This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women’s depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e., improvements in mental health, and changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women’s wellbeing in farming communities.

Farmer Mental Health Interventions: A Systematic Review

“…A total of two articles addressed the Singida Nutrition and Agroecology Project, which taught agroecology methods designed to increase food diversity and food security among smallholder families in Tanzania through increasing biodiversity and increasing the cultivation of legumes [ 140 , 141 ]. A cluster-randomized efficacy trial demonstrated that levels of probable depression, as measured by the Center for Epidemiologic Studies Depression Scale (CES-D), decreased by 43% among women farmers in the intervention group [ 140 ]. Structural equation modelling revealed that the increase in house food security explained 23% of this impact [ 141 ].…”

“…Much of the literature addressed multiple interventions or multi-component interventions, proscribing evaluation of specific mechanisms. Only one intervention was of the gold-standard experimental design, and its narrow target of food-insecure female farmers with young children in Tanzania limits generalizability to other farming populations [ 140 , 141 ]. The most consistent methodology used was self-report questionnaires concerning mental health literacy programs.…”

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