Food insecurity and coping strategies and their association with anxiety and depression: a nationally representative South African survey

Abstract

Objective: To investigate food insecurity and related coping strategies among South African households and their associations with anxiety and depression. Design: Cross-sectional study. Food insecurity and coping strategies were assessed using a modified Community Childhood Hunger Identification Project and the Coping Strategies Index questionnaires. The GAD-7 and PHQ-9 were used to assess anxiety and depression risk. Ordered logistic regressions were used to test associations between food insecurity and related coping strategies, and anxiety and depression. Setting: South Africa during COVID-19, October 2021. Participants: Nationally representative sample of 3,402 adults, weighted to 39,640,674 South African households. Results: About 20.4% of South African households were food insecure, with the most affected being from the lowest socio-economic groups. Shifting from “food secure” to “at risk” or from “at risk” to “food insecure” group was associated with 1.7 times greater odds of being in a higher category of anxiety or depression (p<0.001). All coping strategies were used to some extent in South African households, with 46.0% relying on less preferred and less expensive foods, and 20.9% sending a household member to beg for food. These coping strategies were mostly used by food insecure households. Although the odds of moving to a higher category of anxiety and depression were observed among all coping strategies (all p<0.001), begging for food was associated with the highest odds (odds ratio=2.3). Conclusions: Food insecurity remains a major health threat in South Africa. Public measures to address mental health should consider reductions in food insecurity as part of their strategy.

Food insecurity and coping strategies associate with higher risk of anxiety and depression among South African households with children

“…In the present study, food insecurity was dependent on socioeconomic factors, such that respondents who were Black, unemployed and with no formal education were the most food insecure. This has also been shown in our previous nationally representative study conducted during COVID-19 restrictions (5) . In these nationally representative studies, assessing socio-economic factors was key because coping strategies used to deal with food insecurity are strongly related to the socio-economic status of household members (5) .…”

“…This has also been shown in our previous nationally representative study conducted during COVID-19 restrictions (5) . In these nationally representative studies, assessing socio-economic factors was key because coping strategies used to deal with food insecurity are strongly related to the socio-economic status of household members (5) . For example, relying on cheaper foods (the most common coping strategy) is largely dependent on employment status, which is, in turn, influenced by the level of education (5,32) .…”

“…It is also possible that households with children were disproportionally affected by food insecurity, as suggested by previous global reports (1) . Our previous study also demonstrated that living in a food-insecure household was associated with an increased risk of anxiety and depression (5) . Additionally, all coping strategies were found to associate with a higher risk of anxiety and depression, and sending a household member to beg for food was the strongest predictor (5) .…”

“…Our previous study also demonstrated that living in a food-insecure household was associated with an increased risk of anxiety and depression (5) . Additionally, all coping strategies were found to associate with a higher risk of anxiety and depression, and sending a household member to beg for food was the strongest predictor (5) . On the 4th of April 2022, the South African Government announced the end of COVID-19 lockdown restrictions (12) .…”

“…mental health (5) . Food insecurity among households with children is even more concerning because when a child has inadequate access to food, nutritional status is greatly affected, leading to a negative impact on the child's physical, emotional and cognitive development (8)(9)(10) .…”