Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa

Abstract

Background Although the public health impacts of food insecurity and depression on both maternal and child health are extensive, no studies have investigated the associations between food insecurity and postnatal depression or suicidality. Methods We interviewed 249 women three months after they had given birth and assessed food insecurity, postnatal depression symptom severity, suicide risk, and hazardous drinking. Multivariable Poisson regression models with robust standard errors were used to estimate the impact of food insecurity on psychosocial outcomes. Results Food insecurity, probable depression, and hazardous drinking were highly prevalent and co-occurring. More than half of the women (149 [59.8%]) were severely food insecure, 79 (31.7%) women met screening criteria for probable depression, and 39 (15.7%) women met screening criteria for hazardous drinking. Nineteen (7.6%) women had significant suicidality, of whom 7 (2.8%) were classified as high risk. Each additional point on the food insecurity scale was associated with increased risks of probable depression (adjusted risk ratio [ARR], 1.05; 95% CI, 1.02–1.07), hazardous drinking (ARR, 1.04; 95% CI, 1.00–1.09), and suicidality (ARR, 1.12; 95% CI, 1.02–1.23). Evaluated at the means of the covariates, these estimated associations were large in magnitude. Limitations The study is limited by lack of data on formal DSM-IV diagnoses of major depressive disorder, potential sample selection bias, and inability to assess the causal impact of food insecurity. Conclusion Food insecurity is strongly associated with postnatal depression, hazardous drinking, and suicidality. Programmes promoting food security for new may enhance overall psychological well-being in addition to improving nutritional status.

Investigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Study

“…There is a high prevalence of antenatal psychological distress and depression, consistent with previous work in the Western Cape (Dewing et al, 2013, Hartley et al, 2011, Roos et al, 2013 and Tomlinson et al, 2014). Substance use, particularly tobacco and alcohol use, is common, again consistent with prior local work (Dewing et al, 2013, Petersen Williams et al, 2014 and Vythilingum et al, 2012). In addition, there is a high reported prevalence of IPV within this cohort, as has been previously found during pregnancy in South Africa (Groves et al, 2014).…”

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application

“…Khayelitsha is one of the largest such settlements in South Africa, with a population exceeding 1 million residents (Brunn and Wilson 2013) who are primarily Xhosa-speaking, black Africans living in informal housing (i.e., shacks) on unserviced land. Unemployment, food insecurity, and subsistence-level poverty rates are extremely high (BeLue et al 2008; Cooper et al 1991; Dewing et al 2013; Muzigaba and Puoane 2011; Pick and Obermeyer 1996; Venkataramani et al 2010). Khayelitsha leads all sub-districts of Cape Town in age-standardized mortality, with the leading causes being HIV/AIDS, homicide, and tuberculosis (Groenewald et al 2010).…”

“…In South Africa, nearly one-half of women in township settings have been diagnosed with major depressive disorder during the antenatal and postnatal periods (Cooper et al 1999; Dewing et al 2013; Rochat et al 2011; Tsai and Tomlinson 2012). The public health impacts of major depressive disorder are compounded by its intergenerational effects:newborn children of mothers with depression have poorer health and socio-emotional development (Rahman et al 2004; Straub et al 2012; Weissman et al 2006), and these in turn have adverse implications for their long-term psychosocial, cognitive, and economic outcomes (Heckman 2007; Pearson et al 2013; Venkataramani 2012).…”

How community physical, structural, and social stressors relate to mental health in the urban slums of Accra, Ghana

“…Existing research on mental health in sub-Saharan Africa has primarily focused on individual and household risk factors, including poverty, unemployment, inadequate housing, food insecurity, gender, age, marital status, education, intimate partner violence, and HIV status (Bove and Veleggia, 2009;Cole and Tembo, 2011;de Menil et al, 2012;Dewing et al, 2013;Gruebner et al, 2012;Khumalo et al, 2012;Kuo et al, 2012;Patel and Kleinman, 2003;Myer et al, 2008;Olagunju et al, 2012;Patel et al, 2006;Pillay and Kriel, 2006;Pitpitan et al, 2012;Sipsma et al, 2013). To date there is scant population-based research on how the structural, institutional, and social dynamics in disadvantaged urban settings can contribute to mental health outcomes.…”