Hunger in Vulnerable Families in Southeastern Europe: Associations With Mental Health and Violence

Abstract

Background: Hunger can influence healthy development of children and has been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health problems. Whilst the majority of research has been conducted in high-income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries. This study explored the experience of hunger in vulnerable families in three Southeastern European countries, and simultaneously examined relationships with four sets of risk factors-lack of financial, mental, familial, and social resources. Methods: Families (N = 140) were recruited for a parenting intervention targeting child behavioral problems. Baseline data was collected on hunger, socioeconomic characteristics, mental health and wellbeing, family violence (i.e., child maltreatment and intimate partner violence), and social and emotional support. Univariate and multivariable risk factors of hunger were examined cross-sectionally with regression models. Results: Overall, 31% of families experienced at least one form of hunger in the last month. Worse family functioning, current intimate partner violence, and more instances of child neglect showed univariate associations with family hunger. In hierarchical analysis, five risk factors remained significantly associated with the experience of hunger: lower adult educational, literacy level, emotional support, more children in the household and higher scores on parental depression, anxiety, and stress. Conclusions: Hunger in Southeastern European families, among families with children showing elevated behavioral problems, was associated with more family violence, but specifically poorer mental health and less emotional support above and beyond socio-structural strains. Adapting parenting interventions to support the primary caregiver in getting more access to emotional support may potentially also change hunger and its association with health and violence. However, this hypothetical pathway of change needs explicit testing.

The Measurement of Food Insecurity in High-Income Countries: A Scoping Review

“…Over 90% of the reviewed empirical studies were conducted after 2015 (only [ 35 , 36 ] were published before that date). Eleven papers reported data on more than one country, with six of them including global samples of more than 100 countries [ 37 , 38 , 39 , 40 , 41 , 42 ], while the others used data from Europe [ 43 ], Macedonia, Moldova and Romania [ 44 ], and a combination of US and Canada [ 45 ]. The rest of the the papers used samples based in one country: US [ 35 , 46 , 47 , 48 , 49 ], Australia [ 50 , 51 ], Portugal [ 36 , 52 ], Canada [ 43 , 53 , 54 ], France [ 55 ], Greece [ 56 ], Italy [ 57 ], Norway [ 58 ] and Poland [ 59 ].…”

“…Three original papers explored the validity of new or existing food insecurity measures [ 37 , 39 , 51 ], while all others explored reported data on food insecurity prevalence with a different focus. Some studied its correlates: sociodemographics [ 40 , 58 , 59 ], age [ 52 ], health, social and poverty stressors [ 35 ] and self-confidence in resource management [ 47 ]; disparities based on gender [ 38 , 42 , 48 ], race [ 46 ] or region [ 36 ]; its health consequences [ 44 , 53 , 57 , 62 ]; and the impact of different policies and strategies [ 43 , 45 , 49 , 54 , 55 , 56 , 63 ]. The literature reviews’ objective was primarily to identify measurement tools available [ 16 , 21 , 22 , 23 , 60 ], although one of them also reviewed studies about food insecurity and environmental correlates [ 64 ], and another focused on gender disparities [ 61 ].…”

“…Fourteen original papers reported food insecurity at the household level [ 36 , 43 , 44 , 45 , 47 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 59 , 65 ] and twelve at the individual level, with only Park et al [ 40 ] not focusing on the adult population (they collect data on the elderly). Literature reviews included both household and individual measures.…”

“…Instruments to assess household food insecurity included the 18-item Household Food Security Survey Module from USDA (18-HFSSM) [ 45 , 47 , 53 , 54 , 55 , 65 ], the Brazilian Food Insecurity Scale [ 36 , 52 ], the Household Food Insecurity Access Scale [ 59 ], the Food Security Survey Module (FSSM) [ 56 ], the Food Insecurity Index (FII) [ 49 ], the Household Hunger Scale (HHS) [ 44 ], the Healthy Diets ASAP [ 51 ] and the European Quality of Life Survey item “could your household afford a meal with meat, chicken or fish every second day if you wanted it?” [ 43 ]. Food Insecurity at the individual level was measured through the Food Insecurity Experience Scale (FIES), mostly through the Gallup World Survey [ 37 , 38 , 39 , 40 , 42 , 62 ], the six or ten-item Household Food Security Survey Module from USDA (6-HFSSM; 10-HFSSM) [ 35 , 46 , 48 ], the 10-item Radimer-Cornell Scale [ 58 ], the Household Food Insecurity Access Scale (HFIAS) [ 57 ] and an ad hoc developed single-item measure [ 50 ].…”

Preventing child mental health problems in southeastern Europe: Feasibility study (phase 1 of MOST framework)

“…Data for the Pilot Feasibility Phase were simultaneously collected in North Macedonia, Republic of Moldova and Romania in 2018 (pre: April to June; post: September to December). Details of the RISE study protocol, recruitment and intervention have been described elsewhere (Frantz et al, 2019;Jansen et al, 2020). Parents of children aged 2-9 years were recruited through a number of strategies (e.g., Feasibility of Parent Training 8 flyers, non-governmental organizations, teachers) and pre-screened for eligibility.…”