Food Insecurity and Mental Health Status: A Global Analysis of 149 Countries

Introduction: This study sought to determine the association of individual-level food insecurity (FI) with mental health status across all global regions. Methods: Cross-sectional data were analyzed in 2016 from the 2014 Gallup World Poll, a series of globally implemented, nationally representative surveys. FI was assessed using the Food Insecurity Experience Scale Survey Module for Individuals, an eight-question psychometric scale reporting individuals' experiences of FI. Individual-level composite indices of mental health, the Negative Experience Index and Positive Experience Index (0-100 scale), were calculated based on responses to five questions of respondents' recent negative and positive experiences, respectively, associated with depression and mental distress. Results: The prevalence of any FI ranged from 18.3% in East Asia to 76.1% in Sub-Saharan Africa. In global analyses (149 countries) using adjusted multiple regression analyses, FI was associated in a dose-response fashion with poorer scores on the mental health indices (coefficient [95% CI]: Negative Experience Index: mild FI, 10.4 [9.5, 11.2]; moderate FI, 17.7 [16.4, 19.0]; severe FI, 24.5 [22.7, 26.3]; Positive Experience Index: mild FI, -8.3 [-9.3, -7.4]; moderate FI, -12.6 [-13.8, -11.3]; severe FI, -16.2 [-17.9, -14.5]). Within-region analyses (11 regions) consistently demonstrated the same trends. Conclusions: FI is associated with poorer mental health and specific psychosocial stressors across global regions independent of SES. The numerous pathways via which FI may contribute to common mental disorders, and the broad social implications of FI linked to efficacy, may contribute to the cross-cultural consistency of the findings.