The Relationship between Household Food Insecurity and Depressive Symptoms among Pregnant Women: A Cross Sectional Study
Abstract
Objective: There is growing evidence suggesting that household food insecurity (HFI) is associated with adverse outcomes on mental health; however, limited evidence exists for pregnant women. This study was conducted to determine the relationship between HFI and depressive symptoms among a sample of pregnant women.
Method: This cross sectional study was performed on 394 pregnant women referring to the health centers located in Qom, Iran, from October 2017 to March 2019. HFI was evaluated using an 18-item US Household Food Security Survey Module. The Beck Depression Inventory-II questionnaire was applied to determine the severity of depressive symptoms. Logistic regression analysis was used to determine the factors associated with elevated depressive symptoms in the study population.
Results: The mean (± standard deviation) age of the study population was 28.59 ± 7.28 years. Almost 48% of participants were food insecure, and 37% experienced elevated levels of depressive symptoms during pregnancy. The prevalence of elevated depressive symptoms was significantly higher in food-insecure (P < 0.001) and unemployed (P = 0.02) women, while it was significantly lower in women with higher education levels (P < 0.001). In the adjusted model, it was revealed that HFI was significantly associated with the higher likelihood of having elevated depressive symptoms (OR = 3.31, 95% CI = 2.07, 5.29), while the higher level of education was negatively associated with the levels of depressive symptoms (OR = 0.40, 95% CI = 0.20, 0.79).
Conclusion: HFI was positively associated with the severity of depressive symptoms in a sample of pregnant women. Further studies are needed to confirm this finding. Meanwhile, routine screening of HFI for all pregnant women in the community health centers is recommended.
1. FAO. Chapter 2. Food security: concepts and measurement. Trade reforms and food security: conceptualizing the links.(available from http://www.fao.org/docrep/005/y4671e/y4671e06.htm, accessed on 12 May 2019).
2. Tarasuk V, Mitchell A, Dachner N. Household food insecurity in Canada, 2014. Toronto: Research to identify policy options to reduce food insecurity (PROOF) (Available from: https://proof.utoronto.ca/food-insecurity).
3. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2017, ERR-256, U.S. Department of Agriculture, Economic Research Service 2018.
4. Chinnakali P, Upadhyay RP, Shokeen D, Singh K, Kaur M, Singh AK, et al. Prevalence of household-level food insecurity and its determinants in an urban resettlement colony in north India. J Health Popul Nutr. 2014;32:227-36.
5. Hakan Bucak I, Tumgor G, Temiz F, Afat E, Yasemen Canöz P, Turgut M. Food insecurity: experience in a tertiary health center in Turkey. Minerva Pediatr. 2015;67:117-21.
6. Jomaa L, Naja F, Kharroubi S, Hwalla N. Prevalence and correlates of food insecurity among Lebanese households with children aged 4-18 years: findings from a national cross-sectional study. Public Health Nutr. 2019;22:202-11.
7. Behzadifar M, Behzadifar M, Abdi S, Malekzadeh R, Arab Salmani M, Ghoreishinia G, et al. Prevalence of Food Insecurity in Iran: A Systematic Review and Meta-analysis. Arch Iran Med. 2016;19:288-94.
8. Hamelin AM, Habicht JP, Beaudry M. Food insecurity: consequences for the household and broader social implications. J Nutr. 1999;129: 525S-8S.
9. Abrahams Z, Lund C, Field S, Honikman S. Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2018;53:363-72.
10. Hromi-Fiedler A, Bermudez-Millan A, Segura-Perez S, Perez-Escamilla R. Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas. Matern Child Nutr. 2011;7:421-30.
11. Laraia BA, Siega-Riz AM, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136:177-82.
12. Johnson CM, Sharkey JR, Lackey MJ, Adair LS, Aiello AE, Bowen SK, et al. Relationship of food insecurity to women's dietary outcomes: a systematic review. Nutr Rev. 2018;76:910-28.
13. Baskin R, Hill B, Jacka FN, O'Neil A, Skouteris H. The association between diet quality and mental health during the perinatal period. A systematic review. Appetite. 2015;91:41-7.
14. Leung BM, Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link--a review of the literature. J Am Diet Assoc. 2009;109:1566-75.
15. Azami M, Badfar G, Shohani M, Mansouri A, Soleymani A, Beigom Bigdeli Shamloo M, et al. The Prevalence of Depression in Pregnant Iranian Women: A Systematic Review and Meta-Analysis. Iran J Psychiatry Behav Sci. 2018;12:e9975.
16. Choi SK, Park YG, Park IY, Ko HS, Shin JC. Impact of antenatal depression on perinatal outcomes and postpartum depression in Korean women. J Res Med Sci. 2014;19:807-12.
17. Eastwood J, Ogbo FA, Hendry A, Noble J, Page A, Early Years Research G. The Impact of Antenatal Depression on Perinatal Outcomes in Australian Women. PLoS One. 2017;12(1):e0169907.
18. Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74:e321-41.
19. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67:1012-24.
20. Tabrizi JS, Nikniaz L, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz Z. Socio-demographic Determinants of Household Food Insecurity among Iranian: A Population-based Study from Northwest of Iran. Iran J Public Health. 2018;47:893-900.
21. Alimoradi Z, Kazemi F, Estaki T, Mirmiran P. Household food security in Iran: systematic review of Iranian articles. Advances in Nursing & Midwifery. 2015;25:63-76.
22. Hakim S, Dorosty AR, Eshraghian M. Association of food insecurity and household socio-economic status with the body mass index among urban women in Dezful. Journal of School of Public Health and Institute of Public Health Research. 2010;8(2):55-66.
23. Rafiei M, Nord M, Sadeghizadeh A, Entezari MH. Assessing the internal validity of a household survey-based food security measure adapted for use in Iran. Nutr J. 2009;8:28.
24. Bickel G, Nord M, Price C, Hamilton WL, Cook J. Guide to measuring household food security, Revised 2000. USDA. Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation, Alexandria VA. 2000.
25. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21:185-92.
26. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. 1996.
27. Kazemi F, Moafi F, Samiei Siboni F, Alimoradi Z. Prevalence and predictors of food insecurity among pregnant women: A cross sectional study in Qazvin Province, Iran. Midwifery. 2018;66:25-9.
28. Natamba BK, Mehta S, Achan J, Stoltzfus RJ, Griffiths JK, Young SL. The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study. Matern Child Nutr. 2017;13: e12351.
29. Aktas S, Yesilcicek Calik K. Factors Affecting Depression During Pregnancy and the Correlation Between Social Support and Pregnancy Depression. Iran Red Crescent Med J. 2015;17(9):e16640.
30. Thompson O, Ajayi I. Prevalence of Antenatal Depression and Associated Risk Factors among Pregnant Women Attending Antenatal Clinics in Abeokuta North Local Government Area, Nigeria. Depress Res Treat. 2016;2016:4518979.
31. Yanikkerem E, Ay S, Mutlu S, Goker A. Antenatal depression: prevalence and risk factors in a hospital based Turkish sample. J Pak Med Assoc. 2013;63:472-7.
32. Weiss BD, Francis L, Senf JH, Heist K, Hargraves R. Literacy education as treatment for depression in patients with limited literacy and depression: a randomized controlled trial. J Gen Intern Med. 2006;21:823-8.
33. Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic Inequalities in Depression: A Meta-Analysis. Am J Epidemiol. 2003;157:98-112.
34. Francis L, Weiss BD, Senf JH, Heist K, Hargraves R. Does literacy education improve symptoms of depression and self-efficacy in individuals with low literacy and depressive symptoms? A preliminary investigation. J Am Board Fam Med. 2007;20:23-27.
35. Golbasi Z, Kelleci M, Kisacik G, Cetin A. Prevalence and correlates of depression in pregnancy among Turkish women. Matern Child Health J. 2010;14(4):485-91.
36. Jarahi L, Zavar A, Neamat Shahi M. Evaluation of Depression and related factors in pregnant women referred to urban and rural health centers of Sarakhs. Journal of Midwifery and Reproductive Health. 2015;3:343-48.
2. Tarasuk V, Mitchell A, Dachner N. Household food insecurity in Canada, 2014. Toronto: Research to identify policy options to reduce food insecurity (PROOF) (Available from: https://proof.utoronto.ca/food-insecurity).
3. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2017, ERR-256, U.S. Department of Agriculture, Economic Research Service 2018.
4. Chinnakali P, Upadhyay RP, Shokeen D, Singh K, Kaur M, Singh AK, et al. Prevalence of household-level food insecurity and its determinants in an urban resettlement colony in north India. J Health Popul Nutr. 2014;32:227-36.
5. Hakan Bucak I, Tumgor G, Temiz F, Afat E, Yasemen Canöz P, Turgut M. Food insecurity: experience in a tertiary health center in Turkey. Minerva Pediatr. 2015;67:117-21.
6. Jomaa L, Naja F, Kharroubi S, Hwalla N. Prevalence and correlates of food insecurity among Lebanese households with children aged 4-18 years: findings from a national cross-sectional study. Public Health Nutr. 2019;22:202-11.
7. Behzadifar M, Behzadifar M, Abdi S, Malekzadeh R, Arab Salmani M, Ghoreishinia G, et al. Prevalence of Food Insecurity in Iran: A Systematic Review and Meta-analysis. Arch Iran Med. 2016;19:288-94.
8. Hamelin AM, Habicht JP, Beaudry M. Food insecurity: consequences for the household and broader social implications. J Nutr. 1999;129: 525S-8S.
9. Abrahams Z, Lund C, Field S, Honikman S. Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2018;53:363-72.
10. Hromi-Fiedler A, Bermudez-Millan A, Segura-Perez S, Perez-Escamilla R. Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas. Matern Child Nutr. 2011;7:421-30.
11. Laraia BA, Siega-Riz AM, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136:177-82.
12. Johnson CM, Sharkey JR, Lackey MJ, Adair LS, Aiello AE, Bowen SK, et al. Relationship of food insecurity to women's dietary outcomes: a systematic review. Nutr Rev. 2018;76:910-28.
13. Baskin R, Hill B, Jacka FN, O'Neil A, Skouteris H. The association between diet quality and mental health during the perinatal period. A systematic review. Appetite. 2015;91:41-7.
14. Leung BM, Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link--a review of the literature. J Am Diet Assoc. 2009;109:1566-75.
15. Azami M, Badfar G, Shohani M, Mansouri A, Soleymani A, Beigom Bigdeli Shamloo M, et al. The Prevalence of Depression in Pregnant Iranian Women: A Systematic Review and Meta-Analysis. Iran J Psychiatry Behav Sci. 2018;12:e9975.
16. Choi SK, Park YG, Park IY, Ko HS, Shin JC. Impact of antenatal depression on perinatal outcomes and postpartum depression in Korean women. J Res Med Sci. 2014;19:807-12.
17. Eastwood J, Ogbo FA, Hendry A, Noble J, Page A, Early Years Research G. The Impact of Antenatal Depression on Perinatal Outcomes in Australian Women. PLoS One. 2017;12(1):e0169907.
18. Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74:e321-41.
19. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67:1012-24.
20. Tabrizi JS, Nikniaz L, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz Z. Socio-demographic Determinants of Household Food Insecurity among Iranian: A Population-based Study from Northwest of Iran. Iran J Public Health. 2018;47:893-900.
21. Alimoradi Z, Kazemi F, Estaki T, Mirmiran P. Household food security in Iran: systematic review of Iranian articles. Advances in Nursing & Midwifery. 2015;25:63-76.
22. Hakim S, Dorosty AR, Eshraghian M. Association of food insecurity and household socio-economic status with the body mass index among urban women in Dezful. Journal of School of Public Health and Institute of Public Health Research. 2010;8(2):55-66.
23. Rafiei M, Nord M, Sadeghizadeh A, Entezari MH. Assessing the internal validity of a household survey-based food security measure adapted for use in Iran. Nutr J. 2009;8:28.
24. Bickel G, Nord M, Price C, Hamilton WL, Cook J. Guide to measuring household food security, Revised 2000. USDA. Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation, Alexandria VA. 2000.
25. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21:185-92.
26. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. 1996.
27. Kazemi F, Moafi F, Samiei Siboni F, Alimoradi Z. Prevalence and predictors of food insecurity among pregnant women: A cross sectional study in Qazvin Province, Iran. Midwifery. 2018;66:25-9.
28. Natamba BK, Mehta S, Achan J, Stoltzfus RJ, Griffiths JK, Young SL. The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study. Matern Child Nutr. 2017;13: e12351.
29. Aktas S, Yesilcicek Calik K. Factors Affecting Depression During Pregnancy and the Correlation Between Social Support and Pregnancy Depression. Iran Red Crescent Med J. 2015;17(9):e16640.
30. Thompson O, Ajayi I. Prevalence of Antenatal Depression and Associated Risk Factors among Pregnant Women Attending Antenatal Clinics in Abeokuta North Local Government Area, Nigeria. Depress Res Treat. 2016;2016:4518979.
31. Yanikkerem E, Ay S, Mutlu S, Goker A. Antenatal depression: prevalence and risk factors in a hospital based Turkish sample. J Pak Med Assoc. 2013;63:472-7.
32. Weiss BD, Francis L, Senf JH, Heist K, Hargraves R. Literacy education as treatment for depression in patients with limited literacy and depression: a randomized controlled trial. J Gen Intern Med. 2006;21:823-8.
33. Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic Inequalities in Depression: A Meta-Analysis. Am J Epidemiol. 2003;157:98-112.
34. Francis L, Weiss BD, Senf JH, Heist K, Hargraves R. Does literacy education improve symptoms of depression and self-efficacy in individuals with low literacy and depressive symptoms? A preliminary investigation. J Am Board Fam Med. 2007;20:23-27.
35. Golbasi Z, Kelleci M, Kisacik G, Cetin A. Prevalence and correlates of depression in pregnancy among Turkish women. Matern Child Health J. 2010;14(4):485-91.
36. Jarahi L, Zavar A, Neamat Shahi M. Evaluation of Depression and related factors in pregnant women referred to urban and rural health centers of Sarakhs. Journal of Midwifery and Reproductive Health. 2015;3:343-48.
| Files | ||
| Issue | Vol 15 No 2 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v15i2.2684 | |
| Keywords | ||
| Depression Food Insecurity Pregnancy Women Socioeconomic Factors | ||
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How to Cite
1.
Khoshgoo M, Eslami O, Khadem Al-Hosseini M, Shidfar F. The Relationship between Household Food Insecurity and Depressive Symptoms among Pregnant Women: A Cross Sectional Study. Iran J Psychiatry. 2020;15(2):126-133.
