Caught in a downward spiral? The bidirectional relationship among food insecurity, financial strain, and depression and anxiety: A NESDA study.

BACKGROUND

The relationship among food insecurity, financial strain, and depression and anxiety is complex and likely bidirectional, yet most studies have examined this relationship unidirectionally and cross-sectionally. Our study investigates the longitudinal bidirectional relationship among depression and/or anxiety and food insecurity and financial strain.

METHODS

Food insecurity and financial strain were measured at four waves across 13 years in the NESDA cohort. Clinical diagnoses of depression and anxiety were determined using the CIDI. Symptom severity was assessed using the IDS-SR and BAI. Lagged multilevel models examined whether food insecurity and financial strain predicted changes in depression and/or anxiety and vice versa. All models adjusted for age, sex, education, household income contributors, and prior outcome levels.

RESULTS

Among 2,567 individuals (mean age 42.4 years (SD 13.2), 34.6% women), higher food insecurity and financial strain significantly predicted increased odds of onset of depressive disorders (OR = 2.12, 95% CI: 1.43-3.15 and OR = 1.92, 95% CI: 1.51-2.45, respectively), and greater depressive symptom severity at the next wave (p's for trend < .001 and p = .001, respectively). Associations with anxiety disorders and symptom severity were weaker. Conversely, depressive disorders and symptoms predicted higher subsequent food insecurity and financial strain, whereas anxiety symptoms did not.

CONCLUSIONS

Our findings support a bidirectional temporal association among food insecurity, financial strain and depression, with weaker evidence for anxiety. Approaches that address financial hardship and mental health may be beneficial. Further long-term studies in diverse populations are needed to clarify mechanisms linking financial insecurity with mental health and to guide effective intervention development.