Psychosocial mechanisms largely mediate the path between food insecurity and depressive symptoms in later life.

Food insecurity (FI) is highly prevalent and can lead to depression. This study 1) examines the association of FI with depression symptoms (DS) among older adults in Ghana, 2) explores the degree to which psychosocial factors mediate the FI-DS link, and 3) investigates the effect modification of the association by age and sex differences. Data from adults aged ≥50 years in the AgeHeaPsyWel-HeaSeeB Study were analyzed. DS (cutoff of ≥9) was assessed using the CES-D-10 scale. Continuous score and categorical FI were measured with hunger and skipped breakfast items due to insufficient food or resources. Multivariable regression and bootstrapping analyses were used to evaluate the hypothesized associations. The sample included 1201 individuals (Mage=66.1[11.9]; F = 63.3%). Moderate (OR=1.75, 95%CI=1.22-2.51) and severe FI (OR=4.69, 95%CI=2.58-8.55) (vs no FI) were associated with DS, while a unit increase in FI was associated with 1.67 (95%CI=1.39-2.01) times higher odds for DS. The association was much stronger in males than in females and in those aged 50-69 years than in those aged ≥70. Anxiety (mediated percetage 41%), loneliness (30%), hopelessness (8%), and social isolation (4%) mediated the FI-DS association. Higher FI levels are positively associated with DS. Addressing FI and the identified psychosocial mediators may reduce DS in food-insecure older adults in low-income countries, pending future longitudinal conclusions.