Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger

Abstract

Background

Child hunger represents an adverse experience that could contribute to mental health problems in later life. The objectives of this study were to: (1) examine the long-term effects of the reported experience of child hunger on late adolescence and young adult mental health outcomes; and (2) model the independent contribution of the child hunger experience to these long-term mental health outcomes in consideration of other experiences of child disadvantage.

Methods

Using logistic regression, we analyzed data from the Canadian National Longitudinal Survey of Children and Youth covering 1994 through 2008/2009, with data on hunger and other exposures drawn from NLSCY Cycle 1 (1994) through Cycle 7 (2006/2007) and mental health data drawn from Cycle 8 (2008/2009). Our main mental health outcome was a composite measure of depression and suicidal ideation.

Results

The prevalence of child hunger was 5.7% (95% CI 5.0–6.4). Child hunger was a robust predictor of depression and suicidal ideation [crude OR=2.9 (95% CI 1.4–5.8)] even after adjustment for potential confounding variables, OR=2.3 (95% CI 1.2–4.3).

Limitations

A single question was used to assess child hunger, which itself is a rare extreme manifestation of food insecurity; thus, the spectrum of child food insecurity was not examined, and the rarity of hunger constrained statistical power.

Conclusions

Child hunger appears to be a modifiable risk factor for depression and related suicide ideation in late adolescence and early adulthood, therefore prevention through the detection of such children and remedy of their circumstances may be an avenue to improve adult mental health.

Introduction

Food insecurity refers to the financial inability of households to access adequate food and is generally measured as moderate versus severe (Health Canada, 2007). Moderate food insecurity means that there is an indication that quality and/or quantity of food consumed have been compromised. Severe food insecurity means that there is an indication of reduced food intake and disrupted eating patterns. According to the 2007–2008 Canadian Community Health Survey (CCHS), the national prevalence of food insecurity is 8% for households overall, while the child-level of food insecurity is 5% (Statistics Canada, 2010a). Severe child food insecurity, analogous to the more emotive term ‘child hunger’, occurs in about 2% of Canadian children (Statistics Canada, 2010a).

Population-based studies have demonstrated that food insecurity affects specific vulnerable populations with well-described characteristics related to gender (women/mothers), age (children>adults), household composition (lone parent-led), household income (inadequate, poverty level), housing (rented), ethnicity (aboriginal off-reserve), and main income source (social assistance) (Che and Chen, 2001, Health Canada, 2007, Rainville and Brink, 2001, Statistics Canada, 2010a). Thus, children affected by severe food insecurity likely live in conditions of general child adversity.

There is good evidence from Canada and the United States that demonstrates that household food insecurity is associated, in cross-sectional studies, with a range of poor physical health outcomes among children (e.g., Alaimo et al., 2001, McIntyre et al., 2000, Broughton et al., 2005, Gundersen and Kreider, 2009, To et al., 2004). A sparser literature has shown that food insecurity in childhood has long-term negative impacts on physical health (Casey et al., 2010), including chronic conditions such as asthma, even when controlling for confounding conditions of baseline health, preexisting chronic conditions and other household markers of disadvantage such as low income and rental housing (Kirkpatrick et al., 2010).

Less is understood about the food insecurity- mental health relationship. Cross-sectional studies have demonstrated a relationship between child food insecurity and child and youth mental health problems. Weinreb et al. (2002) found that school-aged children with severe hunger had significantly higher anxiety and internalizing behaviors independent of other associations. Alaimo et al. (2001) examined dysthymia and suicidal ideation in food insufficient adolescents and found a significant independent association. A small prospective study from the United Kingdom found that food insecure children, followed for 2 to 5 years until age 12, had moderately higher levels of emotional problems relative to food secure children when adjusted for various household environmental and maternal variables (Belsky et al., 2010). Another two year follow up study of children 4 to 14 years in the United States found that children from food insecure households were significantly more likely to have internalizing and externalizing problems, independent of poverty status (Slopen et al., 2010).

A burgeoning literature on food insecurity among women deals with the impact of mothers’ depressive symptomatology on adverse child outcomes such as problem behaviors (Whitaker et al., 2006) as well as her depression appearing to perpetuate the household living in a food insecure state (Casey et al., 2004, Melchior et al., 2009). Such studies add to well-established evidence that maternal depression is associated with a small but consistently increased risk of behavioral, emotional, and developmental problems in their children across the developmental age span (Goodman et al., 2010). Maternal depression is usually considered to contribute to these associations through poor parenting and parental interactions with their children (Goodman et al., 2010). From an epidemiological point of view, only a longer term prospective study can untangle the causal connections between child hunger and mental health of both the mother and the child.

Whitaker et al.'s (2006) early life stress hypothesis would predict longer term mental health problems resulting from the childhood experience of food insecurity. They have called for studies to examine whether or not household food insecurity does increase a child’s susceptibility to later mental health problems. Slopen et al. (2010) also felt that their short-term follow up study of child disadvantage and behavioral problems implicated food insecurity as a novel risk factor for child mental well-being; suggesting that if causal, this might motivate prevention efforts.

We recognized that the National Longitudinal Survey of Children and Youth (NLSCY) presented a unique opportunity to study the long term impact of child and youth hunger on mental health in late adolescence and young adulthood. This is because of the richness of the dataset which includes a consistent hunger measure over sixteen years of follow up and a variety of sociodemographic variables and diverse health outcomes. The objectives of the study were therefore to: (1) examine the long-term effects of the reported experience of child/youth hunger on late adolescence and young adult mental health outcomes; and (2) model the independent contribution of the child/youth hunger experience to these long-term mental health outcomes in consideration of other experiences of child disadvantage.