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Independent and combined associations of intimate partner violence and food insecurity on maternal depression and generalized anxiety disorder
Abstract
While research has investigated intimate partner violence (IPV) and food insecurity (FI) as independent experiences on mental health, research is lacking on the possible longitudinal associations of combined experiences of IPV and FI on maternal depression and generalized anxiety disorder (GAD). Using data from the Fragile Families and Child Wellbeing study (n=1,440), the current study examined the independent and combined associations of IPV and FI mothers experienced 3-5 years after their child’s birth on depression and GAD at Year 15. Five mutually exclusive dichotomous variables were created based on IPV and FI experiences during Year 3 and Year 5. Depression and GAD were measured at Year 15 using the Composite International Diagnostic Interview-Short Form. According to the covariate-adjusted logistic regression models, exposure to IPV and FI, both concurrently and independently predicted greater depression at Year 15. Mothers in all IPV and FI categories had greater odds of having GAD at Year 15 compared to those with no exposure. Compared to the independent effect of IPV and FI, the combined effect of IPV and FI was highly associated with maternal GAD, but not depression. Using a trauma-informed approach to counseling in combination with food assistance programs might be an effective strategy in preventing mental health symptoms.
... Twelve studies reported on the experiences of family violence and food insecurity among a female population (Barreto et al., 2019;Brandhorst & Clark, 2022;Chilton & Booth, 2007;Chilton et al., 2014Chilton et al., , 2017Daundasekara et al., 2022;Hernandez et al., 2014;Hunt et al., 2019;Laraia et al., 2022;Melchior et al., 2009;Power, 2006;Ricks et al., 2016), nine of these studies were based in the USA, two in Canada, and one in the UK. Five studies that focused on a female population specifically were longitudinal, four were qualitative, two were cross sectional, and one was a case study. ...
... Five studies reported on women who were pregnant or who had children in the home and all reported an association between food insecurity, family violence, and maternal depressive symptoms (Chilton et al., 2014;Daundasekara et al., 2022;Hernandez et al., 2014;Laraia Melchior et al., 2009). In a longitudinal study of women from the UK, Melchior et al., (2009) Hernandez et al., (2014) found that food insecurity was associated with domestic violence (OR: 1.22 [95% CI: 1.01-1.49]) ...
... p < 0.001). Also in longitudinal work from the USA Daundasekara et al., (2022) found that mothers had increased odds of major depression when experiencing food insecurity (OR = 1.69, p < 0.001), domestic violence (OR = 1.54, p < 0.001), or both concurrently (OR = 1.88, p = 0.004). Laraia et al., (2022) found that women reporting very low food security had a 165% (95% CI: 1.86-3.79) ...
Purpose
This review aimed to investigate and describe the current research that has reported on family violence and food insecurity and to explore any links. Research is beginning to explore the relationship between food insecurity and family violence, as such, this is a good time to review the current body of literature to identify existing gaps.
Methods
This research employed a narrative systematic review allowing for a broad search while maintaining methodological rigour. Key word searches were performed in 6 electronic databases in January 2023. Two overarching concepts were used: “family violence” and “food security”. The findings were synthesised into a narrative review, reporting on specific population groups separately.
Results
The search generated 1724 articles, of which 868 were duplicates. The titles and abstracts of 856 articles were screened; 765 articles were excluded because they did not investigate the experience of food insecurity and family violence. The full text of 91 articles was reviewed, with 32 included in this review. Most were from the USA, and most employed qualitative or mixed methods. Studies explored food insecurity and family violence in women, men and women, children, people who are HIV positive, and the relationship between the COVID-19 pandemic and food insecurity.
Conclusions
Food insecurity and family violence are significant societal problems, with evidence that both have increased in prevalence and severity due to the onset of the COVID-19 pandemic. This review provides initial evidence for a bi-directional relationship between food insecurity and family violence in high income countries.
... food insecurity) (Beck, 1976). Food insecurity has consistently been associated with maternal depression (Bronte-Tinkew et al., 2007;Hadley and Patil, 2008;Reesor-Oyer et al., 2021;Whitaker et al., 2006) and anxiety (Daundasekara et al., 2022;Hadley and Patil, 2008;Whitaker et al., 2006). Identifying factors involved in the food insecurity-maternal mental health relationship is important, because maternal depression and anxiety negatively impact children. ...
Background:
Identifying family environment factors related to food insecurity and maternal mental health could inform additional support for mothers who experience food insecurity. This study seeks to examine the mechanistic roles of co-parenting support and parenting stress on the food insecurity-maternal mental health relationship.
Methods:
Data from the Future of Families and Child Well-being Study, which recruited mothers post-delivery from 75 urban hospitals, was utilized. Analysis includes 1808 mothers followed for 15 years. Food insecurity was assessed at year 5, co-parenting support and parenting stress at year 9, and maternal depression and anxiety at year 15. Structural equation models evaluated the role of food insecurity on maternal depression (model 1) and anxiety (model 2) through co-parenting support and parenting stress simultaneously, adjusting for socio-demographics.
Results:
Co-parenting support did not mediate the relationships of food insecurity and maternal depression and anxiety, controlling for parenting stress. Controlling for co-parenting support, parenting stress did not mediate the food insecurity-maternal depression relationship, but partially mediated the food insecurity-maternal anxiety relationship (specific indirect: B = 0.026, CI:0.01, 0.05; specific direct: B = 0.131, CI:-0.04, 0.32).
Limitations:
There was a significant period of time (10 years) between assessment of food insecurity and assessment of maternal mental health. Self-reported data on sensitive topics may be susceptible to bias. With observational research, it is possible that unobserved confounding variables impact the findings.
Conclusions:
Cumulative support in the form of - parenting, economic (e.g., utilities), and food - may help reduce parenting stress and anxiety among mothers who experience food insecurity.
Background and Objectives
Individuals of color and of low socioeconomic status are at greater risk of experiencing community violence and food insecurity, which are both influenced by neighborhood conditions. We evaluated neighborhood collective efficacy as a linkage between community violence exposure and household food insecurity.
Methods
Mothers from the Future of Families and Child Wellbeing Study who completed phone surveys when the child was 3 (time 1, T1) and 5 years old (time 2, T2) were included (n = 2068). A covariate-adjusted structural equation model estimated direct and indirect effects of community violence exposure on household food insecurity. A covariate-adjusted multiple mediator model estimated the indirect effects of the 2 neighborhood collective efficacy subscales (informal social control; social cohesion and trust).
Results
At T1, 40% of mothers reported community violence exposure; 15% experienced food insecurity at T2. Mean neighborhood collective efficacy (range 1-5) at T1 was 2.44 (SD = 0.94). Neighborhood collective efficacy indirectly influenced the association between community violence exposure and food insecurity (indirect effect = 0.022, 95% CI = 0.007 to 0.040). Only social cohesion and trust contributed independent variance to the indirect effect model (indirect effect = 0.028, 95% CI = 0.001 to 0.056).
Conclusions
Community-based efforts to reduce household food insecurity should emphasize building social cohesion and trust in communities experiencing violence.
This report provides statistics on food security in U.S. households throughout 2020 based on the Current Population Survey Food Security Supplement data collected in December 2020. An estimated 89.5 percent of U.S. households were food secure throughout the entire year in 2020, with access at all times to enough food for an active, healthy life for all household members. The remaining households (10.5 percent, unchanged from 10.5 percent in 2019) were food insecure at least some time during the year, including 3.9 percent with very low food security (not significantly different from 4.1 percent in 2019). Very low food security is the more severe range of food insecurity where one or more household members experienced reduced food intake and disrupted eating patterns at times during the year because of limited money and other resources for obtaining food. Although the prevalence of food insecurity and very low food security for all households remained unchanged from 2019, some subgroups experienced increases in food insecurity and very low food security. For example, among children, food insecurity and very low food security increased significantly from 2019. Children and adults were food insecure in 7.6 percent of U.S. households with children in 2020 (up from 6.5 percent in 2019); very low food security among children was 0.8 percent (up from 0.6 percent in 2019). In 2020, the typical food-secure household spent 18 percent more on food than the typical food-insecure household of the same size and household composition. About 55 percent of food-insecure households participated in one or more of the three largest Federal nutrition assistance programs: Supplemental Nutrition Assistance Program (SNAP, formerly food stamps); Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and the National School Lunch Program during the month prior to the 2020 survey. Because of the coronavirus (COVID-19) pandemic, USDA granted States significant program flexibilities and contingencies to serve nutrition assistance program participants. The prevalence of food insecurity in the 30-day period from mid-November to mid-December 2020 was 5.7 percent for the Nation. Food insecurity was substantially higher for households with a householder or reference person (an adult household member in whose name the housing unit is owned or rented) who was unable to work because of the pandemic (16.4 percent food insecure in the 30-day period from mid-November to mid-December 2020) and households with a reference person who was not employed and was prevented from looking for work because of the pandemic (20.4 percent food insecure in the same 30-day period).
Objective
To determine the temporal directionality of the association between food insecurity and maternal depression.
Design
Food insecurity was measured at two time points using the 18-item USDA Food Security Scale. Maternal depression was measured at two time points using the 15-item Composite International Diagnostic Interview-Short Form. Two structural equation models were utilized to evaluate the impact of food insecurity on maternal depression (model 1) and the impact of maternal depression on food insecurity (model 2). Both models controlled for socio-demographic and parenting characteristics and child behavior problems, along with prior measures of the dependent variable, concurrent measures of the independent variable.
Setting
Fragile Families and Child Wellbeing (FFCW) study, 20 cities across the United States
Participants
4,897 mothers who participated in two waves of the FFCW study.
Results
On average, 17% (time 1) and 15% (time 2) of mothers experienced food insecurity and 21% (time 1) and 17% (time 2) of mothers experienced depression over time. Maternal depression at time 1 was associated with 53% increased odds (OR=1.53; B=0.43; p <.001) of food insecurity at time 2, controlling for time 1 food insecurity, concurrent depression, and covariates. Food insecurity at time 1 was associated with 36% increased odds (OR=1.36; B=0.31; p <.001) of maternal depression at time 2, controlling for time 1 depression, concurrent food insecurity, and covariates.
Conclusions
We found a bidirectional relationship between food insecurity and maternal depression. A holistic approach that combines food assistance and mental health services may be an efficacious approach to reducing both depressive symptoms food insecurity among low-income mothers.
An estimated 88.2 percent of U.S. households were food secure throughout the entire year
in 2017, meaning they had access at all times to enough food for an active, healthy life
for all household members. The remaining households (11.8 percent) were food insecure
at least some time during the year, including 4.5 percent with very low food security,
meaning that at times the food intake of one or more household members was reduced
and their eating patterns were disrupted because the household lacked money and other
resources for obtaining food. Declines from 2016 in food insecurity overall and in very
low food security were statistically significant. The rate of food insecurity declined from
12.3 percent in 2016, and very low food security declined from 4.9 percent, continuing
downward trends. Among children, changes from 2016 in food insecurity and very low
food security were not statistically significant. Children and adults were food insecure in
7.7 percent of U.S. households with children in 2017, versus 8.0 percent in 2016. Very low
food security among children was 0.7 percent in 2017, essentially unchanged from 2016.
In 2017, the typical food-secure household spent 23 percent more on food than the typical
food-insecure household of the same size and household composition. About 58 percent
of food-insecure households participated in one or more of the three largest Federal food
and nutrition assistance programs (Supplemental Nutrition Assistance Program (SNAP,
formerly food stamps); Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC); and the National School Lunch Program) during the month prior to the
2017 survey.
This supplement provides statistics that complement those in Household Food Security in
the United States in 2015 (ERR-215). That research report provides the primary national
statistics on household food security, food spending, and use of Federal food and nutrition
assistance programs by food-insecure households. This Supplement provides additional
statistics on component items of the household food security measure, the frequency of
occurrence of food insecure conditions, and selected statistics on household food security, food spending, and use of Federal and community food and nutrition assistance programs.
Objective
We reviewed cohort studies to determine the magnitude and temporal direction of the association between recent intimate partner violence (IPV) and a range of adverse health outcomes or health risk behaviours.
Design
Systematic review and meta-analysis.
Methods
Medline, EMBASE and PsycINFO were searched from the first record to November 2016. Recent IPV was defined as occurring up to and including the last 12 months; all health outcomes were eligible for inclusion. Results were combined using random-effects meta-analysis.
Results
35 separate cohort studies were retrieved. Eight studies showed evidence of a positive association between recent IPV and subsequent depressive symptoms, with a pooled OR from five estimates of 1.76 (95% CI 1.26 to 2.44, I²=37.5%, p=0.172). Five studies demonstrated a positive, statistically significant relationship between depressive symptoms and subsequent IPV; the pooled OR from two studies was 1.72 (95% CI 1.28 to 2.31, I²=0.0%, p=0.752). Recent IPV was also associated with increased symptoms of subsequent postpartum depression in five studies (OR=2.19, 95% CI 1.39 to 3.45, p=0.000), although there was substantial heterogeneity. There was some evidence of a bidirectional relationship between recent IPV and hard drug use and marijuana use, although studies were limited. There was no evidence of an association between recent IPV and alcohol use or sexually transmitted infections (STIs), although there were few studies and inconsistent measurement of alcohol and STIs.
Conclusions
Exposure to violence has significant impacts. Longitudinal studies are needed to understand the temporal relationship between recent IPV and different health issues, while considering the differential effects of recent versus past exposure to IPV. Improved measurement will enable an understanding of the immediate and longer term health needs of women exposed to IPV. Healthcare providers and IPV organisations should be aware of the bidirectional relationship between recent IPV and depressive symptoms.
PROSPERO registration number
CRD42016033372.
Food insecurity is a persistent concern in high-income countries, and has been associated with poor mental health, particularly among females. We conducted a scoping review to characterize the state of the evidence on food insecurity and mental health among women in high-income countries. The research databases PubMed, EMBASE, and psycINFO were searched using keywords capturing food insecurity, mental health, and women. Thirty-nine articles (representing 31 unique studies/surveys) were identified. Three-quarters of the articles drew upon data from a version of the United States Department of Agriculture Household Food Security Survey Module. A range of mental health measures were used, most commonly to measure depression and depressive symptoms, but also anxiety and stress. Most research was cross-sectional and showed associations between depression and food insecurity; longitudinal analyses suggested bidirectional relationships (with food insecurity increasing the risk of depressive symptoms or diagnosis, or depression predicting food insecurity). Several articles focused on vulnerable subgroups, such as pregnant women and mothers, women at risk of homelessness, refugees, and those who had been exposed to violence or substance abuse. Overall, this review supports a link between food insecurity and mental health (and other factors, such as housing circumstances and exposure to violence) among women in high-income countries and underscores the need for comprehensive policies and programs that recognize complex links among public health challenges.
Little research has assessed the impact of emotional intimate partner violence (IPV) and economic IPV on women’s mental health. Using cross-sectional data from the Stepping Stones and Creating Futures intervention trial baseline, in eThekwini Municipality, South Africa we assess three questions. First, whether emotional IPV and economic IPV make independent contributions to mental health outcomes; second what matters, severity, variety, or absolute experience? and third, are some items more important in driving mental health impacts than others? We assess associations between past 12-month emotional IPV, past 12-month economic IPV, and past week depressive symptoms and past four-week suicidal ideation. We describe the prevalence of each mental health outcome by individual items, including never/ever and frequency, and combined emotional IPV, and economic IPV, reporting depression scores and percentage of suicidal ideation and 95% confidence intervals (CI). Second, we created four-level categorical variables for combinations of emotional, economic, sexual and physical IPV, and present its frequency, and the mean/% and 95% CI for depression symptomatology and suicidal ideation. 680 women (aged 18–30) were enrolled. High levels of past year emotional IPV, economic IPV were reported. 45.3% reported clinically relevant symptoms of depression, and 30.0% past four-week suicidal ideation. All measures of emotional IPV and economic IPV showed a consistent positive correlation with CESD scores, and suicidal ideation. For all four-level categorical constructs the highest depression scores, and prevalence of suicidal ideation, were for combinations of emotional IPV or economic IPV with physical and/or sexual IPV. For depression in 17/18 combinations this was significantly different compared to women reporting no IPV. For suicidal ideation this was significant in 6/18 combinations all related to economic IPV. Emotional IPV and economic IPV have independent associations with women’s mental health, beyond physical IPV and sexual IPV, and also have distinct patterns between each other.
Trial registration
NCT03022370. Registered 13 January 2017, retrospectively registered.
An estimated 86.0 percent of American households were food secure throughout the entire year in 2014, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.0 percent) were food insecure at least some time during the year, including 5.6 percent with very low food security, meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. The change in food insecurity overall from the prior year (from 14.3 percent in 2013) was not statistically significant. The cumulative decline in food insecurity from 2011 (14.9 percent) to 2014 (14.0 percent) was statistically significant. The prevalence rate of very low food security was essentially unchanged from 5.6 percent in 2013 and 5.7 percent in 2011 and 2012. Children and adults were food insecure in 9.4 percent of households with children in 2014, essentially unchanged from 9.9 percent in 2013 and 10.0 percent in 2011 and 2012. In 2014, the typical foodsecure household spent 26 percent more on food than the typical food-insecure household of the same size and household composition. Sixtyone percent of all food-insecure households participated in one or more of the three largest Federal food and nutrition assistance programs during the month prior to the 2014 survey.
Background
Sensitive and responsive maternal caregiving behavior strengthens infant self-regulatory capacities (HL), but this regulatory role may be diminished in some mothers with second-trimester prenatal exposure to depression and/ or anxiety (MDA). This study examined maternal and infant behavior during infant heel lance (HL) when mothers had or did not have MDA. Ethological methods and micro-analytic approaches capable of distinguishing and comparing time-based patterning in maternal and infant behavior were used to clarify biological mechanisms, such as MDA, that may underlie observed behavior. Aims were to examine group differences in caregiving behavior between mothers with and without MDA 5 min Pre-HL and 5 min Post-H, and relationships between MDA, maternal caregiving behavior and infant pain behavior self-regulation, concurrently. Methods
At second trimester, mothers were assessed for symptoms of mild-severe depression or anxiety. Mothers whose scores exceeded predetermined cut-off scores on one or more of the mental health measures were allocated to the MDA-exposure group, those below to the non-MDA-exposure group. Reliable observers, blinded to MDA status and study phases, coded video records of the caregiving behavior of each study mother for the full duration of the 5 min Pre-HL and 5 min Post-HL study phases. Group differences and associations between mean measures of maternal mental health scores, time-based measures of maternal behavior, and time-based measures of infant pain behavior regulation (previously coded) were concurrently analyzed using comparative and correlational statistics. ResultsMDA-exposed mothers spent significantly more time not embracing, engaging or responding to infant cues than maternal controls Pre-HL and Post-HL. MDA was associated with atypical maternal caregiving behavior, which in turn was related to atypical infant pain behavior self-regulation during and after the HL. Conclusion
Our findings have implication for practice. We recommend inclusion of mothers with MDA and their infants in interventions that strengthen the early mother-infant interaction and mother’s regulatory caregiving role. MDA and maternal caregiving behavior must be considered in future infant pain studies to examine if they confound effectiveness of mother driven caregiving interventions for neonatal pain. We highlight the importance of examining maternal mental health throughout the perinatal and postnatal trajectory, and particularly the newborn period.
Objectives:
We examined associations of physical intimate partner violence (PIPV) with selected mental health disorders using a nationally representative sample of emergency department (ED) discharges corresponding to men and women (18-64 years) from the 2010 Nationwide Emergency Department Sample.
Methods:
PIPV was determined using International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) external cause of injury code E967.3 (battering by spouse or partner). ICD-9-CM clinical classification of discharge diagnoses was used to identify mental health disorders. Multivariable logistic regression models were constructed to estimate adjusted odds ratios (ORadj) and their 95% confidence intervals (CIs).
Results:
PIPV prevalence was estimated at 0.36 per 1000 ED discharges. The strongest correlates of PIPV were alcohol-related (ORadj = 3.02, 95% CI: 2.62-3.50), adjustment (ORadj = 2.37, 95% CI: 1.56-3.58), intentional self-harm (ORadj = 1.41, 95% CI: 1.05-1.89), anxiety (ORadj = 1.23, 95% CI: 1.07-1.40), drug-related (ORadj = 1.22, 95% CI: 1.01-1.47), and mood (ORadj = 1.16, 95% CI: 1.04-1.31) disorders. PIPV's association with alcohol-related disorders was stronger among women (ORadj = 3.22, 95% CI: 2.79-3.72) versus men (ORadj = 1.98, 95% CI: 1.42-2.77). Similarly, drug-related disorders were stronger correlates of PIPV among women (ORadj = 1.32, 95% CI: 1.09-1.60) versus men (ORadj = 0.59, 95% CI: 0.31-1.16).
Conclusions:
In EDs, PIPV was linked to several mental health disorders, with women experiencing comorbid PIPV and substance use more frequently than men.
Background: Contextual factors, such as exposure to stressors, may be antecedents to IPV perpetration. These contextual factors may be amenable to modification through intervention and prevention. However, few studies have examined specific contextual factors. To begin to address this gap, we examined the associations between financial stressors and three types of physical IPV perpetration.
Methods: This analysis used data from Wave IV of The National Longitudinal Study of Adolescent to Adult Health. We used logistic regression to examine the associations of financial stressors and each type of IPV (minor, severe,
causing injury), and multinomial logit regression to examine the associations of financial stressors and patterns of co-occurring types of IPV perpetration (only minor; only severe; minor and severe; minor, severe, and causing injury; compared with no perpetration).
Results: Fewer men perpetrated threats/minor physical IPV (6.7 %) or severe physical IPV (3.4 %) compared with women (11.4 % and 8.8 %, respectively). However, among physical IPV perpetrators, a higher percentage of men (32.0 %) than women (21.0 %) reported their partner was injured as a result of the IPV. In logistic regression models of each type of IPV perpetration, both the number of stressors experienced and several types of financial stressors were associated with perpetrating each type of IPV. Utilities nonpayment, housing nonpayment, food insecurity, and no phone service were associated with increased odds of perpetrating each form of IPV in adjusted analysis. Eviction was associated with perpetrating severe physical IPV but not threats/minor IPV or IPV causing injury. In multinomial logit regression comparing patterns of IPV perpetration to perpetrating no physical IPV, the relationships of financial stressors were less consistent. Food insecurity was associated with perpetrating only minor physical IPV. Comparatively, overall number of financial stressors and four types of financial stressors (utilities nonpayment, housing nonpayment, food insecurity, and disconnected phone service) were associated with perpetrating all three
forms of physical IPV.
Conclusions: Combined with prior research, our results suggested interventions to improve financial well-being may be a novel way to reduce physical IPV perpetration.
Objective:
to identify the relationship between posttraumatic stress disorder, trait and state anxiety, and intimate partner violence during pregnancy.
Method:
observational, cross-sectional study developed with 358 pregnant women. The Posttraumatic Stress Disorder Checklist - Civilian Version was used, as well as the State-Trait Anxiety Inventory and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence.
Results:
after adjusting to the multiple logistic regression model, intimate partner violence, occurred during pregnancy, was associated with the indication of posttraumatic stress disorder. The adjusted multiple linear regression models showed that the victims of violence, in the current pregnancy, had higher symptom scores of trait and state anxiety than non-victims.
Conclusion:
recognizing the intimate partner violence as a clinically relevant and identifiable risk factor for the occurrence of anxiety disorders during pregnancy can be a first step in the prevention thereof.
Background
Numerous social factors, generally studied in isolation, have been associated with older adults’ health. Even so, older people’s social circumstances are complex and an approach which embraces this complexity is desirable. Here we investigate many social factors in relation to one another and to survival among older adults using a social ecology perspective to measure social vulnerability among older adults.
Methods
2740 adults aged 65 and older were followed for ten years in the Canadian National Population Health Survey (NPHS). Twenty-three individual-level social variables were drawn from the 1994 NPHS and five Enumeration Area (EA)-level variables were abstracted from the 1996 Canadian Census using postal code linkage. Principal Component Analysis (PCA) was used to identify dimensions of social vulnerability. All social variables were summed to create a social vulnerability index which was studied in relation to ten-year mortality.
Results
The PCA was limited by low variance (47%) explained by emergent factors. Seven dimensions of social vulnerability emerged in the most robust, yet limited, model: social support, engagement, living situation, self-esteem, sense of control, relations with others and contextual socio-economic status. These dimensions showed complex inter-relationships and were situated within a social ecology framework, considering spheres of influence from the individual through to group, neighbourhood and broader societal levels. Adjusting for age, sex, and frailty, increasing social vulnerability measured using the cumulative social vulnerability index was associated with increased risk of mortality over ten years in a Cox regression model (HR 1.04, 95% CI:1.01-1.07, p = 0.01).
Conclusions
Social vulnerability has important independent influence on older adults’ health though relationships between contributing variables are complex and do not lend themselves well to fragmentation into a small number of discrete factors. A social ecology perspective provides a candidate framework for further study of social vulnerability among older adults.
Background:
Examination of maternal experiences of intimate partner violence (IPV) and depression as risk factors for food insecurity can provide a more nuanced understanding of the role that the family environment and women's health plays in the lives of families with young children that experience food insecurity. We investigated the longitudinal association between mothers' experiences of IPV and household food insecurity, and whether maternal depression mediated the relationship.
Methods:
IPV, depression, and food insecurity were assessed among 1,690 socioeconomically disadvantaged mothers of young children who participated in the Fragile Families and Child Wellbeing study. Longitudinal multivariate logistic regression models were used to examine the association between IPV measured 3 years after the child's birth and increase in food insecurity from child's third to fifth birthday, as well as the mediating role of maternal depression, controlling for a number of maternal and household characteristics.
Results:
Mothers who reside in food insecure households and those who experience IPV share similar characteristics of socioeconomic disadvantage and a greater propensity for depression compared to their counterparts. Mothers' experiences of IPV predicted an increased risk of household food insecurity two years later, and the relationship was mediated by maternal depression.
Conclusions:
Food insecure mothers may benefit from widespread assistance. Targeting issues central to women's health must become a priority in combating food insecurity. Having IPV and mental health screenings coincide with food assistance applications may help identify women who would benefit from resources designed to increase physical safety, psychological well-being, and food security.
Latin America has among the highest rates of intimate partner violence. While there is increasing evidence that intimate partner violence is associated with mental health problems, there is little such research for developing countries. The purpose of this paper is to examine the relationship between Bolivian women's experiences with physical, psychological, and sexual intimate partner violence and mental health outcomes.
This study analyzes data from the 2008 Bolivia Demographic and Health Survey. 10,119 married or cohabiting women ages 15--49 are included in the analysis. Probit regression models are used to assess the association between intimate partner violence and mental health, after controlling for other demographic factors and partner characteristics. The questionnaire uses selected questions from the SRQ-20 to measure symptoms of mental health problems.
Intimate partner violence is common in Bolivia, with 47% of women experiencing some type of spousal abuse in the 12 months before the survey. Women exposed to physical spousal violence in the past year are more likely to experience symptoms of depression, anxiety, psychogenic non-epileptic seizures, and psychotic disorders, after controlling for other demographic and partner characteristics. Women who experienced sexual abuse by a partner are most likely to suffer from all mental health issues. Psychological abuse is also associated with an increased risk of experiencing symptoms of depression, anxiety, and psychogenic seizures. Women who experienced only psychological abuse report mental health problems similar to those who were physically abused.
This study demonstrates an urgent need for research on the prevalence and health consequences of psychological abuse in developing countries. Our findings highlight the need for mental health services for victims of intimate partner violence. Because physical and psychological violence are often experienced concurrently, it is recommended that health providers who are treating victims of physical intimate partner violence also screen them for symptoms of potential mental health problems and refer them to appropriate mental health services.
This article describes a revised Conflict Tactics Scales (the CTS2) to measure psychological and physical attacks on a partner in a marital, cohabiting, or dating relationship; and also use of negotiation. The CTS2 has (a) additional items to enhance content validity and reliability; (b) revised wording to increase clarity and specificity; (c) better differentiation between minor and severe levels of each scale; (d) new scales to measure sexual coercion and physical injury; and (e) a new format to simplify administration and reduce response sets. Reliability ranges from .79 to .95. There is preliminary evidence of construct validity.
The WHO Multi-country Study on Women’s Health and Domestic Violence against Women is a landmark research project, both in its scope and in how it was carried out. For the results presented in this report, specially trained teams collected data from over 24 000 women from 15 sites in 10 countries representing diverse cultural settings: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania.
Depression and suicide are responsible for a substantial burden of disease globally. Evidence suggests that intimate partner violence (IPV) experience is associated with increased risk of depression, but also that people with mental disorders are at increased risk of violence. We aimed to investigate the extent to which IPV experience is associated with incident depression and suicide attempts, and vice versa, in both women and men.
We conducted a systematic review and meta-analysis of longitudinal studies published before February 1, 2013. More than 22,000 records from 20 databases were searched for studies examining physical and/or sexual intimate partner or dating violence and symptoms of depression, diagnosed major depressive disorder, dysthymia, mild depression, or suicide attempts. Random effects meta-analyses were used to generate pooled odds ratios (ORs). Sixteen studies with 36,163 participants met our inclusion criteria. All studies included female participants; four studies also included male participants. Few controlled for key potential confounders other than demographics. All but one depression study measured only depressive symptoms. For women, there was clear evidence of an association between IPV and incident depressive symptoms, with 12 of 13 studies showing a positive direction of association and 11 reaching statistical significance; pooled OR from six studies = 1.97 (95% CI 1.56-2.48, I (2) = 50.4%, p heterogeneity = 0.073). There was also evidence of an association in the reverse direction between depressive symptoms and incident IPV (pooled OR from four studies = 1.93, 95% CI 1.51-2.48, I (2) = 0%, p = 0.481). IPV was also associated with incident suicide attempts. For men, evidence suggested that IPV was associated with incident depressive symptoms, but there was no clear evidence of an association between IPV and suicide attempts or depression and incident IPV.
In women, IPV was associated with incident depressive symptoms, and depressive symptoms with incident IPV. IPV was associated with incident suicide attempts. In men, few studies were conducted, but evidence suggested IPV was associated with incident depressive symptoms. There was no clear evidence of association with suicide attempts. Please see later in the article for the Editors' Summary.
Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time.
Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights.
Findings: Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions.
Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.
Funding: Bill & Melinda Gates Foundation.
Purpose:
Studies suggest that people who are food insecure are more likely to experience mental illness. However, little is known about which aspects of food insecurity place individuals most at risk of mental illness. The purpose of this study was to establish the prevalence of mental illness among food insecure Canadians, and examine whether mental illness differs between those who are consuming insufficient amounts of food versus poor quality foods.
Methods:
This analysis utilized the publically available dataset from the Canadian Community Health Survey cycle 4.1. Bivariable and multivariable logistic regression were used to examine the associations between food insecurity and mental health disorder diagnosis, while adjusting for potential confounders. Stratified analyses were used to identify vulnerable sub-groups.
Results:
Among 5,588 Canadian adults (18-64 years) reporting food insecurity, 58 % reported poor food quality and 42 % reported food insufficiency. The prevalence of mental health diagnosis was 24 % among participants with poor food quality, and 35 % among individuals who were food insufficient (hunger). After adjusting for confounders, adults experiencing food insufficiency had 1.69 adjusted-odds [95 % confidence interval (CI): 1.49-1.91] of having a mental health diagnosis. Stratified analyses revealed increased odds among women (a-OR 1.89, 95 % CI 1.62-2.20), single parent households (a-OR 2.05, 95 % CI 1.51-2.78), and non-immigrants (a-OR 1.88, 95 % CI 1.64-2.16).
Conclusion:
The prevalence of mental illness is alarmingly high in this population-based sample of food insecure Canadians. These findings suggest that government and community-based programming aimed at strengthening food security should integrate supports for mental illness in this population.
Poor housing conditions and residential instability have been associated with distress among women; however, this association could be the result of other social factors related to housing, such as intimate partner violence (IPV) and economic hardship. We examined associations of housing conditions and instability with maternal depression and generalized anxiety disorder (GAD) while accounting for IPV and economic hardship in the Fragile Families and Child Wellbeing Study (N = 2,104). In the third study wave, interviewers rated indoor housing quality, including housing deterioration (e.g., peeling paint and holes in floor) and housing disarray (e.g., dark, crowded, and noisy). Mothers reported whether they had moved more than twice in the past two years, an indicator of housing instability. A screening for depression and GAD was obtained from questions derived from the Composite International Diagnostic Interview-Short Form in the second and third study waves. IPV and economic hardship were assessed through questionnaire. In this sample, 16% of women were classified as having probable depression and 5% as having probable GAD. In adjusted analyses, mothers experiencing housing disarray (odds ratio [OR], 1.3 [95% confidence interval (CI), 1.0, 1.7]) and instability (OR, 1.4 [95% CI, 1.2, 2.3]) were more likely to screen positive for depression. In addition, those experiencing housing instability were more likely to screen positive for GAD (OR 1.9 [95% CI, 1.2, 3.0]) even after adjusting for other social factors. No associations were noted between housing deterioration and maternal mental health. Similar associations were noted when incident cases of probable depression and GAD were examined. Housing instability and disarray, but not deterioration, are associated with screening positive for depression and generalized anxiety among women regardless of other social stressors present in their lives. Housing could potentially present a point of intervention to prevent mental health consequences among mothers and possibly their children.
depression remains a major public health problem that is most often evaluated and treated in primary care settings. The objective of this study was to examine the prevalence, treatment, and control of depressive symptoms in a national data sample using a common primary care screening tool for depression.
we analyzed a sample of adults (n = 4836) from 2005 to 2008 National Health and Nutrition Examination Survey data. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) to determine the overall prevalence, rates of treatment, and antidepressant control of mild, moderate, moderately severe, and severe depressive symptoms.
of the sample, 20.1% reported significant depressive symptoms (PHQ-9) score, ≥ 5), the majority of whom had mild depressive symptoms (PHQ-9) score, 5-9). Even among individuals with severe depressive symptoms, a large percentage (36.9%) received no treatment from a mental health professional or with antidepressant medication. Of those taking antidepressants, 26.4% reported mild depressive symptoms and 18.8% had moderate, moderately severe, or severe depressive symptoms.
despite greater awareness and treatment of depression in primary care settings, the prevalence of depressive symptoms remains high, treatment levels remain low, and control of depressive symptoms are suboptimal. Primary care providers need to continue to focus their efforts on diagnosing and effectively treating this important disease.
Depression has been found to predict the incidence of hypertension and other adverse cardiovascular events in prospective studies. Insomnia and short sleep duration, which are typical symptoms of depression, have also been shown to increase the risk for hypertension incidence. Insomnia is associated with increased activation of the hypothalamic-pituitary-adrenal axis, and short sleep duration raises average 24-h blood pressure, which over time could lead to structural adaptations that gradually reset the entire cardiovascular system to operate at an elevated pressure equilibrium. No previous published population studies have examined whether insomnia and sleep duration mediate the relationship between depression and hypertension incidence.
We conducted multivariate longitudinal (1982-1992) analyses stratified by age of the First National Health and Nutrition Examination Survey (NHANES I) (n = 4,913) using Cox proportional hazards models.
Middle-aged subjects who suffered from depression at baseline were 44% more likely to be diagnosed with hypertension over the follow-up period after controlling for covariates (hazard ratio (HR) = 1.44, 95% confidence interval (CI) 1.15-1.80). Both short sleep duration and insomnia were also significantly associated with hypertension incidence. Consistent with insomnia and sleep duration acting as mediators of the relationship between depression and hypertension incidence, the inclusion of these variables in the multivariate models appreciably attenuated the association (HR = 1.27, 95% CI 1.00-1.61). Depression, sleep duration, and insomnia were not significantly associated with hypertension incidence in elderly subjects.
These results suggest the hypothesis that treatment of sleep problems in middle-aged individuals suffering from depression could reduce their risk for developing hypertension, and its vascular and cardiac complications.
Historically, substance abuse treatment has developed as a single-focused intervention based on the needs of addicted men. Counselors focused only on the addiction and assumed that other issues would either resolve themselves through recovery or would be dealt with by another helping professional at a later time. However, treatment for women's addictions is apt to be ineffective unless it acknowledges the realities of women's lives, which include the high prevalence of violence and other types of abuse. A history of being abused increases the likelihood that a woman will abuse alcohol and other drugs. This article presents the definition of and principles for gender-responsive services and the Women's Integrated Treatment (WIT) model. This model is based on three foundational theories: relational-cultural theory, addiction theory, and trauma theory. It also recommends gender-responsive, trauma-informed curricula to use for women's and girls' treatment services.
Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors.
We analyzed the data collected from 177,047 participants (aged>or=18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software.
The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMI<18.5 kg/m(2)), in women who were overweight (BMI: 25-<30 kg/m(2)) or obese (BMI>or=30 kg/m(2)), and in men who had class III obesity (BMI>or=40 kg/m(2)) than in those with a normal BMI (18.5-<25 kg/m(2)). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMI>or=40 kg/m(2) were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMI<18.5 kg/m(2) were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders.
Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.
Household food insecurity has been associated with several negative health outcomes, yet little is known about the prevalence and correlates of household food insecurity during pregnancy. This study was conducted as part of the Pregnancy, Infection, and Nutrition prospective cohort study to identify risk factors of preterm birth. The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes <or= 400% of poverty. Descriptive statistics and logistic regression were used to identify socioeconomic, demographic, and psychosocial predictors of household food insecurity. Among 606 pregnant women, 75% were from fully food-secure, 15% from marginally food-secure, and 10% from food-insecure households. Women from marginally food-secure and food-insecure households had significantly less income, less education, and were older than women from fully food-secure households. In bivariate analysis, all psychosocial factors were significantly associated with household food insecurity and showed a dose-response relation with increasing food insecurity. Socioeconomic and demographic predictors for household food insecurity were income, black race, and age. After controlling for socioeconomic and demographic variables, psychosocial indicators of perceived stress, trait anxiety, and depressive symptoms, and a locus of control attributed to chance were positively associated with any household food insecurity. Conversely, self-esteem and mastery were inversely associated with any household food insecurity. Psychosocial factors as well as socioeconomic and demographic indicators are associated with household food insecurity among pregnant women; however, the direction of causation between psychosocial indicators and food insecurity cannot be determined in these data.
Introduction
In a time of global uncertainty, understanding the psychological health of the American public is imperative. There are no current data on anxiety trends among adults in the United States (US) over time. This study aimed to investigate prevalence of anxiety among US adults from 2008-2018.
Methods
Data from the National Survey on Drug Use and Health (NSDUH), which is an annual, cross-sectional survey on substance use and mental health in the US, were analyzed in 2020. Prevalence of past-month anxiety was estimated among those ages ≥18, by survey year from 2008 to 2018. Time trends were tested using logistic regression.
Results
Anxiety increased from 5.12% in 2008 to 6.68% in 2018 (p<.0001) among adult Americans. Stratification by age revealed the most notable increase from 7.97% to 14.66% among respondents 18-25 years old (p<.001), which was a more rapid increase than among 26-34 and 35-49 year olds (differential time trend p<.001). Anxiety did not significantly increase among those ages 50 and older. Anxiety increased more rapidly among those never married and with some college education, relative to their respective counterparts. Apart from age, marital status and education, anxiety increased consistently among sociodemographic groups.
Conclusions
Anxiety is increasing among adults under age 50 in the US, with more rapid increase among young adults. To prepare for a healthier adulthood and given direct and indirect (via 24/7 media) exposure to anxiety-provoking world events, prophylactic measures that can bolster healthy coping responses and/or treatment seeking seem warranted on a broad scale.
Background:
We aimed to assess the relationship between intimate partner violence (IPV) and maternal mental health ten years after a first birth METHODS: 1507 first-time mothers completed questionnaires at 3, 6, 12 and 18 months postpartum and 4 and ten years post the index birth. Exposure to IPV was assessed using the Composite Abuse Scale at 1, 4 and ten years. Standardised measures of depressive (CES-D), anxiety (BAI) and post-traumatic stress symptoms (PCL-C) were completed at ten-year follow-up.
Results:
One in three (34%) women experienced IPV between the birth of their first child and their child turning 10. For the one in six women (18.6%) who experienced IPV in the year prior to ten-year follow-up, the prevalence of depressive symptoms was 38.9% compared with 14.2% for women who never reported IPV (adjusted odds ratio [AdjOR] 2.9, 95% confidence interval [CI] 1.9-4.5). Prevalence of anxiety symptoms was 28.1% compared with 8.5% (AdjOR 3.4, 95% CI 2.0-5.9); and prevalence of post-traumatic stress symptoms was 41.9% compared with 11.3% (AdjOR 4.9, 95% CI 3.0-7.9).
Limitations:
Mental health symptoms and exposure to IPV were assessed by self-report and may be subject to misclassification bias as a result of non-disclosure.
Conclusions:
The high prevalence of mental health symptoms among women exposed to IPV in the ten years after giving birth coupled with the extent of post-traumatic stress symptoms and co-morbid mental health symptoms reinforce the need to provide appropriate care and referral pathways to women in the decade after having a baby. Recognition of the context of IPV and nature of mental health concerns is needed in tailoring responses.
Background:
Food insecurity-the inability to provide adequate food for at least one household member sometime during the year-is linked to negative physical and mental health outcomes. Child reports of experiences in other domains of life are only moderately related to parental proxy reports of the same experiences. The goal of our study was to assess the convergence of parent and child reports of food insecurity and several specific mental health symptoms.
Methods:
Dyads of parents and children attending medical appointments were surveyed. Inclusion criteria consisted of English-speaking adults and their children between the ages of 8 and 17 years.
Results:
Sixty-two percent of adults and 50% of children self-reported meeting screening criteria for food insecurity, and adult-child dyad reports were significantly correlated. However, when asked about the child worrying about food running out or having eaten less than desired in order to conserve food, adult and child reports diverged significantly, with adults more frequently underestimating worry and conservation behaviors compared to child self-reports. Similar discrepancies were found for items probing specific symptoms of depression, general anxiety, and obsessive-compulsive disorder.
Conclusion:
Our data show that adults may not accurately perceive the subjective effects of food insecurity on children in their household, particularly in households receiving food assistance, perhaps because of objectively greater need. Because food insecurity may have profound effects on child development, pediatricians should be aware of the mental health risks for children in food-insecure homes.
Objectives:
To investigate associations between household food insecurity and multiple family well-being variables in an effort to illuminate previously understudied, policy-amenable mechanisms through which food insecurity threatens healthy development.
Study design:
Data are drawn from the nationally representative Early Childhood Longitudinal Study-Birth Cohort. The Early Childhood Longitudinal Study-Birth Cohort contains longitudinal data on household food insecurity and several family well-being factors including maternal physical and mental health, positive parenting practices and disciplinary strategies, and frequency and severity of spousal conflict. We use regression models with lagged dependent variables to estimate associations between food insecurity and family well-being outcomes, on a subsample of low-income families (N ≈ 2100-4700).
Results:
Household food insecurity was significantly associated with poorer maternal physical health; increased depressive symptoms and use of harsh discipline strategies; and greater frequency and negativity of conflict between parents. Associations were strongest and most consistent when children were preschool aged. Transitions into food insecurity between toddlerhood and preschool were also associated with significantly worse parental physical and mental health outcomes, and more family conflict, with similar though slightly weaker and less consistent associations for transitioning into food insecurity between infancy and toddlerhood.
Conclusions:
Food insecurity is associated with significant decreases in family health and well-being. Clinicians and other public health officials play a critical role in assessing risk for children and families, and linking families with supportive services. Screening families experiencing or at risk for food insecurity and connecting them with resources is an avenue through which public health practitioners can support family health.
Gender inequities place women at an increased risk for HIV acquisition, and this association may particularly disenfranchize young pregnant women. Intimate partner violence (IPV) and food insecurity may contribute to gender differences in power, thereby influencing HIV disparities between women and men. Factors influencing gender disparities in HIV are unique and country-specific within sub-Saharan Africa, yet these factors are understudied among women in Liberia. This paper sought to examine the unique contributions and intersections of intimate partner violence (IPV) and food insecurity with HIV-related risk factors among young pregnant women in Liberia. Between March 2016 and August 2016, cross-sectional data collected from 195 women aged 18–30, residing in Monrovia, Liberia who were receiving prenatal services were used to examine the independent and interaction effects of IPV and food insecurity on HIV-related risk factors (i.e., sexual partner concurrency, economically-motivated relationships). IPV (31.3%) and food insecurity (47.7%) were prevalent. Young women who experience IPV are more likely to report food insecurity (p < 0.05). Young women who experienced IPV and food insecurity were more likely to start a new relationship for economic support (ps < 0.05). Young women who experience IPV and food insecurity were more likely to report engaging in transactional sex (ps < 0.05). There were no significant interaction effects between IPV and food insecurity (ps > 0.05). IPV and food insecurity each uniquely heighten young Liberian women’s vulnerability to HIV. Intervention and policy efforts are need to promote and empower women’s sexual health through integrated sexual and reproductive health services, and reduce IPV and food insecurity among pregnant Liberian women.
The objective of this study was to investigate associations between household food insecurity, maternal clinical depression, and child behavior problems in low-income Latino households. Data were collected from a cohort of 168 children and their Latina mothers recruited prenatally at two San Francisco hospitals from 2006 to 2007. Food insecurity at year four was associated with increased odds of maternal clinical depression at years four to five (adjusted OR 1.22, 95% confidence interval 1.03–1.43). Food insecurity at year four was associated with child pervasive developmental problems at year five (B = 0.21, p = 0.041) in adjusted models. The association between food insecurity at year four and oppositional defiant problems at year five was partially mediated (28.7% mediation, p = 0.046) by maternal clinical depression in years four and five. Our results suggest that household food insecurity is associated with greater maternal depression, and both food insecurity and maternal depression uniquely predict certain types of child behavior problems. Assessing for and addressing household food insecurity may be beneficial additions to psychosocial interventions targeting maternal and child mental health.
Abbreviations: DSM: Diagnostic and Statistical Manual; CBCL: Child Behavior Checklist; MINI: Mini International Neuropsychiatric Interview; US HFSSM: US Household Food Security Scale Module
Background:
Intimate partner violence (IPV) and mental disorders (MD) are important public health problems disproportionally affecting women. We aimed to study the epidemiology of IPV victimization, MD, and co-occurring IPV-MD in Spanish men and women in terms of i) prevalence, ii) association between IPV and MD, and iii) sociodemographic and clinical characteristics associated with IPV, MD, and co-occurring IPV-MD.
Methods:
Community-based cross-sectional study with 4507 randomly selected participants. Measurement instruments (Mini International Neuropsychiatric Interview and set of validated questions about IPV during the last 12 months) were administered by trained interviewers in participants' households. Statistical analyses included multivariate logistic regression models.
Results:
The prevalence of IPV was 9.4%, of MD 22.3%, and of co-occurring MD-IPV 4.4%. MD was associated with higher odds of experiencing IPV (OR = 3.6; p < 0.05). Lack of social support, neuroticism, impulsivity, and family history of MD were associated with higher odds of IPV, MD, and co-occurring IPV-MD in men and women. Poor health status was associated with MD and with co-occurring IPV-MD in men and women. In women, not being married was associated with MD and with co-occurring IPV-MD; having a non-Spanish nationality was associated with IPV and co-occurring IPV-MD; and older age with IPV. In men, younger age was associated with MD.
Limitations:
The cross-sectional nature of this study limited our ability to examine causal inferences.
Conclusions:
MD and IPV are strongly associated. Although less frequently than in women, IPV in men is also associated with depression, post-traumatic and mood disorders, which has relevant implications for healthcare delivery.
Depression is a highly prevalent risk factor for incident coronary heart disease (CHD) and for cardiovascular morbidity and mortality in patients with established CHD. Several biological and behavioural mechanisms have been hypothesized to underlie the relationship between depression and CHD, but none has been shown to account for more than a small proportion of the risk. Only a few clinical trials have examined whether treating depression decreases the risk of cardiac events in patients with established CHD. None of these trials has shown that treatment results in improved cardiac outcomes, but the differences in depression outcomes between the intervention and control groups have been small and not clinically significant. Nevertheless, secondary analyses of these trials suggest that prognosis improves when depression improves. Concerted efforts to develop more potent interventions for depression, identification of high-risk subtypes of depression, and further research on the biobehavioural mechanisms linking depression to CHD are needed to pave the way for definitive clinical trials.
Objective
To investigate the direct and indirect associations between psychological and physical intimate partner violence and the occurrence of common mental disorders (CMD) and how they relate to the occurrence of household food insecurity (HFI).
Design
This was a population-based cross-sectional study. Intimate partner violence was assessed using the Brazilian version of the Revised Conflict Tactics Scale (CTS2) and HFI was assessed using the Brazilian Food Insecurity Scale. The propositional analytical model was based on a review of the literature and was tested using path analysis.
Setting
Duque de Caxias, Greater Rio de Janeiro, Brazil (April–December 2010).
Subjects
Women (
n
849) who had been in a relationship in the 12 months preceding the interview.
Results
Both psychological and physical violence were found to be major risk factors of HFI. Psychological violence was associated with HFI indirectly via physical violence and CMD, and directly by an unidentified path. The effects of physical violence seemed to be manifested exclusively through CMD. Most of the variables in the propositional model related to socio-economic position, demographic characteristics, degree of women’s social support and partner alcohol misuse were retained in the ‘final’ model, indicating that these factors contribute significantly to the increased likelihood of HFI.
Conclusions
The results reinforce the importance of considering domestic violence and other psychosocial aspects of family life when implementing interventions designed to reduce/eradicate HFI.
Objective:
To determine the relations between household material hardships and having a low internal locus of control over the prevention of child obesity in low-income Hispanic pregnant women.
Methods:
We performed a cross-sectional analysis of baseline data collected during a third trimester prenatal visit from women participating in the Starting Early Study, a randomized controlled trial to test the efficacy of a primary care-based family-centered early child obesity prevention intervention. Using multiple logistic regression analyses, we determined whether four domains of material hardship (food insecurity, difficulty paying bills, housing disrepair, neighborhood stress), considered both individually and cumulatively, were associated with having a low internal locus of control over the prevention of child obesity.
Results:
The sample included 559 low-income Hispanic pregnant women, with 60% having experienced at least one hardship. Food insecurity was independently associated with a low internal locus of control over the prevention of child obesity (AOR 2.38, 95% CI 1.50 - 3.77), controlling for other hardships and confounders. Experiencing a greater number of material hardships was associated in a dose-dependent relationship to an increased odds of having a low internal locus of control.
Conclusions:
Prenatal material hardships, in particular food insecurity, were associated with having a lower prenatal internal locus of control over the prevention of child obesity. Longitudinal follow-up of this cohort is needed to determine how relations between material hardships and having a low internal locus of control will ultimately impact infant feeding practices and child weight trajectories.
Objective:
To assess the association between physical intimate partner violence and household food security within households with schoolchildren.
Design:
Cross-sectional study.
Setting:
Salvador, Bahia, north-eastern Brazil.
Subjects:
The study was conducted in 1019 households with students. Violence between couples was evaluated using the Portuguese version of the revised Conflict Tactics Scales (CTS2), previously adapted and validated for use in Brazil. The Brazilian Food Insecurity Scale (BFIS) was used to identify food insecurity. We also obtained socio-economic information for each participant. We used multivariate Poisson regression to assess the associations of interest.
Results:
According to the results of the BFIS, 62·5 % of the households were found to experience food insecurity, including 19·5 % moderate food insecurity and 6·5 % severe food insecurity. The prevalence of minor physical violence was 9·6 % (95 % CI 7·8, 11·4 %) and of severe physical violence was 4·7 % (95 % CI 3·4, 6·0 %) among the couples. In the final multivariate model, it was found that couples reporting minor (prevalence ratio=1·23; 95 % CI 1·12, 1·35) and severe (prevalence ratio=1·16; 95 % CI 1·00, 1·34) physical violence were more likely to be experiencing household food insecurity, compared with those not reporting physical violence.
Conclusions:
Physical intimate partner violence was associated with food insecurity of households. The present study brings new data to the subject of the role of violence in the context of food insecurity.
Objective:
To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management.
Method:
Representatives from the American Psychiatric Association, the American College of Obstetricians and Gynecologists and a consulting developmental pediatrician collaborated to review English language articles on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing. Articles were obtained from Medline searches and bibliographies. Search keywords included pregnancy, pregnancy complications, pregnancy outcomes, depressive disorder, depressive disorder/dt, abnormalities/drug-induced/epidemiology, abnormalities/drug-induced/et. Iterative draft manuscripts were reviewed until consensus was achieved.
Results:
Both depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, but the majority of studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder. Short-term neonatal irritability and neurobehavioral changes are also linked with maternal depression and antidepressant treatment. Several studies report fetal malformations in association with first trimester antidepressant exposure but there is no specific pattern of defects for individual medications or class of agents. The association between paroxetine and cardiac defects is more often found in studies that included all malformations rather than clinically significant malformations. Late gestational use of selective serotonin reuptake inhibitor antidepressants is associated with transitory neonatal signs and a low risk for persistent pulmonary hypertension in the newborn. Psychotherapy alone is an appropriate treatment for some pregnant women; however, others prefer pharmacotherapy or may require pharmacological treatment.
Conclusions:
Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or problematic health behaviors that can adversely affect pregnancy.
To investigate the association between food insecurity and intimate partner violence in a population-based sample of heterosexual women.
Logistic regression was used to evaluate the association between three levels of food insecurity and intimate partner violence.
Data from 6 years of the California Women's Health Survey.
Randomly selected women (n 16 562) aged 18 years and older from the State of California, USA.
We found: (i) that African-American women had a higher prevalence of food insecurity and were more likely to report severe intimate partner violence; (ii) a strong positive association between food insecurity and intimate partner violence; (iii) evidence of effect modification of the association between food insecurity and intimate partner violence by marital status; and (iv) higher odds of intimate partner violence among those reporting more severe food insecurity.
Food insecurity is an important risk indicator for intimate partner violence among women. Understanding the factors that put women, especially minority women, at greatest risk facilitates intervention development.
BackgroundA growing body of research has examined maternal anxiety symptoms and disorders during the perinatal period. This systematic review provides an update of the literature reporting on the prevalence and risk factors for maternal perinatal anxiety.Methods
Three databases (PubMed, PsycInfo and Web of Science) were searched to identify articles focused on the prevalence and risk factors for maternal perinatal anxiety published between 2006 and 2014. Initially, 1416 unique papers were identified, and 98 papers met the inclusion criteria for the review.ResultsMaternal perinatal anxiety is common. The number of studies reporting prevalence estimates for perinatal anxiety disorders has grown; however, there is wide variation in reported estimates (2.6–39% for “any anxiety disorder”). Prominent risk factors identified included socio-economic disadvantage, history of poor mental health, adverse circumstances around the pregnancy and birth, and poor quality partner relationships. Complexities in reviewing this literature include significant heterogeneity in study methodology.Conclusions
There is a substantial evidence-based reporting prevalence estimates and identifying the key risk factors for maternal anxiety during the perinatal period. However, there is further need to synthesise the available literature in a meaningful way in order to translate findings into useful screening tools and intervention programs.
Analyses of cross-sectional population survey data in Canada and the United States have indicated that household food insecurity is associated with poorer self-rated health and multiple chronic conditions. The causal inference has been that household food insecurity contributes to poorer health, but there has been little consideration of how adults' health status may relate to households' vulnerability to food insecurity. Our objectives were to examine how the presence of an adult with one or more chronic physical or mental health conditions affects the odds of a household being food insecure and how the chronic ill-health of an adult within a food-insecure household affects the severity of that household's food insecurity. Using household- and respondent-level data available for 77,053 adults aged 18-64 y from the 2007-2008 Canadian Community Health Survey, we applied logistic regression analyses, controlling for household socio-demographic characteristics, to examine the association between health and household food insecurity. Most chronic conditions increased the odds of household food insecurity independent of household socio-demographic characteristics. Compared with adults with no chronic condition, the odds of household food insecurity were 1.43 (95% CI: 1.28, 1.59), 1.86 (95% CI: 1.62, 2.14), and 3.44 (95% CI: 3.02, 3.93) for adults with 1, 2, and 3 or more chronic conditions, respectively. Among food-insecure households, adults with multiple chronic conditions had higher odds of severe household food insecurity than adults with no chronic condition. The chronic ill-health of adults may render their households more vulnerable to food insecurity. This has important practice implications for health professionals who can identify and assist those at risk, but it also suggests that appropriate chronic disease management may reduce the prevalence and severity of food insecurity.
This study evaluated a community-based treatment program in Sweden for mothers subjected to intimate partner violence. Results based on group means indicated that the mothers showed significantly reduced trauma and psychological symptoms and improved sense of coherence after participating in the program. Surprisingly, no improvement regarding perceived parental locus of control was found. Furthermore, as a complement to group statistics a reliable change index was used, which resulted in more modest results regarding the effectiveness of the treatment.
The author shows how classical psychoanalytical theory and more recent developmental approaches answer the question of whether there are differences between men and women in mental health. In contrast, social theorists focus on how the different positions men and women hold as adults affect mental health. While there are no differences in their overall rates of psychopathology, men and women do differ in terms of the type of psychopathology experienced. Women have higher rates of depression and anxiety ("internalizing" disorders), and men have higher rates of substance abuse and antisocial disorders ("externalizing" disorders). Rosenfield considers various explanations for these gender differences. Divisions in power and responsibilities are critical; women earn less relative to men, tend to have jobs with less power and autonomy, and are more responsive to problems of people in their social networks—all of which can contribute to psychological distress. An unresolved question is whether men and women have different reactions to similar situations, or whether they face different circumstances and stressors. Rosenfield concludes by suggesting that socializing practices that encourage high self-regard and mastery would most benefit the mental health of both men and women. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Data are reported on a series of short-form (SF) screening scales of DSM-III-R psychiatric disorders developed from the World Health Organization's Composite International Diagnostic Interview (CIDI). A multi-step procedure was used to generate CIDI-SF screening scales for each of eight DSM disorders from the US National Comorbidity Survey (NCS). This procedure began with the subsample of respondents who endorsed the CIDI diagnostic stem question for a given disorder and then used a series of stepwise regression analyses to select a subset of screening questions to maximize reproduction of the full CIDI diagnosis. A small number of screening questions, between three and eight for each disorder, was found to account for the significant associations between symptom ratings and CIDI diagnoses. Summary scales made up of these symptom questions correctly classify between 77% and 100% of CIDI cases and between 94% and 99% of CIDI non-cases in the NCS depending on the diagnosis. Overall classification accuracy ranged from a low of 93% for major depressive episode to a high of over 99% for generalized anxiety disorder. Pilot testing in a nationally representative telephone survey found that the full set of CIDI-SF scales can be administered in an average of seven minutes compared to over an hour for the full CIDI. The results are quite encouraging in suggesting that diagnostic classifications made in the full CIDI can be reproduced with excellent accuracy with the CIDI-SF scales. Independent verification of this reproduction accuracy, however, is needed in a data set other than the one in which the CIDI-SF was developed. Copyright © 1998 Whurr Publishers Ltd.
Background:
This paper examines the degree to which symptoms of anxiety and depression at age 14 years are associated with early childhood experience of maternal anxiety and depression, poverty, and mother's marital relationship distress and break-up.
Methods:
In a longitudinal study, 4434 families were followed-up from infancy to adolescence.
Results:
Maternal anxiety and depression during early childhood were found to have small, but significant, influences upon the development of high anxiety-depression symptoms at age 14, after controlling for the effects of poverty and marital relationship factors. This effect was greater with repeated exposure to high maternal anxiety and depression. Poverty, distressed marital relationship and marital break-up during the child's first five years also produced small, but significant, increases in risk of high anxiety and depression symptoms in adolescence. Stable, single-parent status was not found to be a risk factor. There was no evidence of marked gender differences in risk factors, other than poverty, which had a stronger impact for girls than boys.
Conclusions:
Overall, the results suggest that maternal anxiety and depression, poverty, parent relationship conflict and marital break-up during early childhood are associated with small, but significant, increased risk of anxiety-depression symptoms in adolescence.
Food security exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life. Food insecurity is the converse state, is often associated with poverty and low income, and has important implications for the health and nutrition of individuals. Given their contribution to food production and preparation, their role in society as child bearers and caregivers, the increasing number of female-headed households worldwide, and their disproportionately poor economic status, women need special consideration in discussions of food insecurity and its effect on health, nutrition, and behavior. This article reviews the scientific literature on issues related to women and food insecurity. Food insecurity is associated with obesity, anxiety, and depressive symptoms; risky sexual behavior; poor coping strategies; and negative pregnancy outcomes in women, although evidence about the direction and causality of associations is unclear. There is a lack of evidence and understanding of the effects of food insecurity in resource-poor settings, including its effect on weight, nutritional outcomes, and pregnancy outcomes, as well as its effect on progression of diseases such as HIV infection. More research is needed to guide efficient interventions that address food insecurity among women. However, practical experience suggests that both short-term assistance and longer-term strategies that improve livelihoods, address behavioral and coping strategies, acknowledge the mental health components of food insecurity, and attempt to ensure that women have the same economic opportunities, access to land, and economic power as men are important.
To examine the impact of chronicity of maternal intimate partner violence (IPV) on obesity risk among preschool-aged children.
Prospective cohort study.
Several large US cities.
A subsample of the Fragile Families and Child Well-being Study participants (n = 1595), who were children born between 1998 and 2000 and their parents interviewed at baseline and at 12, 36, and 60 months.
Maternal report of restrictive, sexual, and physical abuse from an intimate partner. Chronic IPV was defined as any maternal IPV exposure during both pregnancy or infancy (0-12 months) and early childhood (36-60 months).
Repeated measures of child body mass index.
Among the 1595 children, 16.5% were obese at age 5 years and 49.4% of the mothers reported some form of IPV. Compared with those who had no IPV exposure, children whose mothers reported chronic IPV had an elevated risk for obesity at age 5 years (adjusted odds ratio = 1.80; 95% confidence interval, 1.24-2.61). Stratified analyses indicated increased risk for obesity among girls with a maternal history of chronic IPV (adjusted odds ratio = 2.21; 95% confidence interval, 1.30-3.75) compared with boys (adjusted odds ratio = 1.66; 95% confidence interval, 0.94-2.93) and a larger effect of any maternal IPV on obesity among children living in less safe neighborhoods (adjusted odds ratio = 1.56; 95% confidence interval, 1.03-2.36).
Chronic maternal IPV is associated with increased risk of obesity among preschool-aged children. Preventing family violence and improving community safety may help reduce childhood obesity.
Children from food-insecure families (ie, families that lack access to sufficient, safe, and nutritious food) are at risk for developmental problems. Food insecurity disproportionately occurs among low-socioeconomic status (SES) and low-income families; however, interventions that supplement families' income or diet have not eradicated food insecurity. This may be because food insecurity is also related to nonfinancial factors such as the presence of maternal mental health problems. To clarify whether addressing mothers' mental health problems may be a promising strategy for reducing the burden of food insecurity, we tested the hypothesis that low-SES families are especially vulnerable to food insecurity when the mother experiences depression, alcohol or drug abuse, psychosis spectrum disorder, or domestic violence.
We used data from a nationally representative cohort of 1116 British families (the Environmental Risk Longitudinal Study). Food insecurity, family SES, maternal mental health and exposure to domestic violence, and children's behavioral outcomes were measured by using validated methods.
Overall, 9.7% of study families were food-insecure. Among low-SES families, controlling for income variation, food insecurity co-occurred with maternal depression (odds ratio [OR]: 2.82 [95% confidence interval (CI): 1.62-4.93]), psychosis spectrum disorder (OR: 4.01 [95% CI: 2.03-7.94]), and domestic violence (OR: 2.36 [95% CI: 1.18-4.73]). In addition, food insecurity predicted elevated rates of children's behavior problems.
Among families with young children, food insecurity is frequent, particularly when the mother experiences mental health problems. This suggests that interventions that improve women's mental health may also contribute to decreasing the burden of food insecurity and its impact on the next generation.
The pioneering longitudinal studies of child development (all launched in the 1920s and 1930s) were extended well beyond childhood. Indeed, they eventually followed their young study members up to the middle years and later life. In doing so, they generated issues that could not be addressed satisfactorily by available theories. These include the recognition that individual lives are influenced by their ever-changing historical context, that the study of human lives calls for new ways of thinking about their pattern and dynamic, and that concepts of human development should apply to processes across the life span. Life course theory has evolved since the 1960s through programmatic efforts to address such issues.