J Acad Nutr Diet. 2023 Sep 15:S2212-2672(23)01554-X. doi: 10.1016/j.jand.2023.09.006. Online ahead of print.
BACKGROUND: Women living in WIC-eligible households may be pregnant or breastfeeding. Stress during pregnancy and breastfeeding may affect women’s mental health making them more vulnerable to higher rates of food insecurity.
OBJECTIVE: Determine whether food insecurity (FI) is associated with moderate-to-severe mental distress among women living in WIC-eligible households, and whether the strength of the association differs among WIC participants compared to eligible non-participants with low-income.
DESIGN: Cross-sectional data from the 2011-2018 National Health Interview Survey (NHIS) were utilized.
PARTICIPANTS/SETTING: A total of 7,700 women living in WIC-eligible households with at least one child were analyzed.
MAIN OUTCOME MEASURE(S): Moderate-to-severe mental distress was measured using the validated K6 non-specific psychological distress scale. FI was measured using the 10-item, United States Adult Food Security Survey Module.
STATISTICAL ANALYSES PERFORMED: Multivariate logistic regression was used to examine the association between FI and mental distress. The conditional effects of WIC participation were examined by including interaction terms for FI and WIC participation as well as by stratifying the sample by WIC participation.
RESULTS: Among women in WIC-eligible households, FI was associated with moderate-to-severe mental distress in a dose-response fashion: compared to those who were food secure, the adjusted odds of moderate-to-severe mental distress were 1.8 times higher among those with marginal food security (adjusted odds ratio [AOR] 1.83, 95% CI 1.50-2.23), 2.1 times higher among those with low food security (AOR 2.14, 95% CI 1.76-2.60), and 3.7 times higher among those with very low food security (AOR 3.73, 95% CI 2.95-4.71). The interaction between FI and WIC participation was not significant, with similar associations between FI and mental distress among WIC participants and non-participants.
CONCLUSIONS: Among this nationally representative sample of women in WIC-eligible households, increasing severity of food insecurity was associated with poor mental health among WIC participants and non-participants. WIC participation was not observed to moderate the association between FI and mental distress. More research should consider including mental health screening at WIC clinic visits to enable early identification and referral for care.