Food Insecurity is Associated with Poor Mental Health in Canadian Children and Adolescents

Background

Familial socioeconomic context influences both the development and mental health of children and adolescents. Poor contexts are associated with adverse outcomes that may persist into adulthood. One key socioeconomic indicator is food insecurity, defined as inadequate or insecure access to food, often due to financial constraints. Food insecurity can have serious consequences for children's health by acting as a psychosocial stressor for the family and/or through decreased nutrient intake. ¹

Prior research in industrialized countries has emphasized the harmful impact of children's food insecurity on their mental health. ¹ However, few studies have examined the association among both children and adolescents in a single nationally representative study. Additionally, many of these studies have not examined a wide range of mental health problems, including substance use and suicidality, and updated estimates are necessary as there is concern that the impact of food insecurity is increasing. ² We aimed to examine the association between food insecurity and mental health problems in Canadian children and adolescents.

Methods

We used data from the Canadian Health Survey on Children and Youth, collected by Statistics Canada in 2019; the details are reported elsewhere. ³ In brief, it surveyed a random sample of 1–17-year-olds residing in Canada. Of those who were invited to participate in the study, 52% responded, yielding a total sample size of 47,871.

Data were collected via a self-report questionnaire administered to the person most knowledgeable about the child/youth, who was a parent in 99% of the sample. Child food insecurity in the past 12 months was defined using the classification developed by Health Canada ⁴ ; the child is considered food insecure if 1 or more affirmative responses were given by the parent to any of the eight child-referenced questions.

Parents were asked to rate their children's general mental health using a Likert scale. They were also asked if their child had been diagnosed with any mood or anxiety disorder or any developmental disorder (attention deficit hyperactivity or autism spectrum disorders) lasting 6 months or more. The youth 12–17 years old were asked about their general mental health, and alcohol and cannabis use, while suicidal thoughts and attempts were asked only from the youth aged 15 or older. Current regular drinking is defined as using alcohol once per month or more, and lifetime cannabis use is defined as using more than once. For youth aged 12–17 years old, we compared parent- and youth-reported general mental health, which yielded an 87.7% consensus (kappa = 0.33), indicating a fair agreement.

We ran unadjusted and adjusted logistic models with 1000 bootstrap weights. The weighting procedure accounted for survey design effects and nonresponse. All statistical tests were 2-sided with a significance level of P < 0.05. See details of the statistical analysis in the Supplementary File.

Results

The sample consisted of 48.73% females, and the age groups of 1–11, 12–14, and 15–17 years old made up 64.3%, 17.7%, and 17.0% of the subjects, respectively. The weighted prevalence of food insecurity in children and youth was 11.01% (95% CI, 10.59 to 11.43). Logistic regression analysis showed that all studied mental health problems were associated with child food insecurity, except for alcohol use (Table 1). The adjusted odds ratios ranged from 1.32 for regular alcohol drinking to 2.24 for parent-reported general mental health, which indicates positive associations with food insecurity.

Table 1.

Association Between Food Insecurity and Child and Adolescent Mental Health Problems in the Canadian Health Survey on Children and Youth, 2019.

Mental health problems	Weighted prevalence (%) (95% CI)		Unadjusted OR (95% CI)		Adjusted OR* (95% CI)
Parent-reported poor/fair general mental health: current (1–17 years old)	4.09	(3.83 to 4.35)	2 . 76	(2.38 to 3.2)	2.24	(1.87 to 2.69)
Mood or anxiety disorders: lifetime (5–17 years old)	5.70	(5.36 to 6.04)	2.11	(1.77 to 2.51)	1.92	(1.57 to 2.36)
Developmental disorders: lifetime (1–17 years old)	7.95	(7.60 to 8.30)	1.94	(1.69 to 2.23)	1.69	(1.45 to 1.97)
Youth-reported poor/fair general mental health: current (12–17 years old)	11.92	(11.23 to 12.61)	1.58	(1.31 to 1.91)	1.63	(1.31 to 2.02)
Suicide ideas: past 12 months (15–17 years old)	14.09	(13.05 to 15.2)	1.54	(1.20 to 1.98)	1.83	(1.37 to 2.43)
Suicide attempts: lifetime (15–17 years old)	6.78	(6.04 to 7.61)	2.16	(1.56 to 2.98)	1.95	(1.37 to 2.77)
Regular alcohol drinking: current (12–17 years old)	7.11	(6.48 to 7.74)	1.01	(0.75 to 1.38)	1.32	(0.91 to 1.91)
Cannabis use: lifetime (12–17 years old)	8.84	(8.17 to 9.51)	1.61	(1.27 to 2.04)	1.80	(1.34 to 2.42)

Note. OR = odds ratio; CI = confidence interval. Bold fonts indicate significant association at P < 0.05.

*Adjusted for children's age, sex at birth, minority status, immigrant status, and urban residence, whether they live with biological parents, parent's education and employment, and adjusted household income.

Discussion

In this nationwide study, food insecurity was significantly associated with almost all studied mental health problems in children and youth, which persisted after controlling for sociodemographic variables such as income. This is consistent with several other studies that have found associations between child and adolescent food insecurity and various mental health problems, regardless of income level.

Among the youth, food insecurity was associated with cannabis use but not alcohol drinking. Food insecurity has been linked to impulse control issues, and an increase in the willingness to engage in risk-taking behaviours may in turn influence the risk of substance use. It should be noted that the confidence interval for alcohol use was wide and that it was measured and defined differently from cannabis use in this study.

The cross-sectional design of our study does not allow for causal explanations, however, reverse causation seems very unlikely in these age groups. Another limitation is that mental disorders were not determined by a comprehensive diagnostic instrument. Despite these limitations, this large study provides contemporary information about the association of mental health with food insecurity among Canadian children. We favour the argument that food insecurity is a more direct measure of deprivation than low income, as some studies suggest that food insecurity may be indicative of social disorganization and risk in the home environment beyond inadequate income. ⁵ Our study highlights the importance of food insecurity as a factor that may impact the mental health and development of Canadian children and adolescents. This is a public health challenge that requires interventions to mitigate its detrimental consequences. Future research could explore the causal nature of the observed associations and the responsible mechanisms. This may involve examining how biological, psychological, social, and environmental factors interact to influence the mental health outcomes of children, and identifying the effective interventions that can address this complex issue.