OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Comments
Food assistance programs may not reach families with mental health problems.
To the Editor,
In their letter commenting on our article[1], Dr. Frank and colleagues point out that food assistance programs are not sufficiently accessible to eligible families and argue that such programs are key in eliminating food insecurity.
We agree that programs that provide income supports or food assistance to deprived families should be strengthened. However, our study indicates that these interventions may not reach children of families in which the mother suffers from mental illness. Mothers with mental health problems may not apply for assistance, may do so incorrectly, or may struggle to translate assistance into a healthy diet for their children. Safety net policies that protect children from food insecurity depend on parents, and in many cases mothers, to seek out resources and to effectively pass them on to their children. Mothers are therefore the key conduit link between government policies and children, and mental health problems can weaken this link.
Importantly, mothers’ mental health problems are often treatable[2]. We suggest that to enhance the efficacy of food assistance programs, parallel interventions are needed to identify and treat maternal mental illness among eligible families. Mental disorders affect approximately 25% of individuals, and women of child-bearing age are especially vulnerable, particularly if they experience poverty[3] - thus, a large proportion of individuals eligible for income supports and food assistance programs are affected by mental illness. If mothers' mental health is neglected, then there will always be a substantial segment of the population of poor children whose nutritional needs are left unmet by even the best government assistance programs. Why not do whatever it takes to enable every child to benefit?
References
1. Melchior M, Caspi A, Howard L, Ambler AP, Bolton H, Mountain N, et al. Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics. 2009;124:e564-e572.
2. Weissman MM, Pilowsky DJ, Wickramaratne PJ, Talati A, Wisniewski SR, Fava M, et al. Remissions in maternal depression and child psychopathology: a STAR*D-child report. Journal of the American Medical Association. 2006;295:1389-1398.
3. World Health Organization. World health report 2001-mental health: new understanding, new hope. WHO 2001 http://www.who.int/whr/2001/en/
Conflict of Interest:
None declared
Nutritional assistance programs play a critical role in reducing food insecurity
To the Editor-
Dr. Melchior and colleagues’ recent report on food insecurity raises concerns about the effectiveness of nutritional assistance programs and highlights the role played by maternal mental health and domestic violence. Evidence from Children’s HealthWatch (www.childrenshealthwatch) provides additional information on the link between nutritional assistance programs and children’s health and well-being. Many income eligible families are not reached by nutritional assistance programs due to either bureaucratic barriers or insufficient funding.[1-4] The evidence is clear that children benefit from nutritional assistance programs, such as WIC and SNAP (formerly Food Stamps), and families who do not receive WIC and SNAP have greater food insecurity than those who do.[2, 3] Thus, the problem is with the accessibility and reach of nutritional assistance programs, not with their effectiveness.[1-4]
Unfortunately, many of the nutritional assistance programs are underfunded, meaning that the benefits are too low to enable families to purchase a minimally adequate diet. SNAP benefits are tied to national averages that fall far below the true costs of healthy eating. [5]
We agree with the conclusion that mental health problems are correlated with food insecurity [6] and that strategies to reduce mental health problems and domestic violence are worthy public policy goals that will benefit children’s health and well-being. However, to reduce food insecurity, children and families require secure access to food – benefits that are derived from income supports and nutritional assistance programs.
1. Cook, J.T., et al., A Brief Indicator of Household energy Security: Associations with Food Security, Child Health, and Child Development in US Infants and Toddlers. Pediatrics, 2008. 122(4): p. e867- e875.
2. Perry, A., et al., Food stamps as medicine: A new perspective on children’s health. 2007, Children's HealthWatch. 3. Jeng, K., et al., Feeding our Future: Growing up Healthy with WIC. 2009, Children's HealthWatch.
4. Gayman, A., et al., Funding Shortfall for Housing Vouchers Could Have Serious Health Consequences for Children. 2009, Children's HealthWatch.
5. Thayer, J., et al., Coming up Short: High food costs outstrip food stamp benefits. 2008, Children's HealthWatch.
6. Casey, P., et al., Maternal Depression, Changing Public Assistance, Food Security, and Child Health Status. Pediatrics, 2004. 113(2): p. 298-304.
Conflict of Interest:
None declared