Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces

  • Karen M. Davison
  • Gillian L. Marshall-Fabien
  • Angela Tecson
Original Paper



Although the important public health issues of food insecurity and suicide may be interconnected, they are rarely studied. Using data from a national survey, we examined whether household food insecurity was associated with suicidal ideation after adjusting for relevant covariates.


We examined cross-sectional data from three Canadian provinces (n = 5,270) that were derived from the 2007 Canadian Community Health Survey and included adults (18+ years). Suicidal ideation was based on affirmative response to the question of whether or not the participant had seriously considered committing suicide in the previous 12 months. The Household Food Security Survey Module provided measures of moderate (indication of compromise in quality and/or quantity of food consumed) and severe (indication of reduced food intake and disrupted eating patterns) food insecurity status. Logistic regression determined associations between food insecurity and suicidal ideation with adjustment for demographics, body mass index, and presence of a mood disorder.


There were differences in the proportion experiencing suicide ideation according to moderate (14.7 vs 10.0 % without suicide ideation) and severe (16.4 vs 7.1 % without suicide ideation) food security (p < 0.001). With covariate adjustment, suicidal ideation was significantly associated with moderate (adjusted OR = 1.32, 95 % CI 1.06–1.64) and severe (adjusted OR = 1.77, 95 % CI 1.42–2.23) food insecurity.


The findings of a robust association between food insecurity and suicidal ideation suggest that interventions targeted at food security may reduce suicide-related morbidity and mortality. Longitudinal investigations that examine various dimensions of food insecurity will advance understanding of etiological pathways involved in food insecurity and suicide.


Food insecurity Suicidal ideation Adults Mood disorders 



Body mass index


Canadian Community Health Survey


Household Food Security Survey Module


Odds ratio



The researchers would like to thank statistician Dr. Jonathan Berkowitz for providing his expertise and assistance with the analysis of the data. Financial support for analysis associated with this project was made available from Public Health Agency of Canada which played no role in carrying out the study, analyzing the results, or influencing publication.

Conflict of interest


Ethics approval

Not required for population-based dataset.


  1. 1.
    World Health Organization (2012) Public health action for the prevention of suicide: a framework. World Health Organization, Geneva. Google Scholar
  2. 2.
    Swanson SA, Colman I (2013) Association between exposure to suicide and suicidality outcomes in youth. CMAJ 185(10):870–877. doi: 10.1503/cmaj.121377 CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Hawton K, Van Heeringen K (2009) Suicide. Lancet 373(9672):1372–2381. doi: 10.1016/S0140-6736(09)60372-X CrossRefPubMedGoogle Scholar
  4. 4.
    Mann JJ (2002) A current perspective of suicide and attempted suicide. Ann Intern Med 136(4):302–311CrossRefPubMedGoogle Scholar
  5. 5.
    Liu X, Tein JY (2005) Life events, psychopathology, and suicidal behavior in Chinese adolescents. J Affect Dis 86(2–3):195–203CrossRefPubMedGoogle Scholar
  6. 6.
    Wray M, Colen C, Pescosolido B (2011) The Sociology of Suicide. Annu Rev Sociol 37:505–528. doi: 10.1146/annurev-soc-081309-150058 CrossRefGoogle Scholar
  7. 7.
    Clouston SA, Rubin MS, Colen CG, Link BG (2014) Social inequalities in suicide: the role of selective serotonin reuptake inhibitors. Am J Epidemiol 180(7):696–704. doi: 10.1093/aje/kwu191 CrossRefPubMedGoogle Scholar
  8. 8.
    Tarasuk V, Mitchell A, Dachner N (2014) Household food insecurity in Canada, 2012. Research to identify policy options to reduce food insecurity (PROOF): 2014. Toronto. Retrieved from Accessed 30 Dec 2014
  9. 9.
    Power E (2015) Dietitians of Canada—background to position: Individual and Household Food Insecurity in Canada. Dietitians of Canada, Toronto. (in press)Google Scholar
  10. 10.
    Alaimo K, Briefel RR, Frongillo EA Jr, Olson CM (1998) Food insufficiency exists in the United States: results from the third National Health and Nutrition Examination Survey (NHANES III). Am J Public Health 88(3):419–426CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Rose D (1999) Economic determinants and dietary consequences of food insecurity in the United States. J Nutr 129(2S Suppl):517S–520SPubMedGoogle Scholar
  12. 12.
    Che J, Chen J (2001) Food insecurity in Canadian households [1998/99 data]. Health Rep 12(4):11–22PubMedGoogle Scholar
  13. 13.
    Bukusuba J, Kikafunda JK, Whitehead RG (2007) Food security status in households of people living with HIV/AIDS (PLWHA) in a Ugandan urban setting. Br J Nutr 98(1):211–217CrossRefPubMedGoogle Scholar
  14. 14.
    Health Canada (2012) The Household Food Security Survey Module (HFSSM). Health Canada, OttawaGoogle Scholar
  15. 15.
    Health Canada (2007) Canadian Community Health Survey Cycle 2.2, Nutrition -Income-Related Household Food Security in Canada. Health Canada, OttawaGoogle Scholar
  16. 16.
    Markwick A, Ansari Z, Sullivan M, McNeil J (2014) Social determinants and lifestyle risk factors only partially explain the higher prevalence of food insecurity among Aboriginal and Torres Strait Islanders in the Australian state of Victoria: a cross-sectional study. BMC Public Health 14:598. doi: 10.1186/1471-2458-14-598 CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Hyder AA, Maman S, Nyoni JE, Khasiani SA, Teoh N, Premji Z, Sohani S (2005) The pervasive triad of food security, gender inequity and women’s health: exploratory research from sub-Saharan Africa. Afr Health Sci 5(4):328–334PubMedCentralPubMedGoogle Scholar
  18. 18.
    Stuff JE, Casey PH, Szeto KL, Gossett JM, Robbins JM, Simpson PM, Connell C, Bogle ML (2004) Household food insecurity is associated with adult health status. J Nutr 134(9):2330–2335PubMedGoogle Scholar
  19. 19.
    Siefert K, Heflin CM, Corcoran M, Williams DR (2004) Food insufficiency and physical and mental health in a longitudinal survey of welfare recipients. J Health Soc Behav 45:171–186CrossRefPubMedGoogle Scholar
  20. 20.
    Chilton M, Booth S (2007) Hunger of the body and hunger of the mind: African American women’s perceptions of food insecurity, health and violence. J Nutr Educ Behav 39(3):116–125CrossRefPubMedGoogle Scholar
  21. 21.
    Melchior M, Caspi A, Howard LM, Ambler AP, Bolton H, Mountain N, Moffitt TE (2009) Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics 124(4):e564–e572CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Anema A, Wood E, Weiser SD, Qi J, Montaner JS, Kerr T (2010) Hunger and associated harms among injection drug users in an urban Canadian setting. Subst Abus Treat Prev Policy 5:20CrossRefGoogle Scholar
  23. 23.
    Polivy J (1996) Psychological consequences of food restriction. J Am Diet Assoc 96:589–592CrossRefPubMedGoogle Scholar
  24. 24.
    Heller J, Edelmann RJ (1991) Compliance with a low calorie diet for two weeks and concurrent and subsequent mood changes. Appetite 17(1):23–28CrossRefPubMedGoogle Scholar
  25. 25.
    Coelho JS, Polivy J, Herman CP (2006) Selective carbohydrate or protein restriction: effects on subsequent food intake and cravings. Appetite 47(3):352–360CrossRefPubMedGoogle Scholar
  26. 26.
    Keys A, Brozek J, Henschel A, Mickelsen O, Longstreet Taylor H (1950) The biology of human starvation, vol 2. University of Minnesota Press, MinneapolisGoogle Scholar
  27. 27.
    Weinreb L, Wehler C, Perloff J, Scott R, Hosmer D, Sagor L, Gundersen C (2002) Hunger: its impact on children’s health and mental health. Pediatrics 110(4):e41CrossRefPubMedGoogle Scholar
  28. 28.
    Slopen N, Fitzmaurice G, Williams DR, Gilman SE (2010) Poverty, food insecurity, and the behavior for childhood internalizing and externalizing disorders. J Am Acad Child Adolesc Psychiatry 49(5):444–452PubMedGoogle Scholar
  29. 29.
    Belsky DW, Moffitt TE, Arseneault L, Melchior M, Caspi A (2010) Context and sequelae of food insecurity in children’s development. Am J Epidemiol 172(7):809–818. doi: 10.1093/aje/kwq201 CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Alaimo K, Olson CM, Frongillo EA Jr (2001) Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics 108(1):44–53PubMedGoogle Scholar
  31. 31.
    McIntyre L, Williams JVA, Lavorato DH, Patten S (2013) Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger. J Affect Disord 150(1):123–129. doi: 10.1016/j.jad.2012.11.029 CrossRefPubMedGoogle Scholar
  32. 32.
    Alaimo K, Olson CM, Frongillo EA (2002) Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. J Nutr 132(4):719–725PubMedGoogle Scholar
  33. 33.
    Statistics Canada (2008) Canadian Community Health Survey—Annual Component (CCHS). Statistics Canada, Ottawa. Available from: (cited July 15, 2014)
  34. 34.
    Bickel G, Nord M, Price C, Hamilton W, Cook J (2010) Measuring Food Security in the United States: Guide to Measuring Household Food Insecurity. Office of Analysis, Nutrition, and Evaluation, Food and Nutrition Service, AlexandriaGoogle Scholar
  35. 35.
    Sörberg A, Gunnell D, Falkstedt D, Allebeck P, Åberg M, Hemmingsson T (2014) Body mass index in young adulthood and suicidal behavior up to age 59 in a cohort of Swedish men. PLoS One 9(7):e101213. doi: 10.1371/journal.pone.0101213 CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Rihmer Z (2007) Suicide risk in mood disorders. Curr Opin Psychiatry 20(1):17–22CrossRefPubMedGoogle Scholar
  37. 37.
    Statistics Canada (2008) Low income cut-offs for 2008 and low income measures for 2007. Statistics Canada, Ottawa. Available from: (cited July 15, 2014)
  38. 38.
    Vozoris N, Tarasuk V (2003) Household food insufficiency is associated with poorer health. J Nutr 133(1):120–126PubMedGoogle Scholar
  39. 39.
    Muldoon KA, Duff PK, Fielden S, Anema A (2013) Food insufficiency is associated with psychiatric morbidity in a nationally representative study of mental illness among food insecure Canadians. Soc Psychiatry Psychiatr Epidemiol 48(5):795–803. doi: 10.1007/s00127-012-0597-3 CrossRefPubMedGoogle Scholar
  40. 40.
    Heflin CM, Siefert K, Williams DR (2005) Food insufficiency and women’s mental health: findings from a 3-year panel of welfare recipients. Soc Sci Med 61(9):1971–1982CrossRefPubMedGoogle Scholar
  41. 41.
    Huddleston-Casas C, Charigo R, Simmons LA (2008) Food insecurity and maternal depression in rural, low-income families: a longitudinal investigation. Public Health Nutr 12(8):1133–1140. doi: 10.1017/S1368980008003650 CrossRefPubMedGoogle Scholar
  42. 42.
    Chilton MM, Rabinowich JR, Woolf NH (2014) Very low food security in the USA is linked with exposure to violence. Public Health Nutr 17(1):73–82. doi: 10.1017/S1368980013000281 CrossRefPubMedGoogle Scholar
  43. 43.
    Eicher-Miller HA, Mason AC, Weaver CM et al (2009) Food insecurity is associated with iron deficiency anemia in US adolescents. Am J Clin Nutr 90(5):1358–1371. doi: 10.3945/ajcn.2009.27886 CrossRefPubMedGoogle Scholar
  44. 44.
    Eicher-Miller HA, Mason AC, Weaver CM, McCabe GP, Boushey CJ (2011) Food insecurity is associated with diet and bone mass disparities in early adolescent males but not females in the United States. J Nutr 141:1738–1745. doi: 10.3945/jn.111.142059 CrossRefPubMedGoogle Scholar
  45. 45.
    Davison KM, Kaplan BJ (2011) Vitamin and mineral intakes in adults with mood disorders: comparisons to nutrition standards and associations with sociodemographic and clinical variables. J Am Coll Nutr 30(6):547–558CrossRefPubMedGoogle Scholar
  46. 46.
    Fawcett J (2012) Diagnosis, traits, states, and comorbidity in suicide. In: Dwivedi Y (ed) The neurobiological basis of suicide. CRC Press, Boca RatonGoogle Scholar
  47. 47.
    Huan M, Hamazaki K, Sun Y, Itomura M, Liu H, Kang W, Watanabe S, Terasawa K, Hamazaki T (2004) Suicide attempt and n-3 fatty acid levels in red blood cells: a case control study in China. Biol Psychiatry 56(7):490–496CrossRefPubMedGoogle Scholar
  48. 48.
    Li Y, Zhang J, McKeown R (2009) Cross-sectional assessment of diet quality in individuals with a lifetime history of attempted suicide. Psychiatry Res 165(1–2):111–119. doi: 10.1016/j.psychres.2007.09.004 CrossRefPubMedGoogle Scholar
  49. 49.
    Hammen C, Brennan PA (2002) Interpersonal dysfunction in depressed women: impairments independent of depressive symptoms. J Affect Disord 72(2):145–156CrossRefPubMedGoogle Scholar
  50. 50.
    Crump C, Sundquist K, Sundquist J, Winkleby MA (2014) Sociodemographic, psychiatric and somatic risk factors for suicide: a Swedish national cohort study. Psychol Med 44(2):279–289. doi: 10.1017/S0033291713000810 CrossRefPubMedGoogle Scholar
  51. 51.
    Pompili M, Vichi M, Qin P (2013) Does the level of education influence completed suicide? A nationwide register study. J Affect Disord 147(1–3):437–449. doi: 10.1016/j.jad.2012.08.046 CrossRefPubMedGoogle Scholar
  52. 52.
    Page A, Milner A, Morrell S, Taylor R (2013) The role of under-employment and unemployment in recent birth cohort effects in Australian suicide. Soc Sci Med 93:155–162. doi: 10.1016/j.socscimed.2013.03.039 CrossRefPubMedGoogle Scholar
  53. 53.
    Tarasuk V, Mitchell A, McLaren L, McIntyre L (2013) Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity. J Nutr 143:1785–1793. doi: 10.3945/jn.113.178483 CrossRefPubMedGoogle Scholar
  54. 54.
    Brown GK (2002) A review of suicide assessment measures for intervention research in adults and older adults. Technical report submitted to NIMH under Contract No. 263-MH914950. National Institute of Mental Health, BethesdaGoogle Scholar
  55. 55.
    Taylor SE (2010) Mechanisms linking early life stress to adult health outcomes. Proc Nat Acad Sci 107(19):8507–8512. doi: 10.1073/pnas.1003890107 CrossRefPubMedCentralPubMedGoogle Scholar
  56. 56.
    Szyf M, McGowan P, Meaney MJ (2008) The social environment and the epigenome. Environ Mol Mutagen 49:46–60. doi: 10.1016/j.bbagen.2009.01.009 CrossRefPubMedGoogle Scholar
  57. 57.
    Forget EL (2011) The town with no poverty: the health effects of a Canadian Guaranteed Annual Income field experiment. Can Public Policy 37(3):283–305CrossRefGoogle Scholar
  58. 58.
    Loopstra R, Tarasuk V (2013) Severity of household food insecurity is sensitive to change in household income and employment status among low-income families. J Nutr 143(8):1316–1323. doi: 10.3945/jn.113.175414 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Karen M. Davison
    • 1
    • 2
  • Gillian L. Marshall-Fabien
    • 3
  • Angela Tecson
    • 4
  1. 1.School of NursingUniversity of British ColumbiaVancouverCanada
  2. 2.Health Science Program, Department of BiologyKwantlen Polytechnic UniversitySurreyCanada
  3. 3.Jack, Joseph and Morton Mandel School of Applied Social SciencesCase Western Reserve UniversityClevelandUSA
  4. 4.Berkowitz and Associates Consulting IncorporatedVancouverCanada

Personalised recommendations