Skip to main content

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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution.

Abbreviations

BMI:

Body mass index

CCHS:

Canadian Community Health Survey

HFSSM:

Household Food Security Survey Module

OR:

Odds ratio

References

  1. World Health Organization (2012) Public health action for the prevention of suicide: a framework. World Health Organization, Geneva. http://apps.who.int/iris/bitstream/10665/75166/1/9789241503570_eng.pdf

    Google Scholar 

  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

    Article  PubMed Central  PubMed  Google Scholar 

  3. Hawton K, Van Heeringen K (2009) Suicide. Lancet 373(9672):1372–2381. doi:10.1016/S0140-6736(09)60372-X

    Article  PubMed  Google Scholar 

  4. Mann JJ (2002) A current perspective of suicide and attempted suicide. Ann Intern Med 136(4):302–311

    Article  PubMed  Google Scholar 

  5. Liu X, Tein JY (2005) Life events, psychopathology, and suicidal behavior in Chinese adolescents. J Affect Dis 86(2–3):195–203

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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 http://nutritionalsciences.lamp.utoronto.ca/wp-content/uploads/2014/05/Household_Food_Insecurity_in_Canada-2012_ENG.pdf. Accessed 30 Dec 2014

  9. Power E (2015) Dietitians of Canada—background to position: Individual and Household Food Insecurity in Canada. Dietitians of Canada, Toronto. (in press)

  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):419–426

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Rose D (1999) Economic determinants and dietary consequences of food insecurity in the United States. J Nutr 129(2S Suppl):517S–520S

    CAS  PubMed  Google Scholar 

  12. Che J, Chen J (2001) Food insecurity in Canadian households [1998/99 data]. Health Rep 12(4):11–22

    CAS  PubMed  Google Scholar 

  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):211–217

    Article  CAS  PubMed  Google Scholar 

  14. Health Canada (2012) The Household Food Security Survey Module (HFSSM). Health Canada, Ottawa

    Google Scholar 

  15. Health Canada (2007) Canadian Community Health Survey Cycle 2.2, Nutrition -Income-Related Household Food Security in Canada. Health Canada, Ottawa

  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

    Article  PubMed Central  PubMed  Google Scholar 

  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):328–334

    PubMed Central  PubMed  Google Scholar 

  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):2330–2335

    CAS  PubMed  Google Scholar 

  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 45:171–186

    Article  PubMed  Google Scholar 

  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):116–125

    Article  PubMed  Google Scholar 

  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–e572

    Article  PubMed Central  PubMed  Google Scholar 

  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 5:20

    Article  Google Scholar 

  23. Polivy J (1996) Psychological consequences of food restriction. J Am Diet Assoc 96:589–592

    Article  CAS  PubMed  Google Scholar 

  24. Heller J, Edelmann RJ (1991) Compliance with a low calorie diet for two weeks and concurrent and subsequent mood changes. Appetite 17(1):23–28

    Article  CAS  PubMed  Google Scholar 

  25. Coelho JS, Polivy J, Herman CP (2006) Selective carbohydrate or protein restriction: effects on subsequent food intake and cravings. Appetite 47(3):352–360

    Article  PubMed  Google Scholar 

  26. Keys A, Brozek J, Henschel A, Mickelsen O, Longstreet Taylor H (1950) The biology of human starvation, vol 2. University of Minnesota Press, Minneapolis

    Google Scholar 

  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):e41

    Article  PubMed  Google Scholar 

  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):444–452

    PubMed  Google Scholar 

  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

    Article  PubMed Central  PubMed  Google Scholar 

  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):44–53

    CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):719–725

    CAS  PubMed  Google Scholar 

  33. Statistics Canada (2008) Canadian Community Health Survey—Annual Component (CCHS). Statistics Canada, Ottawa. Available from: http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SurvId=50653&InstaId=29539&SDDS=3226 (cited July 15, 2014)

  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, Alexandria

  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

    Article  PubMed Central  PubMed  Google Scholar 

  36. Rihmer Z (2007) Suicide risk in mood disorders. Curr Opin Psychiatry 20(1):17–22

    Article  PubMed  Google Scholar 

  37. Statistics Canada (2008) Low income cut-offs for 2008 and low income measures for 2007. Statistics Canada, Ottawa. Available from: http://www.statcan.gc.ca/pub/75f0002m/75f0002m2009002-eng.pdf (cited July 15, 2014)

  38. Vozoris N, Tarasuk V (2003) Household food insufficiency is associated with poorer health. J Nutr 133(1):120–126

    CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):1971–1982

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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):547–558

    Article  CAS  PubMed  Google Scholar 

  46. Fawcett J (2012) Diagnosis, traits, states, and comorbidity in suicide. In: Dwivedi Y (ed) The neurobiological basis of suicide. CRC Press, Boca Raton

    Google Scholar 

  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):490–496

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  49. Hammen C, Brennan PA (2002) Interpersonal dysfunction in depressed women: impairments independent of depressive symptoms. J Affect Disord 72(2):145–156

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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, Bethesda

  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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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):283–305

    Article  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

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

None.

Ethics approval

Not required for population-based dataset.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karen M. Davison.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Davison, K.M., Marshall-Fabien, G.L. & Tecson, A. Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces. Soc Psychiatry Psychiatr Epidemiol 50, 963–972 (2015). https://doi.org/10.1007/s00127-015-1018-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-015-1018-1

Keywords

  • Food insecurity
  • Suicidal ideation
  • Adults
  • Mood disorders