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Food insecurity and its impact on substance use and suicidal behaviours among school-going adolescents in Africa: evidence from the Global School-Based Student Health Survey

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Abstract

The study sought to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its impact on substance use and suicidal behaviours (ideation, planning, and repeated attempted suicide) among school-going adolescents in Africa. The study involved a secondary analysis of cross-sectional data from the Global School-Based Student Health Survey (GSHS) conducted in Africa. Substance use and suicidal behaviours were the main outcomes. We employed the Double Selection Least Absolute Shrinkage and Selection Operator Poisson regression (DSLASSOPM) model to assess risk factors associated with FI and further employed Coarsened Exact Matching involving DSLASSOPM to assess the influence of FI on the study outcomes. Meta-analysis was conducted to obtain between-country heterogeneity in the prevalence of FI and the prevalence ratio of substance use and suicidal behaviours. The study involved 34,912 school-going adolescents. The pooled 30-day prevalence estimate of FI was 11.1% (95% CI  9.1–18.6), ranging from 6.7% (95% CI 5.0–8.3) in Tanzania to 18.4% (95% CI 14.4–22.4) in Benin. The most common associated factors included the experience of insomnia and the number of times injured. The pooled prevalence ratio of substance use, suicidal ideation, suicidal planning, and repeated attempted suicide among adolescents experiencing food insecurity were 1.92(95% CI 1.69–2.16), 1.56(95% CI 1.46–1.66), 1.50 (95% CI 1.41–1.58), and 1.90 (95% CI 1.73–2.07) respectively. A considerable heterogeneity between the sub-regions prevalence ratio for suicidal ideation and planning was also observed (I2 = 0, p value > 0.05). The study observed a high prevalence of food insecurity in West Africa with negligible heterogeneity between the countries. A significant positive association between FI and the study outcomes (substance use and suicidal behaviours) was observed. The study recommends country-specific social and school-based health interventions to screen risk factors associated with food insecurity for early identification. Measures to achieve Sustainable Development Goal 2 (Zero Hunger) by 2030 are key in these African countries and is likely to yield demographic dividends through improvement in mental health among school-going adolescents.

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Data availability

Data are available in a public, open access repository. Dataset downloaded from free online from https://extranet.who.int/ncdsmicrodata/index.php/catalog.

References

  1. 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. https://doi.org/10.1093/jn/132.4.719

    Article  CAS  PubMed  Google Scholar 

  2. Betancourt TS, Thomson D, VanderWeele TJ (2018) War-Related Traumas and Mental Health Across Generations. JAMA Psychiat 75(1):5–6. https://doi.org/10.1001/jamapsychiatry.2017.3530

    Article  Google Scholar 

  3. Beymer MR, Reagan JJ, Rabbitt MP, Webster AE, Watkins EY (2021) Association between food insecurity, mental health, and intentions to leave the US Army in a cross-sectional sample of US soldiers. J Nut 151:2051

    Article  Google Scholar 

  4. Breisinger, C., Ecker, O., & Trinh Tan, J.-F. (2015). Conflict and food insecurity: How do we break the links? In IFPRI book chapters (pp. 51–60). International Food Policy Research Institute (IFPRI). https://ideas.repec.org/h/fpr/ifpric/9780896295759-07.html

  5. Broussard NH (2019) What explains gender differences in food insecurity? Food Policy 83:180–194. https://doi.org/10.1016/j.foodpol.2019.01.003

    Article  Google Scholar 

  6. Brück T, d’Errico M (2019) Food security and violent conflict: Introduction to the special issue. World Dev 117:167–171. https://doi.org/10.1016/j.worlddev.2019.01.007

    Article  Google Scholar 

  7. CDC/WHO. (2013). Global School-based Student Health Survey: 2013 GSHS Data User’s Guide. Center for Diease Control. https://www.cdc.gov/gshs/background/pdf/gshs-data-users-guide.pdf

  8. Cheng M-H, Chang S-F (2017) Frailty as a risk factor for falls among community dwelling people: evidence from a meta-analysis. J Nurs Scholarsh 49(5):529–536. https://doi.org/10.1111/jnu.12322

    Article  PubMed  Google Scholar 

  9. Davison KM, Marshall-Fabien GL, Tecson A (2015) Association of moderate and severe food insecurity with suicidal ideation in adults: National survey data from three Canadian provinces. Soc Psychiatry Psychiatr Epidemiol 50(6):963–972

    Article  PubMed  Google Scholar 

  10. Ding M, Keiley MK, Garza KB, Duffy PA, Zizza CA (2015) Food insecurity is associated with poor sleep outcomes among US adults. J Nutr 145(3):615–621. https://doi.org/10.3945/jn.114.199919

    Article  CAS  PubMed  Google Scholar 

  11. Do EK, Bowen GA, Ksinan AJ, Adams EL, Fuemmeler BF (2021) Sleep, food insecurity, and weight status: findings from the Family Life, Activity, Sun, Health, and Eating Study. Child Obes 17(2):125–135. https://doi.org/10.1089/chi.2020.0259

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dodo MK (2020) Understanding Africa’s food security challenges in food security in Africa. IntechOpen. https://doi.org/10.5772/intechopen.91773

    Article  Google Scholar 

  13. Dong KR, Must A, Tang AM, Stopka TJ, Beckwith CG (2018) Food insecurity, morbidities, and substance use in adults on probation in Rhode Island. J Urban Health 95(4):564–575. https://doi.org/10.1007/s11524-018-0290-2

    Article  PubMed  PubMed Central  Google Scholar 

  14. Drammeh W, Hamid NA, Rohana AJ (2019) Determinants of household food insecurity and its association with child malnutrition in Sub-Saharan Africa: a review of the literature. Current Res Nutri Food Sci J 7(3):610–623

    Article  Google Scholar 

  15. Elgar FJ, Sen A, Gariépy G, Pickett W, Davison C, Georgiades K, Hammami N, Da Silva MA, Gordon D, Melgar-Quiñonez HR (2021) Food insecurity, state fragility and youth mental health: a global perspective. SSM-Population Health 14:100764

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fang D, Thomsen MR, Nayga RM (2021) The association between food insecurity and mental health during the COVID-19 pandemic. BMC Public Health 21(1):607. https://doi.org/10.1186/s12889-021-10631-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. FAO. (2020). Hunger and food insecurity. Food and Agriculture Organization of the United Nations. http://www.fao.org/hunger/en/

  18. FAO, Ifad, UNICEF, WFP, & WHO. (2021) The State of Food Security and Nutrition in the World 2021: transforming food systems for food security, improved nutrition and affordable healthy diets for all. FAO, IFAD, UNICEF, WFP and WHO. https://doi.org/10.4060/cb4474en

    Article  Google Scholar 

  19. Food and Agriculture Organisation of the United Nations. (2021). Prevalence of moderate or severe food insecurity in the population (%)—Low & middle income | Data. https://data.worldbank.org/indicator/SN.ITK.MSFI.ZS?locations=XO

  20. Food and Agriculture Organization of the United Nations (FAO), International Fund for Agricultural Development (IFAD), United Nations, Children’s Fund (UNICEF), World Food Program (WFP) and World Health, & Organization (WHO) (2021) The State of Food Security and Nutrition in the World 2021. FAO, IFAD, UNICEF, WFP, WHO. https://doi.org/10.4060/cb4474en

    Article  Google Scholar 

  21. Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J (2017) Diet and sleep physiology: public health and clinical implications. Front Neurol 8:393. https://doi.org/10.3389/fneur.2017.00393

    Article  PubMed  PubMed Central  Google Scholar 

  22. Guarcello MA, Levine RA, Beemer J, Frazee JP, Laumakis MA, Schellenberg SA (2017) Balancing student success: assessing supplemental instruction through coarsened exact matching. Technol Knowl Learn 22(3):335–352

    Article  Google Scholar 

  23. Gundersen C, Kreider B, Pepper J (2011) The economics of food insecurity in the United States. Appl Econ Perspect Policy 33(3):281–303. https://doi.org/10.1093/aepp/ppr022

    Article  Google Scholar 

  24. Gundersen C, Ziliak JP (2015) Food insecurity and health outcomes. Health Aff 34(11):1830–1839. https://doi.org/10.1377/hlthaff.2015.0645

    Article  Google Scholar 

  25. Hanlon J (2010) Mozambique: ‘The war ended 17 years ago, but we are still poor.’ Confl Secur Dev 10(1):77–102. https://doi.org/10.1080/14678800903553902

    Article  Google Scholar 

  26. Hardy, D. (2021). Food Security, Small Island States and Globalization: The Example of Seychelles. Seychelles Research Journal, 3(1). https://seychellesresearchjournalcom.files.wordpress.com/2021/01/food_security_small_island_states_and_globalization-the-example-of-seychelles-dennis_hardy-srj-3-1-1.pdf

  27. Hendrix C, Brinkman HJ (2013) Food insecurity and conflict dynamics: causal linkages and complex feedbacks stability. Inter J Sec Develop. https://doi.org/10.5334/sta.bm

    Article  Google Scholar 

  28. Jones AD (2017) food insecurity and mental health status: a global analysis of 149 countries. Am J Prev Med 53(2):264–273. https://doi.org/10.1016/j.amepre.2017.04.008

    Article  PubMed  ADS  Google Scholar 

  29. Kim TW, Jeong J-H, Hong S-C (2015) The impact of sleep and circadian disturbance on hormones and metabolism. Inter J Endocrinol. 2015:591729. https://doi.org/10.1155/2015/591729

    Article  Google Scholar 

  30. Koren O, Bagozzi BE (2016) From global to local, food insecurity is associated with contemporary armed conflicts. Food Security 8(5):999–1010. https://doi.org/10.1007/s12571-016-0610-x

    Article  Google Scholar 

  31. Koyanagi A, Stubbs B, Oh H, Veronese N, Smith L, Haro JM, Vancampfort D (2019) Food insecurity (hunger) and suicide attempts among 179,771 adolescents attending school from 9 high-income, 31 middle-income, and 4 low-income countries: A cross-sectional study. J Affect Disord 248:91–98. https://doi.org/10.1016/j.jad.2019.01.033

    Article  PubMed  Google Scholar 

  32. Lipsitz SR, Fitzmaurice GM, Sinha D, Hevelone N, Giovannucci E, Hu JC (2015) Testing for independence in J × K contingency tables with complex sample survey data. Biometrics 71(3):832–840. https://doi.org/10.1111/biom.12297

    Article  MathSciNet  PubMed  PubMed Central  Google Scholar 

  33. Loopstra R, Reeves A, Tarasuk V (2019) The rise of hunger among low-income households: an analysis of the risks of food insecurity between 2004 and 2016 in a population-based study of UK adults. J Epidemiol Community Health 73(7):668–673. https://doi.org/10.1136/jech-2018-211194

    Article  PubMed  Google Scholar 

  34. Masa R, Khan Z, Chowa G (2020) Youth food insecurity in Ghana and South Africa: prevalence, socioeconomic correlates, and moderation effect of gender. Child Youth Ser Rev. 116:105180. https://doi.org/10.1016/j.childyouth.2020.105180

    Article  Google Scholar 

  35. McLaughlin KA, Green JG, Alegría M, Jane Costello E, Gruber MJ, Sampson NA, Kessler RC (2012) Food insecurity and mental disorders in a national sample of US adolescents. J Amer Acad Child Adolescent Psychiatry. 51(12):1293–1303. https://doi.org/10.1016/j.jaac.2012.09.009

    Article  Google Scholar 

  36. Na M, Eagleton SG, Jomaa L, Lawton K, Savage JS (2020) Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age. Public Health Nutr 23(4):701–710. https://doi.org/10.1017/S136898001900332X

    Article  PubMed  Google Scholar 

  37. Nagata JM, Palar K, Gooding HC, Garber AK, Tabler JL, Whittle HJ, Bibbins-Domingo K, Weiser SD (2021) Food insecurity, sexual risk, and substance use in young adults. J Adolescent Health 68(1):169–177. https://doi.org/10.1016/j.jadohealth.2020.05.038

    Article  Google Scholar 

  38. Palmer JJ (2020) Sensing sleeping sickness: local symptom-making in South Sudan. Med Anthropol 39(6):457–473. https://doi.org/10.1080/01459740.2019.1689976

    Article  PubMed  Google Scholar 

  39. Peltzer K, Pengpid S (2017) Hunger and psychobehavioural problems among adolescents in the Association of Southeast Asian Nations (ASEAN) Member Countries. Iranian J Psychiatry Behav Sci 11(3):3. https://doi.org/10.5812/ijpbs.8185

    Article  Google Scholar 

  40. Pollard CM, Booth S (2019) Food insecurity and hunger in rich countries—It Is Time for Action against Inequality. Int J Environ Res Public Health 16(10):1804. https://doi.org/10.3390/ijerph16101804

    Article  PubMed  PubMed Central  Google Scholar 

  41. Rao JNK, Scott AJ (1981) The analysis of categorical data from complex sample surveys: chi-squared tests for goodness of fit and independence in two-way tables. J Am Stat Assoc 76(374):221–230. https://doi.org/10.1080/01621459.1981.10477633

    Article  MathSciNet  Google Scholar 

  42. Romo ML, Abril-Ulloa V, Kelvin EA (2016) The relationship between hunger and mental health outcomes among school-going Ecuadorian adolescents. Soc Psychiatry Psychiatr Epidemiol 51(6):827–837. https://doi.org/10.1007/s00127-016-1204-9

    Article  PubMed  Google Scholar 

  43. Satefano, M., Gary, K., & Giuseppe, P. (2009). CEM: Coarsened Exact Matching Software. https://gking.harvard.edu/cem

  44. Seidu A-A, Ahinkorah BO, Agbablo E (2020) Food insecurity among in-school adolescents in Ghana: what are the determinants? J Hunger Environ Nutr. https://doi.org/10.1080/19320248.2020.1745723

    Article  Google Scholar 

  45. Shayo FK, Lawala PS (2019) Does food insecurity link to suicidal behaviors among in-school adolescents? Findings from the low-income country of sub-Saharan Africa. BMC Psychiatry 19(1):1–8

    CAS  Google Scholar 

  46. Siddiqui F, Salam RA, Lassi ZS, Das JK (2020) The intertwined relationship between malnutrition and poverty. Front Public Health. https://doi.org/10.3389/fpubh.2020.00453

    Article  PubMed  PubMed Central  Google Scholar 

  47. Smith L, Shin JI, López-Sánchez GF, Veronese N, Soysal P, Oh H, Grabovac I, Barnett Y, Jacob L, Koyanagi A (2021) Association between food insecurity and fall-related injury among adults aged ≥65 years in low- and middle-income countries: the role of mental health conditions. Archi Gerontol Geriat 96:104438. https://doi.org/10.1016/j.archger.2021.104438

    Article  Google Scholar 

  48. Sweetland AC, Norcini Pala A, Mootz J, Kao JC-W, Carlson C, Oquendo MA, Cheng B, Belkin G, Wainberg M (2019) Food insecurity, mental distress and suicidal ideation in rural Africa: evidence from Nigeria, Uganda and Ghana. Int J Soc Psychiatry 65(1):20–27

    Article  PubMed  Google Scholar 

  49. Tetteh J, Kogi R, Yawson AO, Mensah G, Biritwum R, Yawson AE (2019) Effect of self-rated health status on functioning difficulties among older adults in Ghana: coarsened exact matching method of analysis of the world health organization’s study on global ageing and adult health, Wave 2. PLoS ONE 14(11):0224327. https://doi.org/10.1371/journal.pone.0224327

    Article  CAS  Google Scholar 

  50. The Commonwealth. (2020). Africa. The Commonwealth. https://thecommonwealth.org/regions/africa

  51. United Nations. (2019, July 15). Over 820 million people suffering from hunger; new UN report reveals stubborn realities of ‘immense’ global challenge | UN DESA | United Nations Department of Economic and Social Affairs. https://www.un.org/development/desa/en/news/sustainable/hlpf-2019-state-of-food-security-and-nutrition.html

  52. Whittle HJ, Sheira LA, Frongillo EA, Palar K, Cohen J, Merenstein D, Wilson TE, Adedimeji A, Cohen MH, Adimora AA, Ofotokun I, Metsch L, Turan JM, Wentz EL, Tien PC, Weiser SD (2019) Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States. Addiction 114(1):127–136. https://doi.org/10.1111/add.14418

    Article  PubMed  Google Scholar 

  53. WHO. (2017). Culture and Mental Health in Liberia: A Primer. World Health Organization.

  54. Zialor, C. (2020). ‘Food security is still a challenge for Seychelles’ – FAO rep. https://www.nation.sc/articles/3156/food-security-is-still-a-challenge-for-seychelles--fao-rep

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Authors and Affiliations

  1. Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana

    John Tetteh, Elom Otchi, Isaac Adomako, Henry Quansah & Alfred Edwin Yawson

  2. Department of Psychiatry, Korle-Bu Teaching Hospital, Accra, Ghana

    George Ekem-Ferguson

  3. Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, Accra, Ghana

    Emmanuel Nii-Boye Quarshie

  4. Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana

    Duah Dwomoh

  5. National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana

    Swithin Mustapha Swaray

  6. Korle-Bu Teaching Hospital, Accra, Ghana

    Elom Otchi

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  1. John Tetteh
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Contributions

JT and GE-F conceptualized the study and sought approval Global School-Based Student Health Survey data. JT undertook the statistical analysis and interpretation. JT, GE-F, SMS, HQ drafted the initial manuscript. EN-BQ, EO, IA, DD and AEY read and provided intellectual content revisions and suggestions for clarity and precision on subject matter. All authors read and approved the final review manuscript.

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Correspondence to John Tetteh.

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Tetteh, J., Ekem-Ferguson, G., Quarshie, E.NB. et al. Food insecurity and its impact on substance use and suicidal behaviours among school-going adolescents in Africa: evidence from the Global School-Based Student Health Survey. Eur Child Adolesc Psychiatry 33, 467–480 (2024). https://doi.org/10.1007/s00787-023-02168-x

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