Household food insecurity and maternal depression in rural families

Introduction: Cross-sectional research in urban populations suggests food insecurity, or being unable to obtain enough food to meet household needs due to inadequate resources, is associated with maternal depression. Given studies that show rural women have higher rates of both food insecurity and depression than their urban counterparts, this association needs further investigation among rural populations. Methods: The purpose of this study was to assess the longitudinal relationship between household food insecurity and maternal depression. Using three waves of data from NC-1011 Rural Families Speak (N=413), a multi-state study of low-income, rural families in the United States, we formulated and fit a structural equation model relating food insecurity and depression over time using AMOS, including testing whether food insecurity predicted depression or vice versa. We measured food insecurity using the Core Food Security Module and depression using the Center for Epidemiologic Studies-Depression Scale. Results: Findings suggest the causal relationship between household food insecurity and depression is bidirectional (fit indices for the full model: ÷2 = 7.340 on 4 df [p-value = .119, ÷2/df = 1.835]; RMSEA statistic = .068, and CFI = .989). Conclusions: The recursive nature of the relationship between food insecurity and maternal depression in rural households has implications for U.S. nutrition policy. Food stamp eligibility campaigns should focus on increasing access among the 33% of eligible rural residents who do not utilize this resource. Additionally, nutrition education programs should incorporate depression screenings into programming and make appropriate referrals to increase mental health care access within this population. Finally, mental health care providers in rural areas should screen for food insecurity as part of the psychosocial evaluation and make appropriate referrals to food stamp programs.