Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa

Objective: To determine the impact of food insecurity on postnatal depression, hazardous drinking, and suicidality among women who had recently given birth in a peri-urban settlement near Cape Town, South Africa.

Methods: We interviewed 249 women three months after they had given birth and assessed food insecurity (Household Food Insecurity Access Scale), postnatal depression symptom severity (Edinburgh Postnatal Depression Scale), suicide risk (Mini International Neuropsychiatric Interview), and hazardous drinking (TWEAK). Multivariable Poisson regression models with robust standard errors were used to estimate the impact of food insecurity on psychosocial outcomes.

Findings: Food insecurity, probable depression, and hazardous drinking were highly prevalent and co-occurring. More than half of the women (149 [59.8%]) were severely food insecure, 79 (31.7%) women met screening criteria for probable depression, and 39 (15.7%) women met screening criteria for hazardous drinking. Nineteen (7.6%) women had significant suicidality but only 7 (2.8%) were classified as high risk. Each additional point on the HFIAS was associated with a five percent increased risk of probable depression (adjusted risk ratio [ARR], 1.05; 95% CI, 1.02-1.07), a four percent increased risk of hazardous drinking (ARR, 1.04; 95% CI, 1.00-1.09), and a 12 percent increased risk of suicidality (ARR, 1.12; 95% CI, 1.02-1.23). Evaluated at the means of the covariates, these estimated associations were large in magnitude.

Conclusion: Food insecurity is strongly associated with postnatal depression, hazardous drinking, and suicidality. Programmes promoting food security for new mothers in low- and middle-income countries may enhance overall psychological well-being in addition to improving nutritional status.