Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Division of HIV, ID and Global Medicine.
J Nutr. 2019 Aug 1;149(8):1393-1403. doi: 10.1093/jn/nxz093.
BACKGROUND: Food insecurity, which disproportionately affects marginalized women in the United States, is associated with depressive symptoms. Few studies have examined relations of food insecurity with other mental health outcomes. OBJECTIVE: The aim of this study was to investigate the associations of food insecurity with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD) in the Women's Interagency HIV Study (WIHS), a prospective cohort study of women with or at risk of HIV in the United States. METHODS: Participants were 2553 women with or at risk of HIV, predominantly African American/black (71.6%). Structured questionnaires were conducted during April 2013-March 2016 every 6 mo. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. We measured longitudinal outcomes for GAD (GAD-7 score and a binary GAD-7 screener for moderate-to-severe GAD). Only cross-sectional data were available for outcomes measuring perceived stress (PSS-10 score) and PTSD (PCL-C score and a binary PCL-C screener for PTSD). We examined associations of FS with the outcomes through use of multivariable linear and logistic regression, including lagged associations with GAD outcomes. RESULTS: After adjusting for sociodemographic and health-related factors including HIV serostatus, current marginal, low, and very low FS were associated with increasingly higher GAD-7 scores, and with 1.41 (95% CI: 1.10, 1.80; P < 0.01), 2.03 (95% CI: 1.59, 2.61; P < 0.001), and 3.23 (95% CI: 2.43, 4.29; P < 0.001) times higher odds of screening positive for moderate-to-severe GAD, respectively. Low and very low FS at the previous visit (6 mo earlier) were independently associated with GAD outcomes at current visit. Associations of FS with PSS-10 and PCL-C scores exhibited similar dose-response relations. Very low FS was associated with 1.93 (95% CI: 1.15, 3.24; P < 0.05) times higher odds of screening positive for PTSD. CONCLUSIONS: Food insecurity may be associated with a range of poor mental health outcomes among women in the United States with or at risk of HIV.
背景：粮食不安全在美国严重影响边缘化妇女，与抑郁症状有关。很少有研究调查粮食不安全与其他心理健康结果之间的关系。
目的：本研究旨在探讨粮食不安全与广泛性焦虑障碍（GAD）、压力和创伤后应激障碍（PTSD）症状在妇女艾滋病研究机构（WIHS）中的关联，这是一项在美国具有或有 HIV 风险的妇女的前瞻性队列研究。
方法：研究对象为 2553 名具有或有 HIV 风险的妇女，其中大多数为非裔美国人/黑人（71.6%）。在 2013 年 4 月至 2016 年 3 月期间，每 6 个月进行一次结构化问卷调查。使用家庭粮食安全调查模块测量粮食安全（FS）作为主要预测指标。我们测量了 GAD 的纵向结果（GAD-7 评分和用于中度至重度 GAD 的 GAD-7 筛查器）。用于衡量压力知觉（PSS-10 评分）和 PTSD（PCL-C 评分和用于 PTSD 的 PCL-C 筛查器）的结果仅提供横断面数据。我们通过使用多变量线性和逻辑回归，包括 GAD 结果的滞后关联，来研究 FS 与结果之间的关联。
结果：在调整了包括 HIV 血清状况、当前边缘、低和极低 FS 在内的社会人口统计学和健康相关因素后，GAD-7 评分较高，中度至重度 GAD 筛查阳性的几率分别为 1.41（95%CI：1.10，1.80；P<0.01）、2.03（95%CI：1.59，2.61；P<0.001）和 3.23（95%CI：2.43，4.29；P<0.001）倍。前一次就诊（6 个月前）的低和极低 FS 与当前就诊时的 GAD 结果独立相关。FS 与 PSS-10 和 PCL-C 评分之间的关联呈现出相似的剂量反应关系。极低 FS 与 PTSD 筛查阳性的几率增加 1.93 倍（95%CI：1.15，3.24；P<0.05）有关。
结论：在美国具有或有 HIV 风险的妇女中，粮食不安全可能与一系列不良心理健康结果有关。
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