Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
United Community Clinic, Philadelphia, PA, USA.
J Gen Intern Med. 2019 Dec;34(12):2874-2882. doi: 10.1007/s11606-019-05202-4. Epub 2019 Aug 5.
A large number of peer-reviewed studies, with various methodologies and populations, have addressed the effects of food insecurity (FIS) on mental health conditions such as depression, anxiety, and sleep disorders. There are currently, however, no published systematic assessments or meta-analyses of this literature.
A systematic search of the literature was conducted in PubMed, PsycInfo, Embase, Scopus, and Web of Science. Cross-sectional studies assessing the association between food insecurity and depression, anxiety, or sleep disorders were identified. For each of the three health outcomes, we extracted (or calculated when possible) the following effect sizes: odds ratio (OR), Hedges' g, Pearson correlation coefficients r, or bivariate coefficients. Then, for each mental health-outcome/effect-size pair, the available studies were combined using the random effect model. Heterogeneity, publication bias, and subgroup dependence, for each meta-analysis, were also assessed.
Fifty-seven studies provided cross-sectional data on the relationship between FIS and depression (n = 169,433), 13 on anxiety and psychological distress (n = 91,957), and 8 studies provided data on sleep disorders (n = 85,788). Meta-analysis showed that FIS is associated with an increased risk of testing positive for depression OR = 2.74 [95% CI 2.52-2.97, n = 135,500, Q(df = 41) = 69, I = 40%], anxiety OR = 2.41 [95% CI 1.81-3.22, n = 51,541, Q(df = 3) = 8, I = 63%], and sleep disorders OR = 1.80 [95% CI 1.51-2.15, n = 84,800, Q(df = 5) = 13, I = 62%]. The highest risks were found for depression and anxiety which had statistically similar values. The results were robust to covariates and population groups.
This systematic review and meta-analysis demonstrates a strong association between FIS and depression, anxiety, and sleep disorders, for which more longitudinal studies addressing effect sizes are warranted to further study causation.
大量经过同行评审的研究采用不同的方法和人群，探讨了粮食不安全（FIS）对抑郁、焦虑和睡眠障碍等心理健康状况的影响。然而，目前尚无针对这一文献的系统评估或荟萃分析。
在 PubMed、PsycInfo、Embase、Scopus 和 Web of Science 中进行了系统的文献检索。确定了评估粮食不安全与抑郁、焦虑或睡眠障碍之间关联的横断面研究。对于每种三种健康结果，我们提取（或在可能的情况下计算）以下效应大小：比值比（OR）、Hedges'g、皮尔逊相关系数 r 或双变量系数。然后，对于每个心理健康结果/效应大小对，使用随机效应模型对可用研究进行组合。还评估了每项荟萃分析的异质性、发表偏倚和亚组依赖性。
57 项研究提供了关于 FIS 与抑郁关系的横断面数据（n=169433），13 项研究提供了关于焦虑和心理困扰的横断面数据（n=91957），8 项研究提供了关于睡眠障碍的数据（n=85788）。荟萃分析表明，FIS 与抑郁检测呈阳性的风险增加相关，OR=2.74[95%CI 2.52-2.97，n=135500，Q(df=41)=69，I=40%]、焦虑 OR=2.41[95%CI 1.81-3.22，n=51541，Q(df=3)=8，I=63%]和睡眠障碍 OR=1.80[95%CI 1.51-2.15，n=84800，Q(df=5)=13，I=62%]。抑郁和焦虑的风险最高，且具有统计学上相似的值。结果对于协变量和人群组是稳健的。
本系统评价和荟萃分析表明，FIS 与抑郁、焦虑和睡眠障碍之间存在很强的关联，需要更多的纵向研究来进一步研究因果关系，以确定这些关联的效应大小。
