Elgar Frank J, Sen Akankasha, Gariépy Geneviève, Pickett William, Davison Colleen, Georgiades Kathy, Hammami Nour, Da Silva Marine Azevedo, Gordon David, Melgar-Quiñonez Hugo Ramiro
Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, Quebec, H3A 1A3, Canada.
Margaret A. Gilliam Institute for Global Food Security, McGill University, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.
SSM Popul Health. 2021 Mar 3;14:100764. doi: 10.1016/j.ssmph.2021.100764. eCollection 2021 Jun.
Youth in fragile settings face disproportionate risks of experiencing food insecurity and poor mental health. Cross-national evidence is lacking on the association between food insecurity and mental health in youth populations, and on state fragility as a social determinant of these experiences. We analysed data from six cycles of the Gallup World Poll (2014-2019), an annual survey that contains multi-item scales of food insecurity, mental health problems and positive wellbeing. The analytic sample included 164,118 youth aged 15-24 years in 160 states. We linked individual responses to state-level data from the Fragile States Index-an aggregate measure of state vulnerability to collapse or conflict (coded: sustainable, stable, warning, or alert) and estimated adjusted relative risk (RR) of food insecurity as a function of state fragility. We then used linear regression to examine associations of state fragility and food insecurity with mental health and wellbeing. The prevalence of moderate or severe food insecurity rose from 22.93% in 2014 to 37.34% in 2019. State fragility (alert sustainable) was related to an increased risk of food insecurity (RR = 2.28 [95% CI 1.30 to 4.01]), more mental health symptoms (b = 6.36 [95% CI 1.79 to 10.93]), and lower wellbeing (b = -4.49 [95% CI -8.28 to -0.70]) after controlling for state wealth and household income. Increased food insecurity (severe none or mild) was uniquely related to more mental health symptoms (b = 18.44 [95% CI 17.24 to 19.64]) and reduced wellbeing (b = -9.85 [95% CI -10.88 to -8.83]) after state fragility was also controlled. Globally, youth experience better mental health where states are more robust and food access is more secure. The findings underscore the importance of strong governance and coordinated policy actions that may improve youth mental health.
处于脆弱环境中的青少年面临着粮食不安全和心理健康状况不佳的风险，且这种风险比例失衡。目前缺乏关于青少年群体中粮食不安全与心理健康之间关联以及国家脆弱性作为这些经历的社会决定因素的跨国证据。我们分析了盖洛普世界民意调查六个周期（2014 - 2019年）的数据，该年度调查包含粮食不安全、心理健康问题和积极幸福感的多项目量表。分析样本包括160个国家的164,118名15 - 24岁的青少年。我们将个体回答与脆弱国家指数的国家层面数据相联系，该指数是衡量国家崩溃或冲突脆弱性的综合指标（编码为：可持续、稳定、预警或警戒），并估计了作为国家脆弱性函数的粮食不安全调整相对风险（RR）。然后，我们使用线性回归来研究国家脆弱性和粮食不安全与心理健康及幸福感之间的关联。中度或重度粮食不安全的患病率从2014年的22.93%上升到2019年的37.34%。在控制了国家财富和家庭收入后，国家脆弱性（警戒 可持续）与粮食不安全风险增加（RR = 2.28 [95%置信区间1.30至4.01]）、更多心理健康症状（b = 6.36 [95%置信区间1.79至10.93]）以及更低幸福感（b = -4.49 [95%置信区间 -8.28至 -0.70]）相关。在控制了国家脆弱性后，粮食不安全增加（重度 无或轻度）与更多心理健康症状（b = 18.44 [95%置信区间17.24至19.64]）和幸福感降低（b = -9.85 [95%置信区间 -10.88至 -8.83]）独特相关。在全球范围内，在国家更强大且粮食获取更有保障的地方青少年心理健康状况更好。这些发现强调了强有力的治理和协调一致的政策行动对于改善青少年心理健康的重要性。
