McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, Montreal, Québec, Canada.
School of Psychology, Laval University, Québec City, Québec, Canada.
JAMA Netw Open. 2021 Dec 1;4(12):e2140085. doi: 10.1001/jamanetworkopen.2021.40085.
Household food insecurity has been associated with mental health problems in children independently of family income and other confounders. It is unclear whether food insecurity during childhood is also associated with mental health and functioning during adolescence.
To evaluate longitudinal trajectories of household food insecurity during the first 13 years of life, characteristics associated with these trajectories, and the associations of the trajectories with externalizing, internalizing, substance use, and social adjustment problems at 15 years of age.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included participants from the Québec Longitudinal Study of Child Development, a cohort of 2120 children born in Québec, Canada, in 1997 and 1998 and followed up annually or biannually from 5 months to 15 years of age (1998-2013). Data were analyzed from November 2020 to October 2021.
When children were aged 1.5, 4, 8, 10, 12, and 13 years, mothers reported whether a family member experienced hunger because the family had run out of food or money to buy food in the past 12 months.
Group-based trajectory modeling was used to identify differential exposure to food insecurity from 1.5 to 13 years according to logit functions of age. At 15 years of age, adolescents completed validated questionnaires assessing externalizing, internalizing, substance use, and social adjustment problems. Associations between trajectories of food insecurity and outcomes were assessed using linear regressions.
A total of 2032 individuals were included in the analyses of trajectories of food insecurity (1026 [50.5%] male) and 1441 in the analysis of the association with outcomes at 15 years of age (752 [52.2%] female). Two trajectories of food insecurity were identified between 1.5 and 13 years of age: high risk (73 children [3.6%]) and low risk (1959 children [96.4%]). At 5 months, the high-risk and low-risk groups differed in household characteristics including income insufficiency (58 [80.6%] vs 405 [21.0%]), single parenthood (21 [29.2%] vs 135 [6.9%]), and parental history of depression (mothers: 30 [43.5%] vs 411 [21.7%]; fathers: 12 [32.4%] vs 209 [13.5%]). The high-risk trajectory from 1.5 to 13 years of age was associated with cannabis use (β, 0.47; 95% CI, 0.12-0.81), peer bullying (β, 0.43; 95% CI, 0.08-0.77), and dropout potential (β, 0.38; 95% CI, 0.03-0.68) at 15 years of age after adjustment for sex, household income insufficiency, and parental mental health.
In this cohort study, few children experienced a persistent high risk of food insecurity, which was associated with psychosocial problems later in adolescence after adjustment for confounders including low income. Early identification of risk for food insecurity may guide the delivery of tailored interventions to improve functioning in adolescence.
家庭食物不安全与儿童心理健康问题有关，而与家庭收入和其他混杂因素无关。目前尚不清楚儿童时期的食物不安全是否也与青少年时期的心理健康和功能有关。
评估儿童期前 13 年家庭食物不安全的纵向轨迹，与这些轨迹相关的特征，以及轨迹与 15 岁时外化、内化、物质使用和社会适应问题的关联。
设计、地点和参与者：这项队列研究包括来自魁北克儿童发展纵向研究的参与者，该队列由 1997 年和 1998 年在加拿大魁北克出生的 2120 名儿童组成，从 5 个月到 15 岁（1998-2013 年），每年或每两年进行一次随访。数据分析于 2020 年 11 月至 2021 年 10 月进行。
当儿童年龄为 1.5、4、8、10、12 和 13 岁时，母亲报告在过去 12 个月中是否有家庭成员因家庭食物短缺或无钱购买食物而经历过饥饿。
使用基于群组的轨迹建模根据年龄的逻辑函数识别从 1.5 岁到 13 岁的不同食物不安全暴露情况。在 15 岁时，青少年完成了评估外化、内化、物质使用和社会适应问题的有效问卷。使用线性回归评估食物不安全轨迹与结局之间的关联。
共有 2032 人纳入了食物不安全轨迹分析（男性 1026 人[50.5%]），1441 人纳入了与 15 岁时结局关联的分析（女性 752 人[52.2%]）。在 1.5 岁至 13 岁期间确定了两种食物不安全轨迹：高风险（73 名儿童[3.6%]）和低风险（1959 名儿童[96.4%]）。在 5 个月大时，高风险和低风险组在家庭特征方面存在差异，包括收入不足（58 名[80.6%] vs 405 名[21.0%]）、单亲家庭（21 名[29.2%] vs 135 名[6.9%]）和父母的抑郁史（母亲：30 名[43.5%] vs 411 名[21.7%]；父亲：12 名[32.4%] vs 209 名[13.5%]）。从 1.5 岁到 13 岁的高风险轨迹与大麻使用（β，0.47；95%CI，0.12-0.81）、同伴欺凌（β，0.43；95%CI，0.08-0.77）和辍学倾向（β，0.38；95%CI，0.03-0.68）相关，在调整性别、家庭收入不足和父母心理健康状况后，15 岁时的青少年。
在这项队列研究中，很少有儿童经历持续的高食物不安全风险，这与调整收入等混杂因素后青少年后期的心理社会问题有关。早期发现食物不安全的风险可能有助于提供量身定制的干预措施，以改善青春期的功能。
