Ametti Merelise R, Frering Hannah E, Huang Kierian, Marsh Katya, Althoff Robert R
Department of Psychiatry, Larner College of Medicine at the University of Vermont, Burlington.
Center for Clinical and Translational Science, MaineHealth Institute for Research, Scarborough.
JAMA Netw Open. 2025 Sep 2;8(9):e2530691. doi: 10.1001/jamanetworkopen.2025.30691.
In the US, children in food-insecure households are at risk for adverse psychological outcomes despite being shielded from hunger and malnutrition by their caregivers and school- and community-based programs. Parenting stress may be an important mechanism through which food insecurity is associated with negative outcomes for child mental health.
To investigate associations of household food insecurity with child mental health, parenting stress, and family functioning.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a daily-diary design in a community-based sample to examine associations between daily fluctuations in food insecurity and child and family functioning. The study was conducted remotely during the COVID-19 pandemic in the rural (defined by the Health Resource Services Administration) Northeastern US. Caregivers of school-aged children were enrolled during the 2021 school year and completed a baseline visit followed by mobile surveys for 30 days. Participants were adult, legal caregivers of children ages 6 to 12 years who experienced food insecurity within the past month. Participants were required to have English proficiency and access to a device with internet and texting capabilities. Prospective participants completed an online questionnaire to determine eligibility. A total of 553 respondents were screened, of which 327 respondents (59.1%) met all inclusion criteria. The most common reason for ineligibility was not having a child in the study age range. Data analyses were performed between May 2022 and April 2023.
Household food insecurity.
The primary outcomes were caregiver hunger, negative affect, executive functioning, and parent-child interactions (measured via a daily self-report survey) and child mental health problems (measured via the Child Behavior Checklist [CBCL]).
Among 61 caregivers (mean [SD] age, 36.1 [5.9] years; 51 women [83.6%]; 2 American Indian or Alaska Native [3.3%], 1 Black [1.6%], and 55 non-Hispanic White [90.2%]), greater day-to-day fluctuations in household and child food insecurity were associated with more severe child internalizing problems (CBCL Internalizing Problems scale: β = 0.40; P = .003 for household and β = 0.49; P < .001 for child food insecurity) and total mental health problems (CBCL Total Problems scale: β = 0.34; P = .01 for household and β = 0.35; P = .01 for child food insecurity). Additionally, the daily association between food insecurity and parent-child conflict was fully mediated via 2 sequential pathways of caregiver hunger and negative affect (b = .02; P = .001) and caregiver hunger and attention and impulse control (b = 0.01; P = .04). This model explained 17% of variability in daily parent-child conflict (R2 = 0.17).
This study's findings suggest that caregiver stress and household instability may be key mechanisms by which food insecurity is negatively associated with child mental health.
在美国，尽管粮食不安全家庭中的儿童受到照料者以及学校和社区项目的保护，免受饥饿和营养不良之苦，但他们仍面临不良心理后果的风险。养育压力可能是粮食不安全与儿童心理健康负面结果相关联的一个重要机制。
调查家庭粮食不安全与儿童心理健康、养育压力和家庭功能之间的关联。
设计、背景和参与者：这项横断面研究采用基于社区样本的每日日记设计，以检验粮食不安全的每日波动与儿童及家庭功能之间的关联。该研究在美国东北部农村地区（由卫生资源与服务管理局定义）的新冠疫情期间远程进行。在2021学年招募了学龄儿童的照料者，并完成一次基线访视，随后进行为期30天的移动调查。参与者为过去一个月内经历过粮食不安全的6至12岁儿童的成年法定照料者。参与者需具备英语能力，并能使用具备上网和短信功能的设备。潜在参与者完成一份在线问卷以确定是否符合资格。共筛选了553名受访者，其中327名受访者（59.1%）符合所有纳入标准。不符合资格的最常见原因是没有处于研究年龄范围内的孩子。数据分析在2022年5月至2023年4月期间进行。
家庭粮食不安全。
主要结局包括照料者饥饿感、消极情绪、执行功能和亲子互动（通过每日自我报告调查测量）以及儿童心理健康问题（通过儿童行为量表[CBCL]测量）。
在61名照料者中（平均[标准差]年龄为36.1[5.9]岁；51名女性[83.6%]；2名美洲印第安人或阿拉斯加原住民[3.3%]，1名黑人[1.6%]，55名非西班牙裔白人[90.2%]），家庭和儿童粮食不安全的每日波动越大，与儿童内化问题越严重相关（CBCL内化问题量表：家庭粮食不安全时β = 0.40；P = 0.003，儿童粮食不安全时β = 0.49；P < 0.001）以及总的心理健康问题（CBCL总问题量表：家庭粮食不安全时β = 0.34；P = 0.01，儿童粮食不安全时β = 0.35；P = 0.01）。此外，粮食不安全与亲子冲突之间的每日关联通过照料者饥饿感和消极情绪（b = 0.02；P = 0.001）以及照料者饥饿感和注意力及冲动控制（b = 0.01；P = 0.04）这两条连续途径完全中介。该模型解释了每日亲子冲突中17%的变异性（R2 = 0.17）。
本研究结果表明，照料者压力和家庭不稳定可能是粮食不安全与儿童心理健康负相关的关键机制。
