Food Insecurity Is Associated With Anxiety, Stress, and Symptoms of Posttraumatic Stress Disorder in a Cohort of Women With or at Risk of HIV in the United States

Henry J. Whittle, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Lila A. Sheira, Division of HIV, ID and Global Medicine.
William R. Wolfe, Department of Psychiatry.
Edward A. Frongillo, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC.
Kartika Palar, Division of HIV, ID and Global Medicine.
Daniel Merenstein, Department of Family Medicine, Georgetown University Medical Center, Washington, DC.
Tracey E. Wilson, Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY.
Adebola Adedimeji, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
Kathleen M. Weber, Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago, IL.
Adaora A. Adimora, School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Ighovwerha Ofotokun, School of Medicine, Emory University, Atlanta, GA, and Grady Healthcare System, Atlanta, GA.
Lisa Metsch, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.
Janet M. Turan, Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Eryka L. Wentz, Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
Phyllis C. Tien, Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA.
Sheri D. Weiser, Division of HIV, ID and Global Medicine.


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.