Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. e859-e868 (doi:10.1542/10.1542/peds.2006-0239)

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ARTICLE

Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in their Preschool-Aged Children

Robert C. Whitaker, MD, MPH, Shannon M. Phillips, BA and Sean M. Orzol, MPH

Mathematica Policy Research, Inc, Princeton, New Jersey

OBJECTIVES. We sought to determine if the prevalence of depression and anxiety in mothers and the prevalence of behavior problems in preschool-aged children are more common when mothers report being food insecure.

METHODS. A cross-sectional survey of 2870 mothers of 3-year-old children was conducted in 2001–2003 in 18 large US cities. On the basis of the adult food-security scale calculated from the US Household Food Security Survey Module, mothers were categorized into 3 levels: fully food secure, marginally food secure, and food insecure. The 12-month prevalence in mothers of a major depressive episode and generalized anxiety disorder was assessed by the Composite International Diagnostic Interview-Short Form. A child behavior problem in 1 of 3 domains (aggressive, anxious/depressed, or inattention/hyperactivity) was based on the Child Behavior Checklist.

RESULTS. Seventy-one percent of the respondents were fully food secure, 17% were marginally food secure, and 12% were food insecure. After adjustment for sociodemographic factors plus maternal physical health, alcohol use, drug use, prenatal smoking, and prenatal physical domestic violence, the percentage of mothers with either major depressive episode or generalized anxiety disorder increased with increasing food insecurity: 16.9%, 21.0%, and 30.3% across the 3 levels. Among children, after further adjustment for maternal major depressive episode and generalized anxiety disorder, the percentage with a behavior problem also increased with increasing food insecurity: 22.7%, 31.1%, and 36.7%.

CONCLUSIONS. Mental health problems in mothers and children are more common when mothers are food insecure, a stressor that can potentially be addressed by social policy.

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Key Words: child behavior • depression • anxiety • hunger • food supply • child nutrition • child • preschool

Abbreviations: CIDI-SF—Composite International Diagnostic Interview-Short Form • MDE—major depressive episode • GAD—generalized anxiety disorder • DSM-IV—Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition • CBCL—Child Behavior Checklist • ADHD—attention-deficit/hyperactivity disorder • OR—odds ratio • CI—confidence interval

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Accepted Apr 10, 2006.

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