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, Lila A. Sheira, William R. Wolfe, Edward A. Frongillo, Kartika Palar, Daniel Merenstein, Tracey E. Wilson, Adebola A. Adedimeji, Kathleen M. Weber, Adaora A. Adimora, Ighovwerha Ofotokun, Lisa Metsch, Janet M. Turan, Eryka L. Wentz, Phyllis C. Tien, Sheri D. Weiser

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1393-1403
Number of pages11
JournalThe Journal of nutrition
Volume149
Issue number8
DOIs
StatePublished - Aug 1 2019

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Food Supply
Post-Traumatic Stress Disorders
Anxiety Disorders
Anxiety
HIV
Mental Health
African Americans
Linear Models
Cohort Studies
Logistic Models
Prospective Studies
Depression

Keywords

  • anxiety
  • food insecurity
  • HIV
  • PTSD
  • stress

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

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. / Whittle, Henry J.; Sheira, Lila A.; Wolfe, William R.; Frongillo, Edward A.; Palar, Kartika; Merenstein, Daniel; Wilson, Tracey E.; Adedimeji, Adebola A.; Weber, Kathleen M.; Adimora, Adaora A.; Ofotokun, Ighovwerha; Metsch, Lisa; Turan, Janet M.; Wentz, Eryka L.; Tien, Phyllis C.; Weiser, Sheri D.

In: The Journal of nutrition, Vol. 149, No. 8, 01.08.2019, p. 1393-1403.

Research output: Contribution to journalArticle

Whittle, HJ, Sheira, LA, Wolfe, WR, Frongillo, EA, Palar, K, Merenstein, D, Wilson, TE, Adedimeji, AA, Weber, KM, Adimora, AA, Ofotokun, I, Metsch, L, Turan, JM, Wentz, EL, Tien, PC & Weiser, SD 2019, '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', The Journal of nutrition, vol. 149, no. 8, pp. 1393-1403. https://doi.org/10.1093/jn/nxz093
Whittle, Henry J. ; Sheira, Lila A. ; Wolfe, William R. ; Frongillo, Edward A. ; Palar, Kartika ; Merenstein, Daniel ; Wilson, Tracey E. ; Adedimeji, Adebola A. ; Weber, Kathleen M. ; Adimora, Adaora A. ; Ofotokun, Ighovwerha ; Metsch, Lisa ; Turan, Janet M. ; Wentz, Eryka L. ; Tien, Phyllis C. ; Weiser, Sheri D. / 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. In: The Journal of nutrition. 2019 ; Vol. 149, No. 8. pp. 1393-1403.
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abstract = "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.",
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T1 - 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

AU - Whittle, Henry J.

AU - Sheira, Lila A.

AU - Wolfe, William R.

AU - Frongillo, Edward A.

AU - Palar, Kartika

AU - Merenstein, Daniel

AU - Wilson, Tracey E.

AU - Adedimeji, Adebola A.

AU - Weber, Kathleen M.

AU - Adimora, Adaora A.

AU - Ofotokun, Ighovwerha

AU - Metsch, Lisa

AU - Turan, Janet M.

AU - Wentz, Eryka L.

AU - Tien, Phyllis C.

AU - Weiser, Sheri D.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - 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.

AB - 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.

KW - anxiety

KW - food insecurity

KW - HIV

KW - PTSD

KW - stress

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