@article{38ef76f8f467494fa82fe9f8e59e1f95,
title = "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",
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.",
keywords = "HIV, PTSD, anxiety, food insecurity, stress",
author = "Whittle, {Henry J.} and Sheira, {Lila A.} and Wolfe, {William R.} and Frongillo, {Edward A.} and Kartika Palar and Daniel Merenstein and Wilson, {Tracey E.} and Adebola Adedimeji and Weber, {Kathleen M.} and Adimora, {Adaora A.} and Ighovwerha Ofotokun and Lisa Metsch and Turan, {Janet M.} and Wentz, {Eryka L.} and Tien, {Phyllis C.} and Weiser, {Sheri D.}",
note = "Funding Information: Funded by a Women{\textquoteright}s Interagency HIV Study (WIHS) sub-study grant from the National Institute of Mental Health, R01MH095683 and 5U01AI103401, as well as the National Institute of Allergy and Infectious Diseases (K24AI134326) (Weiser). Additional salary support was provided by K01DK107335 (Palar). Data in this manuscript were collected by the Women{\textquoteright}s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women{\textquoteright}s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I – WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women{\textquoteright}s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR000454 (Atlanta CTSA), and P30-AI-050410 (UNC CFAR). Author disclosures: HJW, LAS, WRW, EAF, KP, DM, TEW, AA, KMW, AAA, IO, LM, JMT, ELW, PCT and SDW, no conflicts of interest. Address correspondence to HJW (e-mail: h.whittle@qmul.ac.uk). Abbreviations used: FS, food security; GAD, generalized anxiety disorder; GAD-7, Generalized Anxiety Disorder-7 scale; HFSSM, Household Food Security Survey Module; PCL-C, Posttraumatic Stress Disorder Checklist-Civilian Version; PLHIV, people living with HIV; PSS-10, Perceived Stress Scale 10; PTSD, posttraumatic stress disorder; WIHS, Women{\textquoteright}s Interagency HIV Study.",
year = "2019",
month = aug,
day = "1",
doi = "10.1093/jn/nxz093",
language = "English (US)",
volume = "149",
pages = "1393--1403",
journal = "Journal of Nutrition",
issn = "0022-3166",
publisher = "American Society for Nutrition",
number = "8",
}