Food insecurity and mental health among children and adolescents in sub-Saharan Africa: systematic review

Abstract

• Food insecurity is consistently associated with worse child mental health in sub-Saharan Africa. • The causal relationship between food insecurity and child mental health is poorly understood. • No intervention studies investigated the effect of reducing food insecurity on mental health. • Measures of food insecurity lacked validity and reliability. • Included observational studies were of acceptable quality. Food insecurity and mental health conditions are important public health problems among children and adolescents in sub-Saharan Africa (SSA). Many potential biological, psychological and social mechanisms may explain the association between food insecurity and mental health among children and adolescents. Experiences of food insecurity are known to affect an individual’s psychological state resulting in anxiety, isolation, stress, and sadness. To systematically review the literature on the association between food insecurity and child and adolescent mental health (CAMH) and the impact of food insecurity reduction interventions on CAMH outcomes in SSA. A systematic search of eight databases (APA PsycINFO, CINAHL, EconLit, Embase, MEDLINE, Scopus, PubMed and Cochrane Library) was conducted to identify relevant studies. Included studies were assessed for quality and correlations between food insecurity and CAMH reported. 9547 published articles were retrieved during literature search. Seventeen observational studies met the inclusion criteria and were included in the review. No articles of intervention studies were identified. Positive significant associations were found between food insecurity and worse CAMH outcomes. Included articles of observational studies were of acceptable quality. Experiencing food insecurity is associated with both internalising and externalizing problems among children and adolescents in SSA. While no interventions reducing food insecurity were found, there is a need to design and conduct intervention studies to assess the impact of such interventions on CAMH. Although cross-sectional evidence for the association between food insecurity and mental health conditions is well established, there is a need for longitudinal studies to assess the bi-directional, temporal associations, and unpack mechanisms through which food insecurity affects mental health (social causation) and through which mental health conditions affect food insecurity (social drift). Reducing food insecurity and improving CAMH is needed to break the cycle of food insecurity and to achieve the United Nations 2030 Sustainable Development Goals.