Food Insecurity Patterns and Mental Health among Youth and Young Adults with Diabetes

BACKGROUND:Food insecurity (FI) is linked to mental health outcomes cross-sectionally, but little is known about temporal patterns of FI and changes in mental health. FI can exacerbate the mental health challenges of managing diabetes, creating a vicious cycle that worsens youth and young adults' (YYAs) mental well-being. PURPOSE:We investigated the association of temporal patterns of FI with symptoms of depression, anxiety, and stress, and changes therein in YYAs with youth-onset type 1 (T1D) and type 2 diabetes (T2D). METHODS:Longitudinal data (2016-2022) including three time points (t1, t2, and t3) from 747 YYAs with T1D and 97 YYAs with T2D were analyzed using multivariable linear regression. Ascertained with the Household Food Security Survey Module, food security was classified as persistently food secure, persistently food insecure (PFI), and intermittently food insecure (IFI). Mental health at t3 and changes from t2 to t3 were characterized with the Center for Epidemiologic Studies Depression Scale, the Generalized Anxiety Disorder Scale, and Cohen's Perceived Stress Scale. FINDINGS:Among YYAs with T1D and T2D, 6.6% and 16.5% were PFI, 20.3% and 42.3% were IFI, respectively. In YYA with T1D, PFI and IFI were associated with greater depressive, anxiety, and stress symptoms at t3, and with increased symptoms over time. In YYA with T2D, PFI was associated with greater depressive symptoms at t3 but not with changes over time. INTERPRETATION:The study identified a previously unrecognized link between prolonged exposure to FI and increased incidence of mental health issues. Both persistent and intermittent FI were associated with adverse mental health symptoms in YYA with diabetes, more so for those with PFI. Subsequent research should prioritize interventions that address FI in this population to evaluate their effectiveness in enhancing both physical and psychological well-being. It should be designed to not only address FI, but also comprehensive support, including mental health services and education.