May 2008

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background Food insecurity refers to the limited or uncertain ability to acquire food. Often associated with hunger, food insecurity has also been shown to have negative effects on the health of adults. In general, outcomes such as disease management and obesity worsen when an individual is food insecure. These effects may even differ by gender, having a greater impact on adult women compared to adult men. It has been hypothesized that food insecurity may have similar negative effects on mental health outcomes such as anxiety and depression. Pregnancy represents a period of dramatic physical change and specialized nutritional requirements for women. It may also mark a period of unique challenges in relation to food insecurity. Food insecurity during pregnancy has previously been associated with several adverse outcomes. One particular effect may be antenatal depression, or depression that occurs during pregnancy. This study tests the hypothesis that women who are food insecure during pregnancy are more likely to experience antenatal depression. Methods This study used data from the 2005 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) to study the association between food insecurity during pregnancy and antenatal depressive symptoms. Oregon PRAMS sampled 2806 women and had a total of 1915 respondents. The un-weighted response rate for PRAMS was 68.2%, and the weighted response rate was 75.6%. Preliminary analysis indicated an association between a measure of food insecurity and one measure of antenatal depressive symptoms. This study sought to further explore this association. Food insecurity was measured using a single item that assessed food access during the 12 months prior to delivery, asking: “During the 12 months before your new baby was born, did you ever eat less than you felt you should because there wasn’t enough money to buy food?” Antenatal depressive symptoms were measured using two items on the PRAMS questionnaire: “While you were pregnant, how often did you feel down, depressed, or hopeless?” and “While you were pregnant, how often did you have little interest or pleasure in doing things?” Women who answered “Always” or “Often” to either question were categorized as having had antenatal depression. Logistic regression analysis was used to examine the association between food insecurity and depressive symptoms, as well as between food insecurity and other independent risk factors for food insecurity. Hierarchical stepwise logistic regression was then used to determine the association between food insecurity and depression, while controlling for additional risk factors. All analyses used weighted data to account for the complex sampling design utilized by PRAMS. Results In univariate logistic analysis, antenatal depressive symptoms were significantly associated with food insecurity during pregnancy (OR 3.56, 95% CI 2.18, 5.80; p < 0.001). When controlling for additional risk factors, women with depressive symptoms were more likely to be food insecure than those without symptoms (OR 1.84, 95% CI 0.92, 3.67), but the association was not statistically significant. Food insecurity was also associated with lower household income, participation in the WIC program, residence in a rural county, experiencing intimate partner violence perpetrated by an ex-partner, and several stressful life events including homelessness. Discussion This study found a significant association between antenatal depressive symptoms and food insecurity during pregnancy. Additional study is needed to determine if antenatal depression is a contributing factors in the development of food insecurity, or if food insecurity during pregnancy produces antenatal depression. Programs focused on addressing food insecurity may benefit from including strategies to recognize and treat depression during pregnancy. Since food insecurity is a complex issue involving many factors, additional studies are also needed to investigate how social and cultural elements influence the risk of food insecurity and what impact they may have on its association with antenatal depression. This research could be very useful for identifying women most at risk for food insecurity and its related adverse health outcomes.




School of Medicine



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