The Relationship Between Food Insecurity and Mental Health


A literature search in PubMed was conducted on September 11, 2023, by using the following MeSH terms: “food supply,” “food insecurity,” and “mental health.” The initial search yielded 89 records. These records were further screened by applying filters, including publication date within the past 10 years and articles that were clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews. To adhere to journal guidelines, the search results were further narrowed down to 20 articles on the basis of relevance to the topic of this article.


The relationship between food insecurity and poor mental health is bidirectional. Food insecurity is a risk factor for developing or worsening of severe mental illness (4). One hypothesis is that food insecurity contributes to poor mental health through nutritional insufficiency (which affects body composition, electrolytes, hormones, blood counts, and other physiological variables) or poor social well-being (preventing people from acting in culturally normative ways or marking social inequality). Other studies have found that food insecurity is not always associated with being undernourished, and social variables did not affect the relationship between food insecurity and mental health symptoms. Rather, it has been suggested that food insecurity harms mental health because the lived experience of poverty is inherently stressful. It involves anxiety surrounding how to fulfill nutritional needs with an unreliable food supply, having to make trade-offs among necessities (which may result in cost-related medication nonadherence), frustration of not being able to obtain preferred foods, or shame of obtaining food in socially undesirable ways (5). Food insecurity can also harm mental health by reducing psychotropic medication efficacy by decreasing medication absorption because of inadequate calorie intake.


Poor mental health is also a risk factor for food insecurity. Poor mental health can result in social isolation and lack of motivation to go grocery shopping or prepare healthy meals. It can result in selecting cheaper, unhealthy food alternatives for comfort (3). Associated apathy can also impede one’s ability to continue working. People with severe mental illness may need family as caregivers, which further contributes to financial strain and food insecurity. Improving access to mental health care was found to reduce food insecurity in households of people with severe mental illness because engagement in integrated care, along with interventions to increase work functioning, improved symptoms (6).


Confounding factors in the risk relationship between food insecurity and poor mental health include socioeconomic factors, health status, level of disability, and level of education, among others (4). All of these factors further contribute to the cycle of food insecurity and poor mental health.


Food insecurity affects all ages, races, ethnicities, genders, and demographic groups. However, individuals more likely to be affected by food insecurity are younger, less educated, Black or African American, female, pregnant, parents, at risk for homelessness, refugees, or current smokers; they may have been exposed to violence or may have substance use disorders, low income, self-reported fair or poor health, or chronic conditions or may utilize government assistance programs (7–9). The elderly population has also been significantly affected by food insecurity (6). This association has been replicated globally. High- and upper-middle–income countries have been found to have higher odds of food insecurity among individuals with severe mental illness compared with low- and lower–middle-income countries. Although it has been suggested that this finding could be due to high food insecurity rates in the general population in lower-income countries, in settings where food insecurity is less common, it has the potential to be more stigmatized, resulting in increased stress for individuals with mental illness (5, 10). Immigrants experience poorer mental well-being than nonimmigrants at the same level of community attachment and food insecurity (8, 9). One of many possible explanations for the increased risk for mental illness in these populations is their vulnerability to experience disparities in access to health care, food resources, social support, and other services (8).


Because of the bidirectional risk relationship between food insecurity and poor mental health, individuals experiencing food insecurity use mental health services to a greater extent than do those not experiencing food insecurity (10). One study found that compared with food-secure individuals, those with severe food insecurity had more mean visits to a psychiatric emergency room (11). Individuals with severe food insecurity had five times higher odds of having a psychiatric emergency room visit in a year compared with food-secure individuals after analyses were adjusted for age, gender, race, and housing status. Increased health care utilization among individuals with food insecurity and mental illness was observed regardless of insurance type (9, 11). These data suggest that efforts to support food-insecure families would improve individuals’ mental health and reduce strain on the mental health system (4, 11, 12).


Despite the known relationship between mental health problems and food insecurity, interventions to reduce food insecurity are underresearched worldwide. Mental health practitioners do not routinely ask patients about food insecurity. No universal measurement tool is available to assess food insecurity in mental health settings. Almost 50 years ago, the World Food Conference pledged to eradicate food insecurity within 10 years, yet it remains a global concern (4).


Pursuing food insecurity intervention research faces some obstacles. Funding is often aimed toward reducing health care utilization, lower costs, or improve metrics in the short term. Long-term outcomes linked to these factors may be understudied, leaving a gap in creating tools to address the association between health-related quality of life, mental health, and food insecurity.


One tool used for examining this association is target trial emulation (which uses observational data to emulate a trial and guide understanding of possible intervention effects). Studies that have used this tool report that interventions to eliminate food insecurity would improve mental and general medical health, lower psychological distress and depressive symptoms, decrease health care utilization, and result in cost savings (11, 13, 14).


The question then becomes what interventions are most effective and where funding should be allocated. Generally, programs that provide financial support to obtain food or directly provide free or reduced-cost nutritious food options are currently known to be effective. One of the largest assistance programs is the Supplemental Nutrition Assistance Program (SNAP). Discussions have arisen regarding how these programs should be implemented and whether new programs should be continually created or whether those that already exist should be better supported or expanded (15). Studies have analyzed the effects of broadened SNAP eligibility on mental health outcomes and found that increased eligibility was associated with decreased rates of past-year major depressive episodes, mental illness, and suicidal ideation among children, adolescents, and adults. Results also suggested that broadened SNAP eligibility decreases the rate of suicide death (16, 17). More studies are needed to assess the relative effectiveness of interventions to create systematic guidelines for reducing food insecurity.


Mental health professionals could use many interventions to address food and nutrition insecurities on the population and individual levels. To address this public health issue, recommended interventions include getting involved in politics and advocating for legislation and policies related to food and nutrition as well as promoting food banks, communal gardens and kitchens, “food is medicine” initiatives, and programs that improve access to affordable and healthy foods and fresh produce. One study (18) specifically examined whether proximity to locations with available vegetables and fruits moderated the association between food insecurity and odds of poor mental health. The authors found that individuals in the bottom 25th percentile of access to vegetables had greater than seven times higher odds of poor mental health compared with individuals in higher percentiles of access to vegetables. In contrast, those in the top 25th percentile of access to vegetables had only a marginal association of food insecurity with poor mental health. Further longitudinal studies are needed to examine the long-term mental health effects of programs and policies that improve availability of nutrient-rich foods in communities with individuals who are food insecure.


On the individual level, consistent food insecurity screening, assessment, treatment, and follow-up are recommended (19). The stigma surrounding food assistance programs has been shown to negatively affect mental health. Studies suggest exploring whether reforms to food assistance programs could help reduce stigma, which could alleviate emotional distress among welfare recipients. Participants from other studies have reported benefits of communal strategies to cope with food insecurity and severe mental illness, such as sharing food and cooking meals jointly (20). Mental health providers may be supplied with information on how to recognize and address food insecurity among their patients and how to suggest strategies to patients that reduce food insecurity and the stigma surrounding it.


Evidence suggests that food insecurity is prevalent among individuals with mental disorders and that the relationship between mental illness and food insecurity is bidirectional. Both have significant effects on the individual and population levels. Both also have indirect and direct effects on the health care system in the United States and globally. An abundance of studies have provided evidence that bolsters the association between mental disorders and food insecurity; however, very few have aimed to discover solutions to this problem. Further studies are needed to explore the effectiveness of interventions to reduce food insecurity in populations of individuals with mental illness and provide information to guide changes in food assistance and related programs.


The author thanks Ned Kletz, M.D., Matthew Hirschtritt, M.D., and Nirmala Ramalingam, M.P.P., at Kaiser Permanente Oakland, for their mentorship and editorial support in the writing of this article and Eve Melton, Director of Library Services at Kaiser Permanente Northern California, for assistance with the literature review.