Prevalence of food insecurity in people with major depression, bipolar disorder, and schizophrenia and related psychoses: A systematic review and meta-analysis

Abstract

People with severe mental illness (SMI), such as major depression, bipolar disorder, and schizophrenia, experience numerous risk factors that may predispose them to food insecurity; however, the prevalence of food insecurity and its effects on health are under-researched in this population group. This systematic review and meta-analysis aimed to describe the prevalence and correlates of food insecurity in people with SMI. A comprehensive electronic search was conducted up to March 2021. Random effects meta-analysis was employed to determine the prevalence of food insecurity in SMI, and odds ratio (OR) of food insecurity in people with SMI compared to non-psychiatric controls/general population. Twenty-nine unique datasets (31 publications) were included. Prevalence estimate of food insecurity in people with SMI was 40% (95% CI 29–52%, I² = 99.7%, N = 27). People with SMI were 2.71 (95% CI 1.72–3.25) times more likely to report food insecurity than the comparator group (Z = 11.09, p < 0.001, I² = 95%, N = 23). The odds of food insecurity in SMI were higher in high/high-middle income countries compared to low/low-middle income countries, likely due to the high food insecurity rates in the general population of lower income countries. There was no difference in food insecurity rates by diagnosis. Food insecurity should be a consideration for health professionals working with community-dwelling people with SMI.

Keywords:

• Food security
• food access
• psychosis
• mood disorder
• mental illness

Acknowledgements

There was no specific funding associated with this project. SBT is a Postdoctoral Research Fellow with the Mindgardens Neuroscience Network and University of New South Wales. SBT was previously a contractor for Nutrition Research Australia, who conduct independent nutrition research for government and industry bodies. ASMS has been funded by the European Commission, the German Research Foundation, the German Federal Ministry of Education and Research, the German Federal Ministry of Health, and the Innovation Fund of the German Joint Federal Committee. AR has received travel or speakers’ honoraria funds from Nutrition Society of Australia, Eastern Finland Medicine Association, University of Turku and The Association of Clinical and Public Health Nutritionists in Finland. WM is currently funded by an Alfred Deakin Postdoctoral Research Fellowship and a Multiple Sclerosis Research Australia early-career fellowship. WM has previously received funding from the NHMRC, Clifford Craig Foundation, Cancer Council Queensland and university grants/fellowships from La Trobe University, Deakin University, University of Queensland, and Bond University, received industry funding and has attended events funded by Cobram Estate Pty. Ltd, received travel funding from Nutrition Society of Australia, received consultancy funding from Nutrition Research Australia, and has received speakers honoraria from The Cancer Council Queensland and the Princess Alexandra Research Foundation. JF is supported by a University of Manchester Presidential Fellowship (P123958) and a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1) and has received honoraria/consultancy fees from Atheneum, ParachuteBH and Nirakara, independent of this work. All authors had access to the data included in this manuscript and accept responsibility for publication.

Availability of data and material

Data included in this review are saved in a separate database. People interested in this data can contact the research team via the corresponding author.

Authors’ contributions

SBT and JF registered the study protocol with input from all authors. SBT conducted the literature searches. SBT and AR conducted title/abstract and full-text screening. SBT, ASMS extracted data with assistance from ME. ST and AR assessed individual study risk of bias. WM ran the meta-analyses and created the supporting figures. SBT, WM, and JF interpreted the findings with input from all authors. SBT drafted the manuscript. All authors provided input on manuscript drafts and approved the final version of the manuscript for submission.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The authors reported there is no funding associated with the work featured in this article.