Poor mental health in SA linked to food insecurity

At least 10 million South Africans didn’t have enough food or money to buy food in 2019, according to Statistics SA. This food insecurity remains a leading health problem that is unlikely to be eradicated any time soon.

To support those affected, it’s important to understand how households cope with food insecurity. Existing research on this has been conducted sub-nationally. The focus has mostly been on the poorest regions of the country. The national picture of household food insecurity has not been clear.

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Another gap in understanding has been the impact of households’ coping strategies on mental health. Such strategies include eating less, borrowing or using credit, and even begging for food on the streets.

Anxiety and depression

Our recent study investigated food insecurity and related coping strategies among SA households and their association with anxiety and depression.

We have shown, for the first time, how the strategies that SA households commonly use to cope with food insecurity are associated in different ways with anxiety and depression.

In other words, some coping strategies may have a greater impact than others on mental health. Our findings suggest that begging for food was the most harmful coping strategy for mental health.

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Conversely, relying on less preferred and less expensive foods was less associated with anxiety and depression.

For our study, we conducted face-to-face interviews with a nationally representative sample of 3 402 adults in October 2021. The survey data was statistically weighted to represent over 39 million SA households.

Food insecurity

We assessed food insecurity using the Community Childhood Hunger Identification Project questionnaire. This survey tool allowed us to categorise the households into three groups: food secure, at risk, and food insecure.

We found that over 20% (1 in 5) of the households were food insecure. But the prevalence varied widely across the provinces. The Eastern Cape province was the most affected (32% of households there were food insecure).

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We also confirmed that food access largely depended on socioeconomic status. People who are uneducated, the unemployed and those receiving a low monthly income are the most severely affected by inadequate food access.

Apartheid policies

Food insecurity was most common among coloured people (24%). Black people (23%) were also more food insecure than white (5%) and Asians (4%). These large differences in food insecurity rates have been attributed to apartheid policies.

These policies led to racial discrimination, geographic segregation, and other unsustainable settlement patterns. Hence, solutions to such inequalities require fundamental restructuring of the SA economy.

We assessed the extent to which households used harmful coping strategies when faced with food insecurity. All coping strategies were used to some extent.

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The most common strategy (used by at least 46%) was relying on less preferred and less expensive foods. Sending household members to beg for food was the least common strategy. It was used by 21% (more than one in five) of households.

Begging for food

We didn’t expect this high rate of begging for food. Begging is a strategy often used by homeless people and it’s sometimes seen as socially unacceptable.

To assess the risk of impaired mental health among respondents, we used the General Anxiety Disorder-7 and Patient Health Questionnaire-9 questionnaires. These are validated tools for screening symptoms of anxiety and depression, respectively.

Our findings demonstrated that living in a food insecure household was associated with a higher risk of anxiety and depression.

-Siphiwe Dlamini is a lecturer, School of Physiology, Wits University