The authors have declared that no competing interests exist.
Conceived and designed the experiments: MM JFC SC RT MB. Analyzed the data: MM JFC. Contributed reagents/materials/analysis tools: MM JFC BF CG SC RT MB. Wrote the paper: MM JFC BF CG SC RT MB.
Food insecurity (which can be defined as inadequate access to sufficient, safe, and nutritious food that meets individuals’ dietary needs) is concurrently associated with children’s psychological difficulties. However, the predictive role of food insecurity with regard to specific types of children’s mental health symptoms has not previously been studied. We used data from the Longitudinal Study of Child Development in Québec, LSCDQ, a representative birth cohort study of children born in the Québec region, in Canada, in 1997–1998 (n = 2120)
In industrialized countries, approximately 5–15% of families experience food insecurity, that is insufficient access to “sufficient, safe, and nutritious food that meets individuals’ dietary needs and preferences for an active and healthy life”
Past research linking food insecurity to children’s outcomes was mostly based on cross-sectional samples
Data for this study come from the Québec Longitudinal Study of Child Development (QLSCD) study, which follows a representative cohort of 2120 children born in the Canadian province of Québec in 1997–1998. To ensure geographic representation and minimize the effect of seasonality, participants were chosen through a random selection of children born throughout the year in each public health geographic area of the province. Twins and children with major diseases or handicaps at birth were excluded from the cohort. Selected children were first seen at 5 months of age and then once each year thereafter (follow-up assessments were conducted at 1½, 2½, 3½, 4½, 5, 6 and 8 years). Data on children and their parents were collected by trained interviewers through home interviews regularly conducted with the person most knowledgeable about the child (the mother in 98% of cases). Participating families gave written informed consent for the study at each assessment. The survey protocol was approved by the Quebec Institute of Statistics (Quebec City, Quebec, Canada) and the St-Justine Hospital Research Center (Montreal, Quebec, Canada) ethics committees. Informed consent for the study was obtained from parents or legal guardians.
Food-insecure children n = 99 | Non food-insecure children n = 1583 | p-value | |
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Sex (%):FemaleMale | 46.553.5 | 50.549.5 | 0.44 |
Immigrant status (%):Non-immigrantImmigrant | 80.819.2 | 88.311.7 |
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Symptoms of depression/anxiety:LowIntermediateHigh | 10.158.631.3 | 19.859.820.4 |
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Symptoms of aggression:LowIntermediateHigh | 18.251.530.3 | 24.150.025.9 |
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Symptoms of hyperactivity/inattention:LowLow/intermediateIntermediateHigh | 17.237.430.315.2 | 21.138.335.15.4 |
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Family structure (%):Two-parent familyParents separated | 49.550.5 | 77.222.8 |
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Maternal age at child’s birth (%):> = 21 years<21 years | 59.640.4 | 80.219.8 |
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Family income (%):SufficientInsufficient | 23.276.8 | 76.024.0 |
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Maternal education (%):<High school degree> = High school degree | 33.766.3 | 15.484.6 |
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Paternal education (%):<High school degree> = High school degree | 4654 | 18.481.6 |
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Prenatal tobacco exposure (%):NoYes | 62.637.4 | 75.924.1 |
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Maternal depression score (µ, se) | 2.24, 1.52 | 1.28, 1.07 |
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Paternal depression score (µ, se) | 1.33, 1.10 | 0.97, 0.94 |
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Family functionning score (µ, se) | 0.27, 0.17 | 0.25, 0.15 | 0.18 |
Negative parenting score (µ, se) | 3.28, 1.18 | 2.98, 1.02 |
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High depression/anxietyprevalence: 21.0%OR (95% CI) | Highaggressionprevalence: 26.2%OR (95% CI) | Highhyperactivity/inattentionprevalence: 6.0%OR (95% CI) | |
Food insecurity :NoYes | 11.79 (1.15–2.79) | 11.21 (0.77–1.90) | 13.06 (1.68–5.55) |
Immigrant status:Non-immigrantImmigrant | 10.90 (0.63–1.30) | 10.91 (0.64–1.28) | 10.89 (0.47–1.70) |
Family structure:Two-parent familyParents separated | 11.11 (0.85–1.45) | 11.52 (1.19–1.95) | 12.54 (1.67–3.85) |
Maternal age at child’s birth:> = 21 years<21 years | 10.93 (0.69–1.25) | 11.55 (1.20–2.02) | 12.33 (1.51–3.59) |
Family income:SufficientInsufficient | 11.28 (0.99–1.65) | 11.40 (1.10–1.78) | 12.11 (1.40–3.19) |
Maternal education:> = High school degree< High school degree | 11.08 (0.79–1.47] | 11.42 (1.07–1.90) | 11.80 (1.12–2.90) |
Paternal education:> = High school degree< High school degree | 11.08 (0.79–1.46) | 11.80 (1.37–2.37) | 12.87 (1.81–4.54) |
Prenatal tobacco exposure:NoYes | 10.88 (0.67–1.16) | 11.60 (1.25–2.04) | 11.96 (1.28–3.00) |
Maternal depression score (per unit) | 1.25 (1.14–1.38) | 1.22 (1.11–1.34) | 1.43 (1.24–1.64) |
Paternal depression score (per unit) | 1.11 (0.98–1.26) | 1.12 (1.00–1.27) | 1.26 (1.03–1.54) |
Family functionning score (per unit) | 1.70 (0.81–3.60) | 2.68 (1.34–5.37) | 2.86 (0.85–9.66) |
Negative parenting score (per unit) | 1.46 (1.30–1.63) | 1.75 (1.56–1.96) | 1.88 (1.57–2.26) |
Highdepression/anxietyOR (95% CI) | HighaggressionOR (95% CI) | Highhyperactivity/inattentionOR (95% CI) | |
Food insecurity :NoYes | 11.44 (0.78–2.66) | 10.67 (0.35–1.29) | 12.65 (1.16–6.06) |
Sex:FemaleMale | 10.80 (0.62–1.05) | 12.07 (1.59–2.69) | 12.46 (1.43–4.23) |
Immigrant status:Non-immigrantImmigrant | 10.65 (0.42–1.02) | 10.79 (0.52–1.20) | 10.69 (0.30–1.60) |
Family structure:Two-parent familyParents separated | 11.04 (0.72–1.50) | 11.25 (0.89–1.77) | 11.36 (0.74–2.49) |
Maternal age at child’s birth:> = 21 years<21 years | 10.94 (0.64–1.40) | 11.25 (0.87–1.81) | 11.55 (0.83–2.90) |
Family income:SufficientInsufficient | 11.05 (0.73–1.52) | 11.05 (0.74–1.50) | 10.90 (0.47–1.72) |
Maternal education:> = High school degree< High school degree | 11.25 (0.82–1.91) | 10.98 (0.65–1.48) | 10.77 (0.36–1.64) |
Paternal education:> = High school degree< High school degree | 10.88 (0.61–1.28) | 11.51 (1.07–2.11) | 11.80 (1.00–3.24) |
Prenatal tobacco exposure:NoYes | 10.68 (0.48–0.96) | 11.18 (0.86–1.62) | 11.11 (0.61–2.00) |
Maternal depression score (per unit) | 1.23 (1.08–1.39) | 1.13 (1.00–1.28) | 1.22 (0.99–1.51) |
Paternal depression score (per unit) | 1.03 (0.89–1.18) | 1.03 (0.90–1.19) | 1.12 (0.88–1.43) |
Family functionning score (per unit) | 1.93 (0.77–4.81) | 2.68 (1.13–6.37) | 1.15 (0.23–5.87) |
Negative parenting score (per unit) | 1.42 (1.24–1.62) | 1.70 (1.49–1.93) | 1.75 (1.39–2.20) |
The ORs presented are adjusted for all the variables in each column.
The average response rate during the 8 years of data collection was 87.0% (range, 68%–100%)
Food insecurity was ascertained when the participating child was 1½ and 4½ years old. On those two occasions, mothers were asked: a) whether family members had eaten less than they should have because they had run out of food or money to buy food (1½ and 4½ years), b) whether family members had eaten the same foods several times because they did not have anything else and could not afford to buy other foods (4½ years only), c) whether the family could not afford to offer nutritious meals to the children (4½ years only), d) how often family members did not eat as much as they should have because they had run out of food or money to buy food (4½ years). These measures of food insecurity were previously shown to predict children’s overweight and obesity
Children’s mental health was assessed at 4½, 5, 6 and 8 years based on parental reports. Symptoms of depression/anxiety were assessed using 5 items adapted from the Preschool Behavior Questionnaire
Based on the four measures of children’s psychological symptoms between ages 4½ and 8 years which were available to us, we used semiparametric mixture models
Analyses were adjusted for the characteristics of children and their families, which can be associated with food insecurity and children’s mental health symptoms
Studies Depression (CESD) Scale
To study the association between food insecurity and children’s mental health outcomes, we combined exposure to food insecurity when children were 1½ and 4½ years of age (ever food-insecure vs. never food-insecure) and tested associations with children’s probability of being on a ‘high’ behavioural trajectory group at ages 4½ to 8 years. First, we tested sex-adjusted associations, in order to account for sex-related differences in the prevalence of mental health symptoms in children. Second, we adjusted for covariates. In additional analyses we tested whether the association between food insecurity and long-term behavioural problems 1) was robust to statistical adjustment on behavioural problems prior to age 4½; 2) differed depending on the child’s sex. Analyses were carried out in a logistic regression framework in SAS (V9).
5.9% of study children experienced food insecurity between ages 1½ and 4½ years. As shown in
In a birth cohort study of families with young children followed for up to 8 years, we found that food insecurity predicted children’s two-fold increase in the likelihood of persistent hyperactivity/inattention, even after accounting for family socioeconomic circumstances and parental mental health, although this association lost statistical significance when further adjusted for children’s behavioural symptoms at age 1½ years. To our knowledge, this is the first study to examine the relationship between food insecurity and children’s mental health over such an extended follow-up, independently of individual and family characteristics known to predict children’s outcomes. Our finding contributes to growing scientific evidence of the impact of food insecurity on children’s well-being, and suggests that exposure very early in life can have lasting effects on development.
Prior to discussing the study findings, we need to acknowledge methodological limitations: 1) due to selective attrition which often occurs in longitudinal cohort studies, the study sample included fewer children from socioeconomically disadvantaged families than the original cohort; thus, the prevalence of food insecurity among Canadian families with small children may be higher than we report; 2) children were not assessed for clinically significant emotional and behavioural problems, barring conclusions regarding the impact of food insecurity on psychological problems that require medical attention; nevertheless, children who experience mental health difficulties early on are at risk of psychiatric disorders later in life implying that symptoms such as the ones we measured require attention from parents, teachers and physicians
Our study also has key strengths: 1) analyses were based on a community sample and we were able to estimate the burden of behavioural problems associated with food insecurity among children in the general population, while most prior studies focused on high-risk families; 2) longitudinal follow-up of children’s mental health allowed us to distinguish different types of symptoms and their developmental patterns over up to 7 years of follow-up; 3) statistical adjustment for multiple individual and family factors potentially associated with children’s outcomes.
Our finding of an association between exposure to food insecurity and children’s mental health symptoms is consistent with prior research conducted cross-sectionally or over a limited follow-up
Adding to prior research which did not always distinguish specific aspects of children’s behaviour, we found that food insecurity is distinctively associated with children’s symptoms of hyperactivity/inattention. This association lost statistical significance after adjusting for children’s behavioural difficulties at age 1½ years, but did not much change, which may be due to the small number of cases of hyperactivity/inattention in our study and calls for additional research in larger samples.
The association between food insecurity and children’s behaviour may reflect several mechanisms. First, food insecure families are disproportionately exposed to multiple risks which can impair children’s development and mental health, including poverty, marital discord, single parenthood, violence, parental substance abuse and psychopathogy
Children growing up in food-insecure families are two-times more likely to have high levels of persistent symptoms of hyperactivity/inattention than children who are not food insecure. Reducing the burden of food insecurity in families could help decrease the burden of mental health problems in school-aged children and reduce social inequalities in development.
We are grateful to the parents and children of the Québec Longitudinal Study of Child Development (QLSCD). We thank the Québec Institute of Statistics, Mireille Jetté, and the GRIP staff for data collection and management.