Childhood food insecurity and youth mental health trajectories in two UK longitudinal cohorts

BackgroundFood insecurity (FI) is associated with overall poorer mental health in childhood and adolescence and negatively impacts longer-term health. However, less is known about how differential exposure to FI may shape the development of different mental health symptoms over this period. MethodsWe used data from two population-based UK birth cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC; n=6,182; born 1991-1992) and Growing Up in Scotland (GUS; n=3,167; born 2004-2005). FI severity at age [~]5 years (No FI/Low FI/High FI) was determined from parent-reported difficulties affording food. Mental health symptoms were parent-reported over the following 10 years using the conduct, emotional, hyperactivity/inattention and peer problem subscales of the Strengths and Difficulties Questionnaire (SDQ). Trajectories were characterised using multilevel growth curve models adjusted for child sex, household income, maternal mental health and multiple deprivation index. FindingsHigh FI at age [~]5 years was associated with worse trajectories of conduct, emotional, hyperactivity/inattention and peer problems over the following 10 years in both cohorts (vs. No FI). In ALSPAC, differences in conduct and hyperactivity/inattention scores were most pronounced at ages 7 (0.31 [0.11,0.51], padj<.001) and 9 (0.44 [0.09,0.79], padj=.008), respectively; these occurred at ages 13 (0.26 [0.04,0.48], padj=.014) and 15 (0.43 [0.04,0.81], padj=.023) in GUS. For emotional (ALSPAC: 0.46 [0.22,0.69], padj<.001; GUS: 0.38 [0.16,0.59], padj<.001) and peer problems (ALSPAC: 0.34 [0.13,0.55], padj<.001; GUS: 0.25 [0.05,0.45], padj=.01), differences between High and No FI groups were most pronounced at age 9 instead. Low FI was also associated - to a lesser degree - with higher peer problem trajectories (vs. No FI); this was most pronounced at age 13 in ALSPAC (0.13 [0.00,0.27], p=.031) and age 15 in GUS (0.28 [0.04,0.52], p=.016). InterpretationChildren who experienced more severe FI had greater levels of mental health symptoms over the next 10 years, even after adjusting for sociodemographic confounders. FI severity may also display a dose-response effect for peer problems. While replication using more robust FI measures remains necessary, we provide further evidence of the persistent negative impact of FI on youth mental health - particularly during late childhood and mid-adolescence. FundingUniversity of Edinburgh, Wellcome Trust, University of Bristol Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed for studies examining youth mental health trajectories after early food insecurity (FI) using the following terms: (food) AND (insecur*) AND ((child*) OR (youth) OR (young people) OR (adolescen*)) AND (("mental health") OR (distress) OR (emotion*) OR (behavio*) OR (internali*) OR (externali*)) AND ((trajectory) OR (trajectories)). Three studies investigated the relationship between FI and youth mental health trajectories using data from South Africa, USA and Canada; none investigated the potential impact of marginal food security. Two studies found an association between FI and persistently high depressive and hyperactivity/inattention symptoms over 1-3.5 years of follow-up. The third study used latent growth curve analysis to investigate eight patterns of FI exposure (based on binary FI status over three timepoints) and teacher-reported behaviour problems, reporting no associations. This study, however, only examined linear changes in behavioural problems which typically follow a non-linear trajectory - i.e. age-related differences in rates of change were not considered. Added value of this studyTo our knowledge, this is the first study to investigate trajectories of mental health symptoms in two generations of UK children and adolescents following exposure to different levels of FI severity. Across two large, population-based birth cohorts, we found that high FI at age 5 was associated with worse 10-year trajectories of emotional, conduct, hyperactivity/inattention and peer problems compared to the no FI group. Low FI - reflecting marginal food security - also associated with heightened peer problems, suggesting a dose-response relationship. Greatest differences between food-secure and food-insecure children in this study occurred in late childhood and mid-adolescence. Findings additionally highlight that the impact of FI has remained consistent for UK children born in the early 1990s and mid-2000s, despite secular changes in youth mental health problems. Implications of all the available evidenceChildhood food insecurity casts a long shadow on mental health and well-being outcomes throughout the lifespan, as demonstrated by substantial work from the 20th and 21st centuries. Here, we also see that the impact of FI on children and young peoples mental health has remained consistent over two generations of UK youth. If left unchecked, the growing prevalence of FI in the UK will only intensify concerns for the long-term mental health of the nations young people - especially those from low-income and marginalised backgrounds who already face a widening gap in health inequalities.