Food insecurity as a determinant of adolescent mental health in Francophone and Anglophone Africa: A multilevel analysis

Food insecurity (also called, simply, FI) levels in sub-Saharan Africa are rising among its growing adolescent population, the world's fastest-growing teenage population. This study examines food insecurity and its role as a social determinant of poor mental health among African adolescents. The study utilised the Gallup World Poll data between 2014 and 2019, including adolescents aged 15 -19 (n=25,368). Poor mental health was measured using five validated responses about negative experiences. We employed a two-level binary logistic regression model to determine the associations between food insecurity and poor mental health. At the individual level, the primary explanatory variable, food insecurity, was measured using the FAO (2015) Food Insecurity Experience Scale (FIES). The odds of poor mental health exhibited a dose-response relationship with food insecurity severity, with mild (OR=1.70; 95% CI (1.57-1.84), moderate (OR=2.35; 95% CI (2.17-2.54) and severe food insecurity (OR=3.19; 95% CI (2.96-3.54) being associated with poorer mental health. Other assessed covariates showed that residing in a Francophone state increased the odds of poor mental health experiences, whereas positive experiences reduced the chances of poor mental health, as did residing in rural areas. There was no difference in the relationship between mental health and food insecurity across the two colonial origins. Food insecurity remains an important determinant of adolescent mental health in Francophone and Anglophone Africa. Investing in cost-effective agricultural and nutrition-sensitive interventions that boost food production could improve adolescent mental well-being while reducing long-term social and economic burdens on families and health systems in sub-Saharan Africa.