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Household food insufficiency and mental health in South Africa
  1. Katherine Sorsdahl1,
  2. Natalie Slopen2,
  3. Kristine Siefert3,
  4. Soraya Seedat4,
  5. Dan J Stein1,
  6. David R Williams2
  1. 1Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
  2. 2Department of Society, Human Development and Health, Harvard University, Cambridge, Massachusetts, USA
  3. 3School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
  1. Correspondence to Dr Katherine Sorsdahl, J-Block Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; katherine.sorsdahl{at}


Background Both mental illness and food insufficiency are common in low and middle income countries. However, there are limited data on the relation between food insufficiency and mental disorders, despite the potential relevance of such data for the development of policy-level interventions. The relationship between food insufficiency and mental disorders within a nationally representative sample of South African adults was examined.

Methods A national survey of 4185 South African adults was conducted using the WHO Composite International Diagnostic Interview to generate psychiatric diagnoses. The survey included a widely used single-item measure of household food insufficiency. The independent effects of food insufficiency and demographic characteristics on 12-month and lifetime DSM-IV diagnosis were assessed using logistic regression.

Results 29% of respondents reported that their household ‘sometimes’ did not have enough to eat while 9% reported that they ‘often’ did not have enough to eat. After controlling for conventional socioeconomic and sociodemographic variables, food insufficiency was associated with having any 12-month (OR 1.44, 95% CI 1.1 to 1.9) and lifetime (OR 1.35, 95% CI 1.1 to 1.7) DSM-IV disorder.

Conclusions In South Africa the prevalence of household food insufficiency is very high compared with studies conducted in the developed world, and is independently associated with having a 12-month and lifetime DSM-IV diagnosis. The relationship between food insufficiency and mental health has implications for reducing the burden of common mental disorders in South Africa since, unlike a number of major risk factors for mental illness, food insufficiency may be relatively amenable to intervention.

  • Food insufficiency
  • mental illness
  • South Africa
  • mental health psych symp
  • nutrition

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  • Funding The activities of the South African Stress and Health study were supported by the United States National Institute of Mental Health (R01MH070884), the John D and Catherine T MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R01-TW006481), the Pan American Health Organisation, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. The South Africa Stress and Health study was funded by grant R01-MH059575 from the National Institute of Mental Health and the National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethical approval was provided by the University of Michigan, Harvard Medical School, and by a single project assurance of compliance from the Medical University of South Africa that was approved by the National Institute of Mental Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.