Past-Year Suicidal Ideation, Plans, and Attempts by Food Security Level in a Nationally Representative Sample of U.S. Adults

Abstract

Objective

The Interpersonal Theory of Suicide posits that suicidal behavior results from thwarted belongingness, perceived burdensomeness, and capability for suicide. Considering that food insecurity (FI) may be linked to these constructs to differing extents based on severity of FI, this study examined cross-sectional associations between levels of FI and suicidal ideation, plans, and attempts in a nationally representative sample of adults in the United States.

Methods

Data for this study were collected in 2001–2003 from 5,552 participants in the National Comorbidity Survey Replication (M_age=44.8 ± 0.5 years; 53.8% female). Prevalence ratios (PRs) and 95% confidence intervals (CIs) were generated using modified Poisson regression to examine past-year ideation, plans, and attempts with intent of lethality by past-year FI level (assessed with a modified version of the Short Form U.S. Household Food Security Scale).

Results

After controlling for sociodemographic covariates, low food security was significantly associated with elevated prevalence of suicidal ideation, plans, and attempts (ideation: PR = 2.21, 95% CI 1.32–3.70; plans: PR = 5.42, 95% CI 2.71–10.83; attempts: PR = 5.35, 95% CI 2.38–12.03). Very low food security (i.e., more severe FI) exhibited stronger associations yet with suicidal ideation, plans, and attempts (ideation: PR = 6.99, 95% CI 4.10–11.92; plans: PR = 17.21, 95% CI 8.41–35.24; attempts: PR = 14.72, 95% CI 4.96–43.69).

Conclusions

Findings indicative of a dose-response relationship between FI and suicidal ideation, plans, and attempts emphasize the need to increase reach of food assistance programs, increase availability of mental health services in food-insecure populations, and routinely screen for FI in mental health practice.

HIGHLIGHTS

• Cross-sectional data from nationally representative sample of U.S. adults

• Food insecurity linked with suicidal ideation, plans, and attempts

• Dose-response relationship observed according to severity of food insecurity

Keywords:

• Food insecurity
• suicidal attempts
• suicidal ideation
• suicidal plans
• United States

DISCLOSURE STATEMENT

The authors declare that they have no conflicts of interest.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are publicly available at https://www.icpsr.umich.edu/web/ICPSR/studies/20240.

Additional information

Funding

The National Comorbidity Survey Replication (NCS-R) was supported by the National Institute of Mental Health with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation under Grant Number 044780, Eli Lilly and Company, and the John W. Alden Trust. The authors’ time spent preparing this article was supported by the National Institute of Mental Health under Grant Number T32 MH082761, PI: Peterson; the National Institute of Diabetes and Digestive and Kidney Diseases under Grant Number R01 DK112487, PIs: Engel/Wonderlich; and the National Institute of General Medical Science under Grant Number P20 GM134969, PI: Wonderlich.

Notes on contributors

Elijah L. H. Olsen

Elijah L. H. Olsen, MPH, Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, Michigan, USA.

Dorian R. Dodd

Dorian R. Dodd, PhD, Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.

Scott J. Crow

Scott J. Crow, MD, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA; The Emily Program, St. Paul, Minnesota, USA.

Ross D. Crosby

Ross D. Crosby, PhD, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.

Vivienne M. Hazzard

Vivienne M. Hazzard, PhD, MPH, RD, Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.