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Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda

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  • Tsai, Alexander C.
  • Bangsberg, David R.
  • Frongillo, Edward A.
  • Hunt, Peter W.
  • Muzoora, Conrad
  • Martin, Jeffrey N.
  • Weiser, Sheri D.

Abstract

Depression is common among people living with HIV/AIDS and contributes to a wide range of worsened HIV-related outcomes, including AIDS-related mortality. Targeting modifiable causes of depression, either through primary or secondary prevention, may reduce suffering as well as improve HIV-related outcomes. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support. Quarterly data were collected by structured interviews and blood draws. The primary outcome was depression symptom severity, measured by a modified Hopkins Symptom Checklist for Depression. The primary explanatory variables were food insecurity, measured with the Household Food Insecurity Access Scale, and social support, measured with a modified version of the Functional Social Support Questionnaire. We found that food insecurity was associated with depression symptom severity among women but not men, and that social support buffered the impacts of food insecurity on depression. We also found that instrumental support had a greater buffering influence than emotional social support. Interventions aimed at improving food security and strengthening instrumental social support may have synergistic beneficial effects on both mental health and HIV outcomes among PLWHA in resource-limited settings.

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  • Tsai, Alexander C. & Bangsberg, David R. & Frongillo, Edward A. & Hunt, Peter W. & Muzoora, Conrad & Martin, Jeffrey N. & Weiser, Sheri D., 2012. "Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda," Social Science & Medicine, Elsevier, vol. 74(12), pages 2012-2019.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:12:p:2012-2019
    DOI: 10.1016/j.socscimed.2012.02.033
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    3. Boateng, Godfred O. & Workman, Cassandra L. & Miller, Joshua D. & Onono, Maricianah & Neilands, Torsten B. & Young, Sera L., 2022. "The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women," Social Science & Medicine, Elsevier, vol. 295(C).
    4. Tsai, Alexander C. & Venkataramani, Atheendar S., 2015. "The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 142(C), pages 37-46.
    5. Mushavi, Rumbidzai C. & Burns, Bridget F.O. & Kakuhikire, Bernard & Owembabazi, Moran & Vořechovská, Dagmar & McDonough, Amy Q. & Cooper-Vince, Christine E. & Baguma, Charles & Rasmussen, Justin D. & , 2020. "“When you have no water, it means you have no peace”: A mixed-methods, whole-population study of water insecurity and depression in rural Uganda," Social Science & Medicine, Elsevier, vol. 245(C).
    6. Hadley, Craig & Stevenson, Edward Geoffrey Jedediah & Tadesse, Yemesrach & Belachew, Tefera, 2012. "Rapidly rising food prices and the experience of food insecurity in urban Ethiopia: Impacts on health and well-being," Social Science & Medicine, Elsevier, vol. 75(12), pages 2412-2419.
    7. Kathryn P Derose & Denise D Payán & María Altagracia Fulcar & Sergio Terrero & Ramón Acevedo & Hugo Farías & Kartika Palar, 2017. "Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-19, July.
    8. Piperata, Barbara A. & Schmeer, Kammi K. & Rodrigues, Andres Herrera & Salazar Torres, Virgilio Mariano, 2016. "Food insecurity and maternal mental health in León, Nicaragua: Potential limitations on the moderating role of social support," Social Science & Medicine, Elsevier, vol. 171(C), pages 9-17.
    9. Tsai, Alexander C. & Tomlinson, Mark & Comulada, W. Scott & Rotheram-Borus, Mary Jane, 2016. "Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa," Social Science & Medicine, Elsevier, vol. 151(C), pages 69-77.
    10. Trudell, John Paul & Burnet, Maddison L. & Ziegler, Bianca R. & Luginaah, Isaac, 2021. "The impact of food insecurity on mental health in Africa: A systematic review," Social Science & Medicine, Elsevier, vol. 278(C).
    11. Cavazos-Rehg, Patricia & Byansi, William & Doroshenko, Christine & Neilands, Torsten B. & Anako, Nnenna & Sensoy Bahar, Ozge & Kasson, Erin & Nabunya, Proscovia & Mellins, Claude A. & Ssewamala, Fred , 2021. "Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+Adherence) on the mental health of adolescents living with HIV in Uganda," Social Science & Medicine, Elsevier, vol. 280(C).
    12. Zekeri, Andrew A. & Diabate, Youssouf, 2014. "Food Insecurity And Psychological Well-Being Among Women Living With Hiv/Aids On Antiretroviral Therapy In The Alabama Black Belt," Professional Agricultural Workers Journal (PAWJ), Professional Agricultural Workers Conference, vol. 2(1), pages 1-9.
    13. Thirlway, Frances & Nyamurungi, Kellen Namusisi & Matovu, Joseph K.B. & Miti, Andrew Kibuuka & Mdege, Noreen Dadirai, 2021. "Tobacco use and cessation in the context of ART adherence: Insights from a qualitative study in HIV clinics in Uganda," Social Science & Medicine, Elsevier, vol. 273(C).
    14. Michael L. Goodman & Beatrice J. Selwyn & Robert O. Morgan & Linda E. Lloyd & Moses Mwongera & Stanley Gitari & Philip H. Keiser, 2016. "Improved food quality, quantity and security among Kenyan orphans and vulnerable children: associations with participation in a multisectoral community-based program, age, gender, and sexual risk," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 8(2), pages 427-442, April.
    15. Andrew Gibbs & Rachel Jewkes & Samantha Willan & Laura Washington, 2018. "Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: A cross-se," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-19, October.
    16. Dube Jara Boneya & Ahmed Ali Ahmed & Alemayehu Worku Yalew, 2019. "The effect of gender on food insecurity among HIV-infected people receiving anti-retroviral therapy: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-15, January.
    17. Miller, Carol T. & Solomon, Sondra E. & Varni, Susan E. & Hodge, James J. & Knapp, F. Andrew & Bunn, Janice Y., 2016. "A transactional approach to relationships over time between perceived HIV stigma and the psychological and physical well-being of people with HIV," Social Science & Medicine, Elsevier, vol. 162(C), pages 97-105.

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