Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-22T05:34:22.425Z Has data issue: false hasContentIssue false
  • English
  • Français

Food insecurity among people with severe mental disorder in a rural Ethiopian setting: a comparative, population-based study

Published online by Cambridge University Press:  16 November 2017

K. Tirfessa ,
C. Lund ,
G. Medhin ,
Y. Hailemichael ,
A. Fekadu  and
C. Hanlon
K. Tirfessa
Affiliation:
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia College of Education and Behavioral Studies, Kotebe Metropolitan University, Addis Ababa, Ethiopia
C. Lund
Affiliation:
Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, Republic of South Africa Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
G. Medhin
Affiliation:
Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
Y. Hailemichael
Affiliation:
School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
A. Fekadu
Affiliation:
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
C. Hanlon*
Affiliation:
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
*
*Address for correspondence: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim.

In low-income African countries, ensuring food security for all segments of the population is a high priority. Mental illness is associated consistently with poverty, but there is little evidence regarding the association with food insecurity. The aim of this study was to compare the levels of food insecurity in people with severe mental disorders (SMD) with the general population in a rural African setting with a high burden of food insecurity.

Method.

Households of 292 community-ascertained people with a specialist-confirmed diagnosis of SMD (including schizophrenia and bipolar disorder) were compared with 284 households without a person with SMD in a rural district in south Ethiopia. At the time of the study, no mental health services were available within the district. Food insecurity was measured using a validated version of the Household Food Insecurity Access Scale. Disability was measured using the World Health Organisation Disability Assessment Schedule 2.0.

Result.

Severe household food insecurity was reported by 32.5% of people with SMD and 15.9% of respondents from comparison households: adjusted odds ratio 2.82 (95% confidence interval 1.62 to 4.91). Higher annual income was associated independently with lower odds of severe food insecurity. When total disability scores were added into the model, the association between SMD and food insecurity became non-significant, indicating a possible mediating role of disability.

Conclusion.

Efforts to alleviate food insecurity need to target people with SMD as a vulnerable group. Addressing the disabling effects of SMD would also be expected to reduce food insecurity. Access to mental health care integrated into primary care is being expanded in this district as part of the Programme for Improving Mental health carE (PRIME). The impact of treatment on disability and food insecurity will be evaluated.

Keywords

Disabilityfood insecuritypsychosissevere mental disordersub-Saharan Africa
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 28 , Issue 4 , August 2019 , pp. 397 - 407
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Asher, L, De-Silva, M, Hanlon, C, Weiss, HA, Birhane, R, Medhin, G, Ejigu, DA, Patel, V, Fekadu, A (2016). Community-based Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE): study protocol for a cluster randomised controlled trial. Trials 17, 299.Google Scholar
Azevedo, MH, Soares, MJ, Coelho, I, Dourado, A, Valente, J, Macedo, A, Pato, M, Pato, C (1999). Using consensus OPCRIT diagnoses. An efficient procedure for best-estimate lifetime diagnoses. British Journal of Psychiatry 175, 154–157.Google Scholar
BasicNeeds (2008). Mental Health and Development: A Model in Practice. Leamington Spa: BasicNeeds.Google Scholar
Coates, J, Swindale, A, Bilinsky, P (2007). Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide. Food and Nutrition Technical Assistance (FANTA) project. United States Agency for International Development: Washington, DC.Google Scholar
Cole, S, Tembo, G (2011). The effect of food insecurity on mental health: panel evidence from rural Zambia. Social Science and Medicine 73, 1071–1079.Google Scholar
Collins, L (2005). The impact of food insecurity on women's mental health. Journal of the Association for Research on Mothering 11, 251–262.Google Scholar
Combaz, E (2013). Social inclusion in productive safety net programmes. Help Desk Research Report. GSDRC, Applied Knowledge Services.Google Scholar
Dua, T, Barbui, C, Clark, N, Fleischmann, A, Poznyak, V, van-Ommeren, M, Taghi Yasamy, MT, Ayuso- Mateos, JL, Birbeck, GL, Drummond, C, Freeman, M, Giannakopoulos, P, Levav, I, Obot, IS, Omigbodun, O, Patel, V, Phillips, M, Prince, M, Rahimi-Movaghar, A, Rahman, A, Sander, JW, Saunders, JB, Servili, C, Rangaswamy, T, Unützer, J, Ventevogel, P, Vijayakumar, L, Thornicroft, G, Saxena, S (2011). Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Medicine 8, e1001122.Google Scholar
Endalew, B, Muche, M, Tadesse, S (2015). Assessment of food security situation in Ethiopia. World Journal of Dairy and Food Sciences 10, 37–43.Google Scholar
Fekadu, A, Medhin, G, Selamu, M, Hailemariam, M, Alem, A, Breuer, E, Lund, C, Prince, M, Hanlon, C (2014). Population level mental distress in rural Ethiopia. BMC Psychiatry 14, 194.Google Scholar
Fekadu, A, Medhin, G, Kebede, D, Alem, A, Cleare, AJ, Prince, M, Hanlon, C, Shibre, T (2015). Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia. British Journal of Psychiatry 206, 289–296.Google Scholar
Fekadu, A, Hanlon, C, Medhin, G, Alem, A, Selamu, M, Welde-Giorgis, T, Shibre, T, Teferra, S, Tegegn, T, Breuer, E, Patel, V, Tomlinson, M, Thornicroft, G, Prince, M, Lund, C (2016). Development of a scalable mental healthcare plan for a rural district in Ethiopia. British Journal of Psychiatry 208, s4–s12.Google Scholar
Flyckt, L, Lothman, A, Jorgenson, L, Rylander, A, Koering, T (2011). Burden of informal caregiving to patients with psychosis: a descriptive and methodological study. International Journal of Social Psychiatry 59, 137–146.Google Scholar
Gebreyesus, SH, Lunde, T, HaileMariam, D, Woldehanna, T, Lindtjørn, B (2015). Is the adapted Household Food Insecurity Access Scale (HFIAS) developed internationally to measure food insecurity valid in urban and rural households of Ethiopia? BMC Nutrition 1, 2.Google Scholar
Goetz, JR (2008). Exploring food insecurity among individuals with serious mental illness: a qualitative study. Ph.D. Thesis, University of Kansas, Kansas, USA.Google Scholar
Habtamu, K, Alem, A, Hanlon, C (2015). Conceptualizing and contextualizing functioning in people with severe mental disorders in rural Ethiopia: a qualitative study. BMC Psychiatry 15, 34.Google Scholar
Habtamu, K, Alem, A, Medhin, G, Fekadu, A, Dewey, M, Prince, M, Hanlon, C (2017). Validation of the World Health Organization Disability Assessment Schedule in people with severe mental disorders in rural Ethiopia. Health and Quality of Life Outcomes 15, 64.Google Scholar
Hadley, C, Patil, C (2006). Food insecurity in rural Tanzania is associated with maternal anxiety and depression. American Journal of Human Biology 18, 359–368.Google Scholar
Hadley, C, Tegegn, A, Tessema, F, Cowan, JA, Asefa, M, Galea, S (2008). Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study. Journal of Epidemiology and Community Health 62, 980–986.Google Scholar
Hailemariam, M, Fekadu, A, Selamu, M, Medhin, G, Prince, M, Hanlon, C (2016). Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study. International Journal for Equity in Health 15, 121.Google Scholar
Jebena, M, Taha, M, Nakajima, M, Lemieux, A, Lemessa, F, Hoffman, R, Tesfaye, M, Tefera Belachew, T, Workineh, N, Kebede, E, Tariku, Y, Segni, H, Kolsteren, P, al'Absi, M (2015). Household food insecurity and mental distress among pregnant women in southwestern Ethiopia: a cross-sectional study design. BMC Pregnancy and Childbirth 15, 250.Google Scholar
Kempson, KM, Keenan, DP, Sadani, PS, Ridlen, S, Rosato, NS (2002). Food management practices used by people with limited resources to maintain food sufficiency as reported by nutrition educators. Journal of the American Dietetic Association 102, 1795–1799.Google Scholar
Lauritsen, JM, Bruus, M (2003–2008). EpiData (version 3). A comprehensive tool for validated entry and documentation of data (ed. T. E. Association): Odense, Denmark.Google Scholar
Lijalem, M (2002). Assessment of nutritional status of people with major mental disorders and their controls in Meskan and Marako District (Butajira), Ethiopia. MSc Thesis, Addis Ababa University, Addis Ababa, Ethiopia.Google Scholar
Lund, C, Breen, A, Flisher, AJ, Kakuma, R, Corrigall, J, Joska, JA, Swartz, L, Patel, V (2010). Poverty and common mental disorders in low and middle income countries: a systematic review. Social Science and Medicine 71, 517–528.Google Scholar
Lund, C, Tomlinson, M, De-Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, Petersen, I, Bhana, A, Kigozi, F, Prince, M, Thornicroft, G, Hanlon, C, Kakuma, R, McDaid, D, Saxena, S, Chisholm, D, Raja, S, Kippen-Wood, S, Honikman, S, Fairall, L, Patel, V (2012). PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Medicine 9, e1001359.Google Scholar
Lund, C, Waruguru, M, Kingori, J, Kippen-Wood, S, Breuer, E, Mannarath, S, Raja, S (2013). Outcomes of the mental health and development model in rural Kenya: a 2-year prospective cohort intervention study. International Health 5, 43–50.Google Scholar
Maes, K, Hadley, C, Tesfaye, F, Shifferaw, S (2010). Food insecurity and mental health: surprising trends among community health volunteers in Addis Ababa, Ethiopia during the 2008 food crisis. Social Science and Medicine 70, 1450–1457.Google Scholar
Mall, S, Hailemariam, M, Selamu, M, Fekadu, A, Lund, C, Patel, V, Petersen, I, Hanlon, C (2017). ‘Restoring the person's life’: a qualitative study to inform development of care for people with severe mental disorders in rural Ethiopia. Epidemiology and Psychiatric Sciences 26, 43–52.Google Scholar
McGuffin, P, Farmer, AE, Harvey, I (1991). A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764–770.Google Scholar
Mengistu, E, Regassa, N, Yusufe, A (2009). The Levels, Determinants and Coping Mechanisms of Food Insecure Households in Southern Ethiopia: Case Study of Sidama, Wolaita and Guraghe Zones. DCG Report No. 55.Google Scholar
Ministry of Agriculture (2014). Productive Safety Net Programme, Phase IV Programme Implementation Manual. 1.0.Google Scholar
Ministry of Agriculture and Rural Development (2009). Food Security Programme 2010–2014: Productive Safety Net. Addis Ababa.Google Scholar
Muldoon, K, Duff, P, Fielden, SJ, Anema, A (2013). Food insufficiency is associated with psychiatric morbidity in a nationally representative study of mental illness among food insecure Canadians. Social Psychiatry and Psychiatric Epidemiology 48, 795–803.Google Scholar
Operational Criteria for Research (2004). Opcrit for Windows (v4), Item Checklist. Retrieved 14th January 2014 from sgdp.iop.kcl.ac.uk/opcrit/checklist.pdf.Google Scholar
Raja, S, Underhill, C, Shrestha, P, Sunder, U, Mannarath, S, Kippen-Wood, S, Patel, V (2012). Integrating mental health and development: a case study of the basic needs model in Nepal. PLoS Medicine 9, e1001261.Google Scholar
Regassa, N, Stoecker, BJ (2011). Household food insecurity and hunger among households in Sidama district, Southern Ethiopia. Public Health Nutrition 15, 1276–1283.Google Scholar
Semrau, M, Evans-Lacko, S, Alem, A, Ayuso-Mateos, JL, Chisholm, D, Gureje, O, Hanlon, C, Jordans, M, Thornicroft, G (2015). Strengthening mental health systems in low- and middle-income countries: the Emerald programme. BMC Medicine 13, 79.Google Scholar
Shibre, T, Negash, A, Kullgren, G, Kebede, D, Alem, A, Fekadu, A, Fekadu, D, Medhin, G, Jacobsson, L (2001). Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia. Social Psychiatry and Psychiatric Epidemiology 36, 299–303.Google Scholar
Shibre, T, Kebede, D, Alem, A, Negash, A, Kibreab, S, Fekadu, A, Fekadu, D, Jacobsson, J, Kullgren, G (2002). An evaluation of two screening methods to identify cases with schizophrenia and affective disorders in a community survey in rural Ethiopia. International Journal of Social Psychiatry 48, 200–208.Google Scholar
Sorsdahl, K, Slopen, N, Siefert, K, Seedat, S, Stein, DJ, Williams, DR (2009). Household food insufficiency and mental health in South Africa. Journal of Epidemiology and Community Health 65, 426e–431e.Google Scholar
StataCorp (1985–2013). STATA/SE 13.1. statacorp, college station, Texas USA.Google Scholar
Swindale, A, Bilinsky, P (2006). Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. Journal of Nutrition 136, 1449S-1452S.Google Scholar
Teferra, S (2011). Studies on psychotic disorders in rural Ethiopia. Umeå University Medical Dissertations. New Series No 1427.Google Scholar
Teferra, S, Hanlon, C, Beyero, T, Jacobsson, L, Shibre, T (2013). Perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry 13, 168.Google Scholar
Trani, J-S, Venkataraman, H, Mishra, N, Groce, NE, Jadhav, S, Deshpande, S (2016). Mental illness, poverty and stigma in India: a case–control study. BMJ Open 5, e006355.Google Scholar
United Nations (2015). Sustainable Development Goals: 17 Goals to transform the world. Retrieved 23 October 2016 from http://www.un.org/sustainabledevelopment/hunger/.Google Scholar
United States Department of Agriculture Economic Research Service (2016). Definitions of Food Security. Retrieved 12 January 2017 from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx.Google Scholar
Ustün, TB, Chatterji, S, Kostanjsek, N, Rehm, J, Kennedy, C, Epping-Jordan, J, Saxena, S, von-Korff, M, Pull, C (2010). Developing the World Health Organization Disability Assessment Schedule 2.0. Bulletin of the World Health Organization 88, 815–823.Google Scholar
Williams, J, Farmer, AE, Ackenheil, M, Kaufmann, CA, McGuffin, P (1996). A multicentre inter-rater reliability study using the OPCRIT computerized diagnostic system. Psychological Medicine 26, 775–783.Google Scholar
World Food Program (2016). Productive safety net program (PSNP): Ethiopia. Retrieved 29 November 2016 from https://www.wfp.org/sites/default/files/PSNP%20Factsheet.pdf.Google Scholar
World Health Organisation (1985). World Health Organisation Disability Assessment Schedule. WHO: Geneva.Google Scholar
World Health Organisation (2008). WHO mhGAP: Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological and Substance use Disorders. WHO: Geneva.Google Scholar
World Health Organisation (2013). WHO Study on Global Ageing and Adult Health (SAGE). WHO: Geneva.Google Scholar
Xiong, W, Philips, M, Hu, X, Wang, R, Dai, Q, Kleinman, J, Kleinman, A (1994). Family-based intervention for schizophrenia patients in China: a randomized control trial. British Journal of Psychiatry 165, 239–247.Google Scholar
Supplementary material: File

Tirfessa et al supplementary material

Tirfessa et al supplementary material 1

Download Tirfessa et al supplementary material(File)
File 32.8 KB
Supplementary material: File

Tirfessa et al supplementary material

Tirfessa et al supplementary material 2

Download Tirfessa et al supplementary material(File)
File 14.5 KB
Supplementary material: File

Tirfessa et al supplementary material

Tirfessa et al supplementary material 3

Download Tirfessa et al supplementary material(File)
File 18.8 KB
Supplementary material: File

Tirfessa et al supplementary material

Tirfessa et al supplementary material 4

Download Tirfessa et al supplementary material(File)
File 13.5 KB