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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])
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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 

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