High Rates of Depression and Food Insecurity Seen in Patients With RA


“Food insecurity may increase an individual’s dependence on inexpensive energy-dense foods that lead to the development of chronic diseases that may affect mental health," investigators stated.

Depression and food insecurity were common among patients with rheumatoid arthritis (RA), according to a study published in BMC Rheumatology.1 While investigators theorized depression may be linked to social determinants of health (SDH), after adjustments for behavioral and lifestyle characteristics, the results were not statistically significant.

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“Food insecurity may increase an individual’s dependence on inexpensive energy-dense foods that lead to the development of chronic diseases that may affect mental health, and the risk of developing chronic conditions increases as food security diminishes,” investigators explained.

Patients with RA were identified using the 2013-2014 and 2015-2016 cross-sectional, nationally representative National Health and Nutrition Examination Surveys (NHANES). Depression was categorized as either 5–9 (mild) or 10-27 (moderate-to-severe) using the depression screening instrument, Patient Health Questionnaire-9 (PHQ-9). The 18-item US Household Food Security Survey Module assessed food insecurity, in which participants with marginal-to-very-low food security were classified as having food insecurity. Depression and food insecurity were calculated among the patient population. Data focusing on demographics, behavioral and lifestyle characteristics, SDH, and disease information was obtained. SDH accounted for annual income, education, health insurance type, marital status, housing information, and the number of members in the household. A mobile examination center (MEC) performed a physical examination, which included laboratory, physiological, medical, and dental assessments.

Weighted logistic regression and penalized regression were used to evaluate the association between SDH and depression.

In total, 527 respondents from both studies were included, with 475 completing the PHQ-9. In the 2013-2014 survey, 37.1% exhibited depression and 44.1% in the 2015-2016 survey. Food insecurity was reported in 33.1% in the 2013-2014 and 43.0% in 2015-2016.

According to the data, food insecurity was linked to a higher prevalence of depression (OR 2.17, 95% CI 1.27, 3.72), which varied by severity. Those with very low food security were significantly more likely to have depression when compared with those with full food security (OR 2.96, 95% CI 1.48, 5.90). However, this was not significantly different for patients with marginal or low food security.

After multivariable logistic regression, females, those with physical disabilities, ≥ 4 physical limitations, and a fair/poor health condition were significantly more likely to experience depression.

Depression was also seen more often in respondents who rented instead of owning a home (OR 1.91, 95% CI 1.06, 3.47) and those who had an annual income of < $20,000 when compared with participants who made ≥ $20,000 (OR 2.22, 95% CI 1.26, 3.90). Patients with non-private insurance plans were more likely to report moderate-to-severe depression when compared with participants with private insurance (OR 2.17, 95% CI 1.05, 4.52).

Analyses were limited by the variables that were collected through the database. As participants are all self-reported, there was no information on physician diagnosis or disease severity of activity available and data may have been subject to recall bias and misclassification.

However, NHANES is a national database that represents the entire US population regardless of insurance status and is a highly reliable measure of health status. The survey uses standardized procedures, which limits inconsistencies in its execution.

“Providing supportive resources to address those SDH amenable to change may help manage the burden of depression among adults with RA,” investigators concluded. “These results warrant further investigation into the relationship between depression and SDH in people with RA.”


Cai Q, Pesa J, Wang R, Fu AZ. Depression and food insecurity among patients with rheumatoid arthritis in NHANES. BMC Rheumatol. 2022;6(1):6. Published 2022 Feb 2. doi:10.1186/s41927-021-00236-w

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