Insegurança alimentar e transtorno mental comum: um estudo realizado com usuários de unidades de atenção primária à saúde

Abstract

Introduction: Food insecurity (FI), defined as uncertain or limited access to nutritionally adequate and safe food, has been associated with adverse mental health outcomes. However, the manifestation of this link can vary considerably based on the degrees of FI. This scenario remains largely unexplored in Primary Health Care (PHC). Objective: To evaluate the association between FI and the presence of Common Mental Disorders (CMD), somatic symptoms, depressive thoughts, depressive-anxious mood, and decreased vital energy among users of Basic Health Units (BHU). Methodology: This is a cross-sectional study conducted with adults (≥ 18 years) enrolled in 6 BHUs in the cities of Fortaleza-CE and Belo Horizonte-MG. Data collection took place between February 2022 and December 2023 through structured interviews, using the Self-Reporting Questionnaire-20 (SRQ-20) to assess response variables, and the Food Insecurity Risk Screening, recommended by the Ministry of Health for use in Primary Health Care to measure exposure. The magnitudes of the associations and their respective 95% confidence intervals (95% CI) between food insecurity levels and mental health conditions, somatic symptoms, depressive thoughts, depressive-anxious mood, and decreased vital energy were estimated, adjusted for sex, age, and family income using Poisson regression with robust variance. The significance level was p<0.05. Results: 634 users who attended the BHU were evaluated, with a mean age of 47.7 ± 13.7 years. The majority of the sample consisted of women (82.9%), earning less than 2 minimum wages - R$2142.00 (62.7%) and self-identifying as mixed race/color (54.4%). The prevalences of mild, moderate, or severe food insecurity and mental health disorders were 15.2%, 16.0%, and 45.0%, respectively. After full adjustment for potential confounders, residing in a household with moderate/severe food insecurity was associated with higher prevalence of mental health disorders (PR: 1.62; 95% CI: 1.35-1.95) compared to those with food security. Additionally, the presence of moderate/severe food insecurity was statistically associated with higher prevalences of all somatic symptoms, depressive thoughts, depressive-anxious mood, and decreased vital energy measured by the SRQ-20 instrument, except for hand tremors (PR 1.09; 95% CI 0.71-1.68). While those residing in households with mild food insecurity remained associated with higher prevalences of mental health disorders (MTDs) and only with the symptoms of being easily startled; lack of interest in things; feeling worthless in their lives; nervousness, tension, or worry; difficulty thinking clearly; and thoughts of ending their lives, compared to those with food security. Conclusion: Both severe/moderate food insecurity are significantly associated with a higher prevalence of MHDs and symptoms related to somatic complaints, depressive thoughts, depressive-anxious mood, and decreased vital energy among primary health care users, albeit with different magnitudes and patterns. This evidence reinforces the need for intersectoral strategies that integrate food security actions and mental health promotion within the scope of public health policies.