Reciprocal relationships among food insecurity, self-esteem, and depressive symptoms: An analysis of a nationwide cohort of Korean adults using a random-intercept cross-lagged panel model (2011-2018)

Abstract

Background Food security has been increasingly recognized as a critical issue in public health. We analyzed the reciprocal relationships among food insecurity, self-esteem, and depressive symptoms. Methods Our study analyzed a nationwide sample of 13,893 adults who were followed-up annually from 2012 to 2019. Food insecurity, self-esteem, and depressive symptoms were measured using the Household Food Security Survey Module-Six-Item Short Form, Rosenberg Self-Esteem Scale, and the Center for Epidemiological Studies Depression, respectively. Random-intercept cross-lagged panel models were employed to estimate within-individual influences between variables. Results At the within-person level, food insecurity was associated with a decline in self-esteem in the subsequent year (B = -0.158; p = 0.001) and an increase in depressive symptoms. (B = 0.136; p = 0.048). Self-esteem negatively predicted food insecurity (B = -0.001; p = 0.046) and depressive symptoms (B = -0.019; p = 0.002) in the subsequent year. Depressive symptoms negatively predicted self-esteem in the following year (B = -0.026; p < 0.001); however, their effect on subsequent food insecurity was not statistically significant (B = 0.001; p = 0.255). We also identified an indirect pathway through which food insecurity increased depressive symptoms by lowering self-esteem (B = 0.003, p = 0.019). Limitations The association between food security and psychological health may vary depending on the regional context. Conclusion Our findings revealed a within-individual dynamic among food insecurity, self-esteem, and depression. The bidirectional dynamics between food insecurity and poor psychological health suggests a vicious cycle in which each factor exacerbates the others.