Linking Food Insecurity With Depressive Symptoms And Changes In Nutritional Status During Pregnancy In Hiv-Infected And -Uninfected Women In Uganda

Abstract

LINKING FOOD INSECURITY WITH DEPRESSIVE SYMPTOMS AND CHANGES IN NUTRITIONAL STATUS DURING PREGNANCY IN HIVINFECTED AND -UNINFECTED WOMEN IN UGANDA OVERALL ABSTRACT There are limited studies from resource-limited settings on (a) how to measure food insecurity and depressive symptoms and (b) the linkages between food insecurity, depressive symptoms, and changes in nutritional status among pregnant women with or without HIV. The appropriateness of the Individually-focused Food Insecurity Access Scale (IFIAS) and the Center for Epidemiologic Studies-Depression (CES-D) as metrics, respectively, for food insecurity, specifically food access and depressive symptoms among pregnant women attending antenatal services in northern Uganda were assessed. Also tested in this study was whether food insecurity was associated with depressive symptoms and/or changes in weight and mid upper arm circumference (MUAC) among pregnant women of mixed HIV status. Finding from this study indicate that the IFIAS and CES-D as used at baseline were valid and demonstrated moderate to high reliability. Results show that the relationship between food insecurity and depressive symptoms is bidirectional and is weakened by social support in both directions. Domestic violence strengthens the unidirectional effect of food insecurity on depressive symptoms. Surprisingly, longitudinal measures of food insecurity in this study were not related to changes in women's weight or MUAC measurements. However, HIV infection status and exposure to the heavy rains season in Gulu predicted, respectively, changes in women's weight and MUAC. In conclusion, results from this study demonstrated appropriateness of metrics for individual level food insecurity, specifically food access, and depressive symptoms. There is need, however, to examine further the IFIAS tools' ability in differentiating cross-sectional and longitudinal differences in actual nutrient intake. Integrated food security and mental health interventions to reduce depressive symptoms that take into account social support and domestic violence are needed. Lastly, there is need for further research to understand the mechanism of reduced weight gain among HIVinfected pregnant women as well as the specific exposures during the heavy rains season that lead to reduced MUAC change trajectories among pregnant women in this context.