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. 2022 Dec;113(6):944-954.
doi: 10.17269/s41997-022-00658-0. Epub 2022 Jun 28.

Household food insecurity, sense of community belonging, and access to a regular medical doctor as mediators in the relationship between mood and/or anxiety disorders and self-rated general health in Canada between 2011 and 2016: a serial cross-sectional analysis

Doreen Nehumba  1 , Adrianna Paiero  2 , Hiwot Tafessu  2 , Kate Salters  2   3 , David Moore  1   2 , Viviane D Lima  4   5
Affiliations

Household food insecurity, sense of community belonging, and access to a regular medical doctor as mediators in the relationship between mood and/or anxiety disorders and self-rated general health in Canada between 2011 and 2016: a serial cross-sectional analysis

Doreen Nehumba et al. Can J Public Health. 2022 Dec.

Abstract
in English, French

Objective: To assess whether (household) food insecurity, access to a regular medical doctor, and sense of community belonging mediate the relationship between mood and/or anxiety disorders and self-rated general health.

Methods: We used six annual cycles of the Canadian Community Health Survey, including Canadian adults aged 18-59 years, between 2011 and 2016. Mediation models, adjusted for key determinants of health, were based on a series of weighted logistic regression models. The Sobel products of coefficients approach was used to estimate the indirect effect, and bootstrapping to estimate uncertainty.

Results: The annual (weighted) prevalence of mood and/or anxiety disorders increased from 11.3% (2011) to 13.2% (2016). Across the 6 years, 23.9-27.7% of individuals with mood and/or anxiety disorders reported fair/poor self-rated health as compared with 4.9-6.5% of those without mood and/or anxiety disorders (p<0.001). Similarly, the 7.2-8.9% of the population reporting fair/poor self-rated health were disproportionately represented among individuals reporting food insecurity (21.1-26.2%, p<0.001) and a weak sense of community belonging (10.0-12.2%, p<0.001). A significantly lower prevalence of poor self-rated health was observed among respondents reporting having access to a regular medical doctor in 2012, 2015, and 2016. In 2016, sense of community belonging and food insecurity significantly mediated the effect of mood and/or anxiety disorders on self-rated general health. Access to a regular medical doctor did not mediate this relationship.

Conclusion: Efficient policies that address food insecurity and sense of community belonging are needed to decrease the mental health burden and improve health satisfaction of Canadians.

RéSUMé: OBJECTIF: Déterminer si l’insécurité alimentaire (du ménage), l’accès à un médecin traitant et le sentiment d’appartenance à la communauté modèrent le lien entre les troubles anxieux et/ou de l’humeur et la santé générale autoévaluée. MéTHODE: Nous avons utilisé six cycles annuels (2011 à 2016) de l’Enquête sur la santé dans les collectivités canadiennes incluant des Canadiens adultes de 18 à 59 ans. Nos modèles de modération, ajustés selon les principaux déterminants de la santé, reposaient sur une série de modèles de régression logistique pondérés. Nous avons utilisé l’approche des produits des coefficients de Sobel pour estimer les effets indirects, et l’autoamorçage pour estimer l’incertitude. RéSULTATS: La prévalence annuelle (pondérée) des troubles anxieux et/ou de l’humeur a augmenté, passant de 11,3 % en 2011 à 13,2 % en 2016. Sur la période de six ans, 23,9 à 27,7 % des personnes ayant des troubles anxieux et/ou de l’humeur ont déclaré avoir une santé moyenne/mauvaise, contre 4,9 à 6,5 % des personnes n’ayant pas de troubles anxieux et/ou de l’humeur (p < 0,001). De même, les 7,2 à 8,9 % de la population ayant déclaré avoir une santé moyenne/mauvaise étaient disproportionnellement représentés chez les personnes disant être en situation d’insécurité alimentaire (21,1-26,2 %, p < 0,001) et avoir un faible sentiment d’appartenance à la communauté (10,0-12,2 %, p < 0,001). Une prévalence significativement plus faible de mauvaise santé autoévaluée a été observée chez les répondants ayant dit avoir accès à un médecin traitant en 2012, 2015 et 2016. En 2016, le sentiment d’appartenance à la communauté et l’insécurité alimentaire modéraient de façon significative l’effet des troubles anxieux et/ou de l’humeur sur la santé générale autoévaluée. L’accès à un médecin traitant ne modérait pas ce lien. CONCLUSION: Des politiques efficaces pour aborder l’insécurité alimentaire et le sentiment d’appartenance à la communauté sont nécessaires pour réduire le fardeau des troubles mentaux et améliorer la satisfaction des Canadiens face à leur santé.

Keywords: Anxiety; Community connectedness; Healthcare access; Household food insecurity; Mental health; Mood disorder; Self-rated general health; Sense of community belonging.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Mediation results of food insecurity, sense of community belonging, and access to a regular medical doctor between mood and/or anxiety disorder diagnosis and self-rated health. Note: Sex, age, sexual orientation, the highest level of education, household income, marital status, country of birth, and region of Canada were controlled for as covariates; aOR = adjusted odds ratio; 97.5% CI = 97.5% confidence interval; B, the regression coefficient for the indirect effect; MA, mood and/or anxiety disorder (Yes vs No [reference]); CB, sense of community belonging (weak vs strong [reference]); FI, food insecurity (food insecure vs not food insecure [reference]); Doc, access to a regular medical doctor (no vs yes [reference]); SRH, self-rated health
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