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    • br Methods br Measures br

    2018-10-24


    Methods
    Measures
    Statistical analyses Data analysis was conducted at the [blinded] Research Data Centre using STATA statistical software (version 14) (Statacorp, College Station, TX, 2015). Marginal effect 5-Iodotubercidin analyses were calculated to quantify the potential reduction in adverse mental health outcomes with the elimination of severe HFI in Canada compared to food secure Canadians. Marginal effects or partial effects, estimated from the probit analysis, measure the change in the conditional estimate of the outcome variable given a change in one of the regressors (e.g. HFI) (Cameron & Trivedi, 2005). We generated probit models, based on the multi-variable fully adjusted and reduced models (data not shown), to assess the probability of reporting each adverse mental health outcomes, controlling for all pertinent study covariates. The proportions were then converted to percentages and represent the percent point reduction in the odds of reporting of each adverse mental health outcome if the respondent’s variable of interest (e.g., movement from severe HFI to food security) were to be changed into the referent group of that variable of interest. While this method of analysis is typically utilized in the study of economics, there has been interest in this technique in the field of public health (Emery et al., 2012; Evans, Wolfe & Adler, 2012; McIntyre, Dutton, Kwok & Emery, 2016; McIntyre, Kwok, Emery & Dutton, 2016).
    Results Table 1 presents the demographic statistics for all respondents included in the sample. After exclusions, the proportion of Canadian adults aged 18–64 years experiencing HFI is approximately 11.8% [95% CI: 11.3–12.2], while severe HFI is reported in 1.4% [95% CI: 1.3–1.5] (Table 1). The proportion of respondents reporting one of the six adverse mental health outcomes ranges from 5.3% (95% CI: 5.2–5.4, poor/fair mental health) to 19.9% (depressive thoughts 95% CI: 19.6–20.3). Table 1 also presents the socio-demographics of food insecure Canadians. Fig. 1 presents the weighted and bootstrapped percent of Canadians reporting the six adverse mental health outcomes by each level of HFI. Overall, the percent of Canadian adults reporting six adverse mental health outcomes is positively correlated with the level of HFI. Six adverse mental health outcomes show a HFI gradient. There is nearly a two-fold difference in the burden of mental health outcomes between food secure and marginally food insecure households. Of particular concern are the extremely high percentages of adverse mental health outcomes reported among respondents in severely food insecure households, which range from 25.5% [95% CI: 23.6–36.6 anxiety disorders] to 41.1% [95% CI: 36.3–46.0, suicidal thoughts in past year]. Table 2 presents results from the marginal effect reduction analyses. In essence these results refer to the percent point reduction for the six adverse mental health outcomes if the respondent were to adopt the characteristics of the food secure referent group. Marginal effects provide insight into the impact of potential interventions that aim to reduce or remove HFI. Provided a severely food insecure households were to become food secure we can expect a 25.2% (22.4- 28.0) point reduction in the reporting of depressive thoughts in the past month as one example. Compared to all other covariates, HFI has the largest individual impact on the reporting of adverse mental health outcomes. Moreover, there is a significant reduction in mental health outcomes for all levels of HFI including marginal HFI if those households were to become food secure. For example, marginal reductions range from a percent point reduction of 3.44 [2.79–4.82] for anxiety disorders and 9.20 [7.10–11.3] for depressive thoughts in the past month.
    Discussion Mental illness derives from a complex interplay among genetic, biological, individual and social factors (for a review, see Public Health Agency of Canada, 2002). Current psychosocial research on the development of mental illness has emphasized the importance of stress in the pathway leading to mental illness regardless of whether the perspective is biological or sociocultural (Kessler, Mickelson, & Williams, 1999; Meyer, 2003; Cohen, Kessler, & Gordon, 1997; Cadoret, Winokur, Dorzab, & Baker, 1972). Within this complex interplay, HFI is a well-documented source of anxiety and stress among affected households (Hamelin, Beaudry, & Habicht, 2002; Runnels, Kristjansson, & Calhoun, 2011; Sim, Glanville, & McIntyre, 2011; Tarasuk, 2001) and is a modifiable factor that should not be overlooked.