Impact of sex and marital status on the prevalence of perceived depression in association with food insecurity

BACKGROUND: While both food insecurity and depression have been reported to be closely related to sex and marital status, the impact of sex and marital status on the prevalence of perceived depression in association with food security status has not been evaluated. MATERIALS & METHODS: We performed a nationwide population study using data for 19,866 adults obtained from the 2012–2015 Korean National Health and Nutrition Examination Surveys. Household food insecurity status was evaluated using the 18-item Food Security Survey Module. Perceived depression was measured using one item questionnaire or the 9-item Patient Health Questionnaire (PHQ-9). We cross-sectionally analyzed associations between perceived depression and variables, including socio-demographic factors and food security status. The prevalence of perceived depression was compared according to sex, marital status, and food security status. We applied survey sampling weights in all analyses. RESULTS: The overall prevalence of perceived depression was 10.5%. Prevalence rates of perceived depression in the high food security group, marginal food security group, low food security group, and very low food security group were 8.9%, 13.6%, 19.7%, and 35.0%, respectively (P < 0.001). Of total participants, 1.8% were categorized as having both perceived depression and food insecurity. After adjusting for confounding covariates, female sex (adjusted odds ratio [aOR]; 2.37), never married (aOR; 1.37), divorced/widowed/separated (aOR; 1.50), low food security (aOR; 1.72), and very low food security (aOR; 3.65) were associated with increased risk of perceived depression. Men with very low food security and divorced/widowed/separated status were most likely to have perceived depression (53.2%), followed by women with very low food security and divorced/widowed/separated status (48.7%), women with very low food security and married status (42.0%), and women with low food security and divorced/widowed/separated status (33.3%). CONCLUSIONS: Female sex and marital status of divorced/widowed/separated were strongly associated with perceived depression. These two factors and food insecurity synergistically contributed to perceived depression.