Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study

Abstract

Objective: This study examined whether diabetic morbidity mediates the relationship of food insecurity with depression among older adults with diabetes.

Methods: Data came from the 2010-2014 waves of the Health and Retirement Study and analyses were limited to respondents with diabetes (n = 2951). Depression was indexed by the 8-item Centers for Epidemiologic Studies Depression Scale. Weighted logistic regression was used to examine relationships of food insecurity and diabetic morbidity with depressive symptoms, both cross-sectionally and longitudinally. Path analysis quantified the contribution of diabetic morbidity as a mediation of the relationship of food insecurity with depressive symptoms.

Results: Food insecurity was associated with having poor diabetes control (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 1.1-2.5) and diabetes-related kidney problems (OR = 1.6; 95% CI = 1.1-2.5). Additionally, food insecurity was associated with depression contemporaneously (OR = 2.0, 95% CI = 1.7-2.4) and longitudinally (OR = 1.5, 95% CI = 1.3-1.8). However, food insecurity was no longer associated with depression when adjusting for diabetic morbidity. In path analyses, diabetic morbidity explained 12.7% (p-value = .04) of the association of food insecurity with depressive symptoms in 2012 and 18.5% (p-value = .09) of the association with depressive symptoms in 2014.

Conclusion: The relationship of food insecurity with depression was attributable to worse diabetes morbidity. Interventions that reduce food insecurity among older adults with diabetes may improve disease management and reduce depression severity.

Keywords: Depression; Diabetes; Epidemiology; Multiple chronic conditions; Older adults; Social determinants.