Objective: The purpose of the present study was to examine the relationship between household food insecurity and maternal depression in a rural sample to determine whether food insecurity predicted mothers' depression over time or vice versa.
Design: The study employed a prospective design using three waves of data from 'Rural Families Speak', a multi-state study of low-income rural families in the USA. Food insecurity was measured using the Core Food Security Module and depression was measured using the Center for Epidemiologic Studies-Depression Scale. A structural equation model was fit to the data using the AMOS software package.
Setting: Sixteen states in the USA (California, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, Oregon, South Dakota, West Virginia, Wyoming) between 2000 and 2002.
Subjects: Subjects included 413 women with at least one child under the age of 13 years living in the home.
Results: Findings based on the 184 subjects with complete data indicated that the causal relationship between household food insecurity and depression is bidirectional (P = 0.034 for causation from depression to food insecurity, P = 0.003 for causation from food insecurity to depression, chi(2)/df = 1.835, root-mean-square error of approximation = 0.068, comparative fit index = 0.989). Findings based on all 413 subjects after imputation of missing values also indicated bidirectionality.
Conclusions: The recursive relationship between food insecurity and depression has implications for US nutrition, mental health and poverty policies. The study highlights the need to integrate programmes addressing food insecurity and poor mental health for the population of rural, low-income women.