Does Food Insecurity Play a Role in Psychotropic Prescriptions Among Women With HIV?

Among women living with HIV in the United States, food insecurity is linked to lower odds of using psychotropic medications independent of depression and anxiety, according to findings published in Epidemiology and Psychiatric Sciences.

Social adversity may increase rates of psychotropic prescriptions, which have surged in recent decades, prompting researchers to perform a cross-sectional analysis of food insecurity and psychotropic prescriptions in the Women’s Interagency HIV Study (WIHS), an ongoing cohort study of women living with HIV in the United States.

Henry J. Whittle, MBBS, from the Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom, and colleagues evaluated food security (FS) as the primary explanatory variable using the Household Food Security Survey Module. The researchers measured the association of FS with symptoms of depression, generalized anxiety disorder, and mental health-related quality of life using multivariable linear regressions. Additionally, they examined relationships between FS and the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics.

In total, 905 women were evaluated in the study, of which 67.5% identified as African American and approximately half reported an annual income of less than $12,000. The researchers found that 36.8% of the sample were considered food insecure and a third were taking psychotropic medications.

Compared with high FS, low and very low FS were significantly associated with greater symptoms of depression and anxiety and with increasingly lower mental health-related quality of life in a dose-response relationship. Marginal and low FS were associated with 2.06 (95% CI, 1.36–3.13; P <.001) and 1.99 (95% CI, 1.26–3.15; P <.01) times higher odds of any psychotropic medication use, respectively. However, the association of very low FS with any psychotropic medication use was not statistically significant. The relationship between FS and antidepressant and sedative use demonstrated a similar pattern of findings.

When adjusting for depression and anxiety, patients with marginal FS had higher odds (adjusted odds ratio, 1.93; 95% CI, 1.16–3.19; P <.05) of any psychotropic medication use compared to those with high FS. Very low FS was associated with lower odds of each outcome, but only significantly in the case of antidepressants (adjusted odds ratio, 0.42; 95% CI, 0.19–0.96; P <.05).

Limitations of the study included the lack of data on who was prescribing psychotropic medications, as well as variables such as access to mental health services, other mental health treatment modalities, and adherence to treatments.

Overall, the findings revealed a complex relationship between food insecurity and psychotropic medication use. The researchers noted that the findings may point to “structural incentives and concomitant factors that favour the prescription of psychotropic medications for all forms of distress, regardless of the nature of the dominant contributing factors.” They supported the reassessment of “the US social safety net and healthcare system,” as well as a focus on “social-structural determinants of health” in clinical programs.

Reference

Whittle HJ, Wolfe WR, Sheira LA, et al. Associations between food insecurity and psychotropic medication use among women living with HIV in the United States [published online April 6, 2020]. Epidemiol Psychiatr Sci. doi:10.1017/S2045796020000232.