Food insecurity and disparities in mental health symptoms and severity among breast cancer survivors.

Abstract

1581 Background: Breast cancer survivors (BCS) often experience mental health challenges during survivorship. Food insecurity is a growing public health concern in the US, which may exacerbate the challenges faced by BCS. However, little is known about the associations between food insecurity and mental health symptoms and severity among BCS. Methods: We conducted a secondary analysis of the 2022 National Health Interview Survey that used stratified clustering sampling to interview US adults aged ≥18. This study was limited to women with a breast cancer history. Food insecurity (secure/insecure) was measured using a 10-item questionnaire assessing past 30-day household food situations. Ever having anxiety was self-reported (yes/no), and the severity level in the past 2 weeks was examined using the 7-item Generalized Anxiety Disorder scale. Women reported ever having a depressive symptom (yes/no), and the 8-item Patient Health Questionnaire depression scale was used to evaluate the severity level in the past 2 weeks. We compared weighted percentages using Rao-Scott Chi-squared tests and computed P -trends using the Cochran-Armitage test. We performed weighted logistic regression to estimate adjusted odds ratios (AOR). All analyses accounted for survey weights. Results: We obtained an unweighted sample of 644 BCS (weighted sample 4,234,520). Overall, 7.6% experienced food insecurity. BCS who were food insecure were younger than those secure (mean age 61 vs 69 years; P <.002). Black (20.4%) or Hispanic (24.3%) BCS were more likely than White BCS (4.7%) to experience food insecurity ( P <.001). BCS who were food insecure reported a higher percentage of depression than those secure (52.9% [95% CI: 35.5-70.3%] vs 24.4% [95% CI: 20.2-28.6%]; P <.001). The proportion of anxiety was higher among BCS who were food insecure than those secure (45.4% [95% CI: 27.7-63.1%] vs 19.8% [95% CI: 16.0-23.6%]; P <.001). After controlling for demographic and socioeconomic factors, BCS who were food insecure had greater odds of depression (AOR 3.19, 95% CI: 1.42-7.17) or anxiety (AOR 3.14, 95% CI: 1.34-7.34) than those secure. Compared with BCS who were food secure, those insecure were more likely to experience moderate (26.0% vs 6.0%) or severe (7.5% vs 0.6%) depression ( P -trend<.001), as well as moderate (6.4% vs 4.4%) or severe (14.5% vs 1.3%) anxiety ( P -trend<.001). BCS who were food insecure also reported a higher proportion of forgoing mental health counseling due to cost than those secure (6.8% vs 1.5%; P =.02). Conclusions: Our findings highlight food insecurity prevalence and associated disparities in mental health symptoms and severity among BCS. Interventions and policies, e.g., food pantries/meals programs and nutrition assistance, are needed to address food insecurity. Cancer centers should also consider routine mental health screening and offer proper services to reduce racial disparities among BCS.